Treatment
Table 1. Current Treatment Recommendations for Patients
with Aortic Stenosis
Treatment
Indication
Major Complications
Surgical Aortic
Valve Replacement
������ Symptomatic severe AS (I-B)
������ Severe AS undergoing CABG,
aortic surgery or other valve
surgery (I-C)
������ Symptomatic moderate AS
undergoing CABG, aortic
surgery or other valve surgery
(IIa-C)
������ Asymptomatic severe AS with
hypotensive response to exercise
(IIb-C)
������ Asymptomatic extremely severe
AS (AVA < 0.6 cm2, mean
gradient > 50 mm Hg, or jet
velocity > 5 m/s) (IIb-C)
������ Mortality (3%)
������ Stroke (2%)
������ Prolonged ventilation (11%)
������ Thromboembolism and bleeding
������ Prosthetic dysfunction
������ Perioperative complications are
higher when surgical AVR is
combined with CABG
Transcatheter
Aortic Valve
Replacement
������ TAVR is recommended
in patients with severe,
symptomatic, calcific stenosis
of a tricuspid aortic valve
who have aortic and vascular
anatomy suitable for TAVR and
a predicted survival >12 months,
and who have a prohibitive
surgical risk as defined by an
estimated 50% or greater risk
of mortality or irreversible
morbidity at 30 days or other
factors such as frailty, prior
radiation therapy, porcelain aorta,
and severe hepatic or pulmonary
disease.
������ TAVR is a reasonable alternative
to surgical AVR in patients at
high surgical risk (PARTNER
Trial Criteria: STS ���8%a)
������ Mortality (3%-5%)
������ Stroke (6%-7%)
������ Access complications (17%)
������ Pacemaker insertion
������ 2%-9% (Sapien)
������ 19%-43% (CoreValveb)
������ Bleeding
������ Prosthetic dysfunction
������ Paravalvular AR
������ Acute kidney injury
������ Other
������ Coronary occlusion
������ Valve embolization
������ Aortic rupture
Balloon Aortic
Valvuloplasty
������ Reasonable for palliation
in adult patients with AS in
whom surgical AVR cannot be
performed because of serious
comorbid conditions (IIb-C)
������ Bridge to surgical AVR (if patient
is poor surgical candidate)
(IIb-C)
������ Mortality
������ Stroke
������ Access complications
������ Restenosis
