Table 7. 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 8. 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
