A 68-year-old man with severe symptomatic aortic stenosis (peak gradient 80 mmHg, AVA 0.7 cm², LVEF 55%) has a Society of Thoracic Surgeons (STS) predicted risk of mortality of 8.2%. He is considered intermediate risk. The PARTNER 2 and SURTAVI trials support which intervention?
- A Transcatheter aortic valve replacement (TAVR/TAVI) as an equivalent alternative to surgical AVR ✓
- B Balloon aortic valvuloplasty as definitive therapy
- C Medical management only with serial echocardiography
- D TAVR only in extremely high surgical risk patients
Explanation
PARTNER 2 (sapien XT) and SURTAVI (CoreValve) trials established TAVR as non-inferior to surgical AVR in intermediate-risk patients with severe aortic stenosis, and PARTNER 3 and Evolut Low Risk trials subsequently showed TAVR equivalence/superiority in low-risk patients. TAVR is now an accepted alternative to SAVR across risk categories for suitable anatomy. Balloon valvuloplasty provides only temporary relief and is used as a bridge. Medical therapy alone is inappropriate for severe symptomatic AS, which has a poor prognosis. TAVR is no longer restricted to extreme/high surgical risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.