10
Aortic Stenosis
Table 11. 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
Table 12. Choice of Intervention in Patients With AS
Recommendations
COR LOE
Surgical AVR is recommended in patients who meet an
indication for AVR with low or intermediate surgical risk.
I A
For patients in whom TAVR or high-risk surgical AVR is being
considered, a Heart Valve Team consisting of an integrated,
multidisciplinary group of healthcare professionals with
expertise in VHD, cardiac imaging, interventional cardiolog y,
cardiac anesthesia, and cardiac surgery should collaborate to
provide optimal patient care.
I C
TAVR is recommended in patients who meet an indication
for AVR who have a prohibitive risk for surgical AVR and a
predicted post-TAVR survival >12 months.
I B
TAVR is a reasonable alternative to surgical AVR in patients
who meet an indication for AVR and who have high surgical
risk for surgical AVR.
IIa B
Percutaneous aortic balloon dilation may be considered as
a bridge to surgical AVR or TAVR in patients with severe
symptomatic AS.
IIb C
TAVR is NOT recommended in patients in whom existing
comorbidities would preclude the expected benefit from
correction of AS.
III: No
Benefit
B
