American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment of choice for symptomatic severe aortic stenosis in low surgical risk patients?

1. Medical management

2. Transcatheter aortic valve replacement (TAVR)

3. Surgical aortic valve replacement

4. Balloon valvuloplasty

The correct answer is: Surgical aortic valve replacement

The treatment of choice for symptomatic severe aortic stenosis in low surgical risk patients is surgical aortic valve replacement. This approach is favored because it directly replaces the narrowed valve with a new valve, effectively alleviating the obstruction, restoring normal blood flow, and thereby improving symptoms and quality of life. Surgical aortic valve replacement has a long history of established outcomes and is considered the gold standard for patients who are suitable for surgery, particularly in those with symptoms due to severe stenosis. In low surgical risk patients, the benefits of surgery, including lower mortality rates and improved functional status, outweigh the risks. While other options like transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty are viable and important treatment choices, TAVR is generally recommended for patients at higher surgical risk or those who are unsuitable for open-heart surgery. Balloon valvuloplasty may provide temporary relief but does not offer a permanent solution, often leading to restenosis. Medical management can be part of the overall strategy, particularly in asymptomatic patients or those with contraindications to surgical intervention, but it does not address the underlying problem of aortic stenosis. Therefore, for low-risk symptomatic patients, surgical aortic valve replacement remains the primary treatment