An 82-year-old man comes to the emergency room complaining of chest pains with walking, shortness of breath with activity and lightheadedness. A week ago he also passed out in the living room. He has had these symptoms for many months but they became worse in the last 2 weeks to the point, in his words, ‘I can’t take it any more’. Physical examination is significant for a systolic crescendo-decrescendo murmur, a palpable LV heave, a weak aortic second sound, and reversed splitting of the second sound. You also notice mild pitting edema in both lower extremities. Echocardiogram revealed an aortic valve area of less than 1.0 cm2 and evidence of an immobile aortic valve. During your discussions with the patient about treatment options, he informed you that he would like to have a treatment that would prolong his life because he would like to attend his granddaughter’s wedding next year. If complications arise due to the surgery, he would not mind a permanent pacemaker or repeat interventions to deal with the complications of the surgery. He also would like to have a shorter hospital stay after the surgery because, ‘I am not a hospital guy’. Which of the following treatments is favored in this patient?
