Aortic Stenosis — EECC MCQ

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EasyValvular Heart DiseaseAortic StenosisEECC

A 78-year-old woman with symptomatic severe aortic stenosis (mean gradient 52 mmHg, AVA 0.7 cm2, LVEF 60%) and a tricuspid aortic valve is assessed by the Heart Team. She has no significant comorbidities and her STS score is 2%. Per the 2025 ESC/EACTS VHD Guidelines, which intervention is recommended?

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Correct answer: E — Transcatheter aortic valve implantation (TAVI)

This patient has symptomatic severe high-gradient aortic stenosis: mean gradient 52 mmHg and AVA 0.7 cm² meet severe AS criteria, and symptoms make valve intervention indicated. Under the 2025 ESC/EACTS VHD guideline, TAVI is recommended for patients aged ≥70 years with tricuspid aortic valve stenosis when anatomy is suitable. She is 78 years old, has a tricuspid aortic valve, preserved LVEF and low operative risk, but the 2025 ESC/EACTS age-based recommendation favours TAVI. SAVR is recommended for patients <70 years if surgical risk is low, not for this 78-year-old. Balloon valvuloplasty is only a bridge in selected unstable/urgent cases, Ross procedure is for selected young patients, and watchful waiting/medical therapy is inappropriate in symptomatic severe AS.

Reference: 2025 ESC/EACTS Guidelines for the management of valvular heart disease, European Heart Journal 2025; doi:10.1093/eurheartj/ehaf194. https://doi.org/10.1093/eurheartj/ehaf194