A 70-year-old man has severe symptomatic aortic stenosis (valve area 0.8 cm², mean gradient 55 mmHg) and ejection fraction of 65%. He has prior CABG and a porcelain aorta. STS score is 8%. Per ACC/AHA 2021 valve guidelines, the preferred intervention is:

• A Surgical aortic valve replacement (SAVR)
• B Balloon aortic valvuloplasty as a bridge
• C Medical management with diuretics only
• D Transcatheter aortic valve replacement (TAVR) ✓

Explanation

TAVR is preferred over SAVR in patients with severe symptomatic aortic stenosis who are at high or intermediate surgical risk (STS score ≥4–8%) or have anatomical contraindications to surgery such as porcelain aorta or prior CABG increasing operative risk. The PARTNER and CoreValve trials demonstrated non-inferiority or superiority of TAVR in high-risk patients. Balloon valvuloplasty is palliative and has no survival benefit.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.