10
Aortic Stenosis
Table 9. Indications for AVR in Patients With AS (cont'd)
Recommendations
COR LOE
AVR is reasonable in symptomatic patients with low-flow/
low-gradient severe AS (stage D3) with LVEF ≥50%, a
calcified aortic valve with significantly reduced leaflet motion,
and a valve area ≤1.0 cm
2
only if clinical, hemodynamic, and
anatomic data support valve obstruction as the most likely
cause of symptoms and data recorded when the patient is
normotensive (systolic BP <140 mm Hg ) indicate:
• An aortic velocity <4 m/s or ∆Pmean <40 mm Hg ;
• A stroke volume index <35 mL/m
2
; and
• An indexed valve area ≤0.6 cm
2
/m
2
.
IIa C
AVR is reasonable for patients with moderate AS (stage B)
with an aortic velocity 3.0–3.9 m/s or ∆Pmean 20–39 mm Hg
who are undergoing cardiac surgery for other indications.
IIa C
AVR may be considered for asymptomatic patients with
severe AS (stage C1) with aortic velocity ≥4.0 m/s or ∆Pmean
≥40 mm Hg if the patient is at low surgical risk and serial
testing shows an increase in aortic velocity ≥0.3 m/s/y.
IIb C
