ACC GUIDELINES Bundle

Transcatheter Aortic Valve Replacement (ACCF Bundle)

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Key Points ÎÎThe most common cause of valvular aortic stenosis (AS) in adults is calcification of a normal tricuspid or congenital bicuspid valve. ÎÎCalcific AS typically presents in older individuals (ie, >75 years) in contrast to bicuspid AS, which presents a decade or more earlier. ÎÎStroke, the greatest risk accompanying aortic valve replacement (AVR), can be kept under 2% even in octogenerians by careful patient selection. ÎÎTranscatheter aortic valve replacement (TAVR) offers new and potentially transformational technology for patients with severe aortic valvular stenosis who are either extremely high-risk candidates or inoperable for surgical AVR or who are inoperable by virtue of associated comorbidities. ÎÎAn estimated 40,000 patients have received TAVR worldwide. Aortic Stenosis •  Predicted survial   <12 months •  Prohibitive TAVR risk •  Severe •  Symptomatic Medical treatment including the potential for balloon valvuloplasty •  Tricuspid valve •  Prohibitive surgical risk OR High surgical risk •  Severe •  Hypotensive response to exercise •  Moderate •  Symptomatic •  Need for related CV Surgery •  Critical Aortic Stenosis TAVR AVR

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