A 60-year-old man with severe aortic stenosis (aortic valve area 0.7 cm², mean gradient 52 mmHg) is asymptomatic. His LVEF is 68%. According to current ACC/AHA guidelines, when should intervention be considered?
- A Intervention should be deferred until symptoms develop, regardless of LVEF
- B Intervention is mandatory when AVA < 0.8 cm² regardless of symptoms
- C Intervention can be considered for asymptomatic severe AS with normal LVEF if surgical risk is low (Class IIa recommendation) ✓
- D Annual CT calcium scoring to decide timing
Correct answer: C. Intervention can be considered for asymptomatic severe AS with normal LVEF if surgical risk is low (Class IIa recommendation)
Explanation
The 2021 ACC/AHA valvular heart disease guidelines include a Class IIa recommendation for aortic valve replacement in truly asymptomatic very severe AS (AVA ≤0.6 cm², Vmean ≥ 5 m/s) or severe AS with rapidly progressive haemodynamics and low surgical risk. For severe AS (AVA 0.7 cm², mean gradient 52 mmHg), intervention is Class IIa if low surgical risk, given the RECOVERY trial showing benefit of early surgery even in asymptomatic severe AS. Waiting for symptoms risks sudden death (1-2%/year) and cardiac events.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.