9
Table 9. Indications for Aortic Valve Replacement (AVR) in
Patients With AS
Recommendations COR LOE
AVR is recommended in symptomatic patients with severe AS
(stage D1) with:
• Decreased systolic opening of a calcified or congenitally
stenotic aortic valve; and
• Aortic velocity ≥4.0 m/s or ∆Pmean ≥40 mm Hg ; and
• Symptoms of HF, syncope, exertional dyspnea, angina, or
presyncope by history or on exercise testing.
I B
AVR is recommended for asymptomatic patients with severe
AS (stage C2) and LVEF <50% with decreased systolic
opening of a calcified aortic valve with an aortic velocity
≥4.0 m/s or ∆Pmean ≥40 mm Hg.
I B
AVR is indicated for patients with severe AS (stage C or D)
when undergoing cardiac surgery for other indications when
there is decreased systolic opening of a calcified aortic valve
and aortic velocity ≥4.0 m/s or ∆Pmean ≥40 mm Hg.
I B
AVR is reasonable for asymptomatic patients with very severe
AS (stage C1) with:
• Decreased systolic opening of a calcified valve;
• Aortic velocity ≥5.0 m/s or ∆Pmean ≥60 mm Hg ;
• Low surgical risk.
IIa B
AVR is reasonable in apparently asymptomatic patients with
severe AS (stage C1) with:
• A calcified aortic valve;
• Aortic velocity 4.0–4.9 m/s or ∆Pmean of 40–59 mm Hg ;
• An exercise test demonstrating decreased exercise
tolerance or a fall in systolic BP.
IIa B
AVR is reasonable in symptomatic patients with low-flow/
low-gradient severe AS with reduced LVEF (stage D2) with a:
• Calcified aortic valve with reduced systolic opening ;
• Resting valve area ≤1.0 cm
2
;
• Aortic velocity <4 m/s or ∆Pmean<40 mm Hg ;
• LVEF <50%; and
• Low-dose dobutamine stress study that shows aortic
velocity ≥4 m/s or ∆Pmean ≥40 mm Hg with valve area
≤1.0 cm
2
at any dobutamine dose.
IIa B
