When to operate in Aortic Stenosis?


Aortic Valve Replacement (AVR) is recommended:

Recommendations
COR
LOE
AVR is recommended in symptomatic patients with severe AS (stage D)
I
B
AVR is recommended for asymptomatic patients with severe AS (stage C2 or D) and LVEF < 50%
I
B
AVR is indicated for patients with severe AS (stage C or D) when undergoing other cardiac surgery
I
B
AS, aortic stenosis; AVR, aortic valve replacement; COR, class of recommendation; LOE, level of evidence; LVEF, left ventricular ejection fraction.

Aortic Valve Replacement (AVR) is reasonable:

Recommendations
COR
LOE
AVR is reasonable for asymptomatic patients with very severe AS (aortic velocity ≥ 5 m/s) (stage C2) and low surgical risk
IIa
B
AVR is reasonable in asymptomatic patients (stage C1) with severe AS and an abnormal exercise test
IIa
B
AVR is reasonable in symptomatic patients with low-flow/low-gradient severe AS with reduced LVEF (stage S1) with a low-dose dobutamine stress study that shows an aortic velocity ≥ 4 m/s (or mean gradient ≥ 40 mm Hg) with a valve area ≤ 1.0 cm 2  at any dobutamine dose
IIa
B
AVR is reasonable for patients with moderate AS (stage B) (velocity 3.0–3.9 m/s) who are undergoing other cardiac surgery
IIa
C


AVR may be considered:
Recommendations
COR
LOE
AVR may be considered for asymptomatic patients with severe AS (stage C1) and rapid disease progression and low surgical risk
IIb
C
AVR may be considered in symptomatic patients who have low-flow/low-gradient severe AS (stage S2) who are normotensive and have an LVEF ≥ 50% if clinical, hemodynamic, and anatomic data support valve obstruction as the most likely cause of symptoms
IIb
C


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