MRCP2-0261

A 50-year-old man presents to the Cardiology Clinic with a history of syncope during his morning walk. He has hypercholesterolaemia and is taking simvastatin 20 mg daily. He has no family history of coronary artery disease and is a non-smoker. On examination, his BP is 110/90 mmHg, and he has a slow rising carotid pulse and an ejection systolic murmur. Investigations reveal left ventricular hypertrophy, a mean aortic valve area of 0.5 cm2, and a peak transvalvular gradient of 80 mmHg. What is the next step in managing this patient?