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78M with exertional dyspnea and syncope. Echo shows AVA 0.7 cm2, mean gradient 28 mmHg (low-gradient pattern), EF 60%. CT calcium score of aortic valve is 3200 AU. STS score is 4.5%. Cardiology team is split between TAVR and SAVR. Is this paradoxical low-flow low-gradient severe AS? Does he need dobutamine stress echo? What factors help determine TAVR vs SAVR in intermediate surgical risk?
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