Aortic Stenosis Case #6

A 84-year-old female with oxygen dependent lung disease, along with chronic kidney disease and mild dementia, is diagnosed with colon cancer after lower gastrointestinal bleeding and is going to require surgical colectomy. Pre-operative examination reveals a III/VI systolic ejection murmur, and echocardiography reveals critical aortic valve stenosis with a mean pressure gradient of 75 mm Hg across the aortic valve and an aortic valve area of 0.6 cm2. Which of the following is the most appropriate treatment plan?

A. Proceed to colectomy with the understanding of high cardiovascular risk

B. Balloon aortic valvotomy

C. Surgical aortic valve replacement prior to colectomy

D. Choices A or B are reasonable