A 70-year-old man with severe aortic stenosis (AVA 0.7 cm², peak gradient 68 mmHg) is symptomatic (NYHA III dyspnoea, pre-syncope). His Society of Thoracic Surgeons (STS) predicted operative mortality score is 8%. What is the preferred intervention according to current guidelines?

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

Explanation

STS score ≥ 8% defines high surgical risk, and TAVI is the guideline-recommended intervention for symptomatic severe AS in high-risk or inoperable patients (ACC/AHA 2021 Valve Guidelines). The PARTNER 1 and US CoreValve trials confirmed TAVI superiority over medical management and non-inferiority/superiority over SAVR in high-risk patients. Balloon valvuloplasty provides only temporary palliation and is a bridge to definitive treatment. Medical management of severe symptomatic AS has very poor prognosis (median survival <2 years without intervention).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.