An 84-year-old male presents with progressive NYHA Class III heart failure due to severe aortic stenosis. Echo revealed aortic valve area of 0.6 cm2 with peak gradient of 48 mmHg with mildly reduced left ventricular function. A cardiac cath revealed non-obstructive CAD. Surgical risk assessment revealed STS predicted risk of mortality of 2.4%. Patient is requesting to undergo transcatheter aortic valve replacement (TAVR) rather than surgical aortic valve replacement (SAVR).

Based on the available data which of the following approach is most appropriate for this patient:

  1. TAVR is clearly indicated in this patient as shown to be superior to SAVR.
  2. TAVR has shown to have lower CVA than SAVR in this patient subset.
  3. SAVR is superior to TAVR in this patient subset.
  4. SAVR is currently the most appropriate choice in this patient and has not been compared with TAVR in this low surgical risk group.

Correct Answer: D

Rationale:

TAVR has shown to be comparable to SAVR in high and extreme surgical risk AS cases while there is no final answer in low to intermediate risk AS cases. Hence in these cases SAVR is the current standard of treatment.

References:

1. Smith CR, Leon, MB, Mack MJ, et al., Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98

2. Adams, DH, Popma, JJ, Reardon, MJ, et al., Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014;370:1790-8

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