Test on Aortic Stenosis Management and Valve Replacement

Question 1: For symptomatic patients with severe AS aged 65 to 80 years and no anatomic contraindication to transfemoral TAVI, SAVR is exclusively recommended over transfemoral TAVI.

A. Ano

B. Ne

Explanation: For symptomatic patients with severe AS aged 65 to 80 years with no anatomic contraindication to transfemoral TAVI, either SAVR or transfemoral TAVI is recommended after shared decision-making about the balance between expected patient longevity and valve durability. SAVR is not exclusively recommended over TAVI.

Question 2: For asymptomatic patients with very severe AS, defined as an aortic velocity of ≥5 m/s, and low surgical risk, Aortic Valve Replacement (AVR) is reasonable.

A. Ano

B. Ne

Explanation: Recommendation 7 states that in asymptomatic patients with very severe AS (aortic velocity ≥5 m/s) and low surgical risk, AVR is reasonable.

Question 3: According to the provided guidelines, for an asymptomatic patient with severe aortic stenosis (AS stage C1), when is Aortic Valve Replacement (AVR) indicated specifically when another cardiac procedure is also being performed?

A. When their left ventricular ejection fraction (LVEF) falls below 50%.

B. When the patient is undergoing cardiac surgery for other indications.

C. If an exercise test demonstrates decreased exercise tolerance (normalized for age and sex).

D. If serial testing shows an increase in aortic velocity ">=0.3 m/s per year.

Explanation: According to TABLE 68.3, recommendation 3 states: "In asymptomatic patients with severe AS (stage C1) who are undergoing cardiac surgery for other indications, AVR is indicated." This directly addresses the scenario of AVR for asymptomatic AS during concurrent surgery. Other options represent other indications for AVR in asymptomatic AS but not specifically linked to concurrent surgery.

Question 4: For an asymptomatic patient with high-gradient severe aortic stenosis (stage C1) and low surgical risk, under which specific condition is Aortic Valve Replacement (AVR) considered reasonable based on the rate of disease progression?

A. When serial testing indicates an increase in aortic velocity of at least 0.5 m/s per year.

B. When the serum B-type natriuretic peptide (BNP) level is greater than three times normal.

C. When serial testing shows an increase in aortic velocity of 0.3 m/s or more per year.

D. When there is a progressive decrease in LVEF to <50% on at least two serial studies.

Explanation: According to Table 68.3, recommendation 9 states: 'In asymptomatic patients with high-gradient severe AS (stage C1) and low surgical risk, AVR is reasonable when serial testing shows an increase in aortic velocity ≥0.3 m/s per year'.

Question 5: For asymptomatic patients with severe AS who have an abnormal exercise test, SAVR is recommended in preference to TAVI.

A. Ano

B. Ne

Explanation: For asymptomatic patients with severe AS and an abnormal exercise test (COR 2a indications for AVR), SAVR is recommended in preference to TAVI.