A 72-year-old woman with severe symptomatic calcific aortic stenosis (AVA 0.6 cm², mean gradient 52 mmHg) has an EuroSCORE II of 8% and is considered intermediate surgical risk. She has no history of coronary artery disease. Which intervention is preferred per 2021 ESC/EACTS valve guidelines?
- A Surgical aortic valve replacement (SAVR)
- B Balloon aortic valvuloplasty as a bridge
- C Transcatheter aortic valve implantation (TAVI) ✓
- D Medical management with digoxin and diuretics
Correct answer: C. Transcatheter aortic valve implantation (TAVI)
Explanation
Based on the PARTNER 2A and SURTAVI trials, TAVI is non-inferior to SAVR in intermediate surgical risk patients for severe symptomatic aortic stenosis. Current ESC/EACTS 2021 guidelines recommend TAVI as preferred over SAVR in patients >75 years or with high/prohibitive surgical risk. For intermediate-risk younger patients, the Heart Team decision should weigh anatomical suitability and individual risk factors. With EuroSCORE II of 8% (intermediate risk) and age 72, TAVI is the current recommended approach in most guidelines for older intermediate-risk patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.