72-year-old hypertensive woman with a family history of coronary artery disease presents with a 3-month history of functional class II dyspnea on exertion (New York Heart Association). The patient has an active lifestyle and plays pickleball 4 x/week with friends. She is currently taking lisinopril 5 mg every day. She complains of neither chest pain nor palpitations.
Physical exam findings
- Pulse: 88 bpm
- Respiration rate: 19/min
- Blood pressure: 110/80 mmHg without orthostatic changes
- Heart sounds: midsystolic ejection murmur heard best at the right upper sternal border
Results from her CBC and CMP were within normal limits.
On echo, there is a mean gradient 42 mmHg, peak aortic velocity of 4.1 m/s, and aortic valve area of 0.9 cm2. Results from the CCT confirmed severe aortic stenosis.
Her Society of Thoracic Surgeons risk is 1.8%. Her projected life expectancy is about 15 years. During patient visit, she expressed a preference for TAVR vs SAVR.
Based on this information, what interventions do you anticipate could be recommended for this patient? What information would you need to decide on TAVR or SAVR for this patient? Would you rather defer this patient to a heart-team to make the treatment decision?