ACC GUIDELINES Bundle

Transcatheter Aortic Valve Replacement (ACCF Bundle)

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Table 1. Current Treatment Recommendations for Patients with Aortic Stenosis (continued) Treatment Indication Medical Therapy •  There is no specific therapy for •  Hemodynamic instability asymptomatic AS •  Medical therapy is not indicated for symptomatic severe AS •  Appropriate control of blood pressure and other risk factors as indicated •  Statins are NOT indicated for preventing progression of AS •  Diuretics, vasodilators and positive inotropes should be avoided in patients awaiting surgery because of risk of destabilization Major Complications The original PARTNER protocol specified inclusion criteria as a minimum STS-predicted risk of mortality of ≥10. During the trial enrollment phase, the minimum STS-predicted risk of mortality was changed to ≥8. In both instances, 2 surgeons had to document that the true predicted risk of mortality was ≥15. b CoreValve is investigational only. a Evidence Grades Class I: Conditions for which there is evidence for and/or general agreement that the procedure or treatment is beneficial, useful, and effective Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy Class IIb: Usefulness/efficacy is less well established by evidence/opinion Level of Evidence A: Data derived from multiple randomized clinical trials or meta-analyses Level of Evidence B: Data derived from a single randomized trial or nonrandomized studies Level of Evidence C: Only consensus opinion of experts, case studies, or standard-of-care.

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