A 68-year-old man with severe aortic stenosis (mean gradient 52 mmHg, AVA 0.75 cm², LVEF 30%) is deemed high surgical risk (STS score 8%). Which intervention is indicated and what trial supports it?

• A Surgical aortic valve replacement (SAVR); STS guidelines
• B Balloon aortic valvuloplasty as definitive treatment
• C Medical optimisation with ACE inhibitor and diuretic only
• D Transcatheter aortic valve implantation (TAVI); PARTNER trial ✓

Explanation

TAVI is the treatment of choice for high-surgical-risk patients with severe symptomatic aortic stenosis. The PARTNER trial (Cohort A: high-risk surgical candidates) demonstrated non-inferiority of TAVI versus SAVR at 1 year, and subsequent cohorts (PARTNER 2, PARTNER 3, Evolut Low Risk) extended TAVI eligibility to intermediate and low surgical risk patients. Balloon valvuloplasty is a bridge to definitive therapy, not a permanent solution. Medical therapy does not alter the natural history of severe AS. Low LVEF is not a contraindication to TAVI.

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

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Written and medically reviewed by the StethoPrep medical team.