A 65-year-old man with severe symptomatic aortic stenosis (valve area 0.7 cm², mean gradient 52 mmHg) is referred for intervention. His STS score is 4.2%, making him intermediate surgical risk. Echocardiography shows preserved LVEF of 58%. According to ACC/AHA 2021 valvular guidelines, which intervention is preferred?
- A Surgical aortic valve replacement (SAVR) is mandatory for all intermediate-risk patients
- B Medical management with beta-blockade until high-risk
- C Transcatheter aortic valve replacement (TAVR) is recommended as the preferred option in intermediate-risk patients with suitable anatomy ✓
- D Balloon aortic valvuloplasty as a bridge to SAVR
Correct answer: C. Transcatheter aortic valve replacement (TAVR) is recommended as the preferred option in intermediate-risk patients with suitable anatomy
Explanation
ACC/AHA 2021 valvular heart disease guidelines recommend TAVR as a reasonable alternative to SAVR for severe symptomatic AS in intermediate-risk patients (STS 4–8%) with suitable anatomy (Class IIa). In the PARTNER 2 and SURTAVI trials, TAVR was non-inferior to SAVR in intermediate-risk patients. A Heart Team evaluation is essential. Balloon valvuloplasty is only a temporising measure. Medical management does not alter the natural history of severe symptomatic AS.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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