A 70-year-old man with severe symptomatic aortic stenosis (valve area 0.7 cm², mean gradient 55 mmHg, EF 35%) is deemed high surgical risk (STS score 8%). Which treatment option offers the best outcomes in this patient?

• A Surgical aortic valve replacement (SAVR)
• B Balloon aortic valvuloplasty as bridge to decision
• C Transcatheter aortic valve implantation (TAVI) ✓
• D Medical management with diuretics and vasodilators

Explanation

TAVI is preferred over SAVR in high-surgical-risk and intermediate-risk patients with severe symptomatic AS. Multiple trials (PARTNER 1&2, SURTAVI, EVOLUT Low Risk) demonstrated non-inferiority or superiority of TAVI vs. SAVR in terms of mortality, stroke, and valve hemodynamics across risk categories. In high-risk patients (STS >8%), TAVI reduces procedural mortality significantly. Medical management does not alter the natural history of severe symptomatic AS, and balloon valvuloplasty is a palliative measure only.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.