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
