Indications for aortic valve replacement in patients with aortic stenosis
Indications for aortic valve replacement in patients with aortic stenosis
Arrows show the decision pathways that result in a recommendation for AVR. Periodic monitoring is indicated for all patients in whom AVR is not yet indicated, including those with asymptomatic AS (stage D or C) and those with low gradient AS (stage D2 or D3) who do not meet the criteria for intervention. For the strength of recommendations: Class I means the procedure/treatment should be performed/administered. Class IIa means it is reasonable to perform procedure/administer treatment. Class IIb means the procedure/treatment may be considered. Class III means that procedure or treatment is not useful/effective and may be harmful. For the level of evidence: Level A means multiple populations evaluated; data derived from multiple randomized clinical trials or meta-analyses. Level B means limited populations evaluated; data derived from a single randomized trial or nonrandomized studies. Level C means very limited populations evaluated; only consensus opinion of experts, case studies, or standard of care.
AS: aortic stenosis; AVA: aortic valve area; AVR: aortic valve replacement by either surgical or transcatheter approach; BP: blood pressure; DSE: dobutamine stress echocardiography; ETT: exercise treadmill test; LVEF: left ventricular ejection fraction; ΔPmean: mean pressure gradient; Vmax: maximum velocity. * AVR should be considered with stage D3 AS only if valve obstruction is the most likely cause of symptoms, stroke volume index is <35 mL/m2, indexed AVA is ≤0.6 cm2/m2, and data are recorded when the patient is normotensive (systolic BP <140 mmHg).
Reproduced from: Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57. Illustration used with the permission of Elsevier Inc. All rights reserved.
