The patient should be referred for surgical aortic valve replacement. She has symptomatic severe aortic stenosis, a class I indication for valve replacement. Surgical aortic valve replacement is the treatment of choice for most patients with symptomatic severe aortic stenosis and is associated with low mortality rates (1%-3%) in patients younger than 70 years.

Balloon valvuloplasty of the aortic valve has an extremely limited role in treating aortic stenosis owing to the high risk of complications associated with the procedure (10%-20%), a short-lived clinical benefit, and poor long-term outcomes. It would not be an appropriate treatment option in this patient.

Medical therapy for aortic stenosis is limited. Multiple agents have been evaluated for treatment of aortic stenosis, including ACE inhibitors, angiotensin receptor blockers, digoxin, diuretics, and statins. None have been shown to alter the progression of disease and valve replacement remains the indicated therapy. These agents are appropriate if there are other indications for their use, none of which are present in this patient.

Transcatheter aortic valve replacement (TAVR) is an option for patients with an indication for aortic valve replacement but who are not operative candidates or are at high risk for death or major morbidity with open aortic valve replacement. However, TAVR is not currently approved in patients with a bicuspid aortic valve, and given this patient's age and significant lack of comorbidities, she would appear to be a good candidate for surgical replacement.