Cardiovascularcommon
A 76-year-old man reports that for three months he has felt light-headed and has twice nearly fainted walking up the hill to the shops, together with a tight feeling across the chest that goes away when he rests. He has no symptoms at rest. His pulse is 68/min and slow to rise, and there is a harsh crescendo–decrescendo systolic murmur loudest in the second right intercostal space radiating to both carotids. Echocardiography shows a heavily calcified aortic valve with a mean gradient of 52 mmHg, a valve area of 0.7 cm² and a left ventricular ejection fraction of 58%.
Which one of the following is the most appropriate management?