Sandbox Rim
Indications for Aortic Valve Replacement
Shown below is an algorithm depicting the indications for aortic valve replacement (AVR). If the patient does not meet any of the decision pathways in the algorithm, regular monitoring is recommended and AVR is not indicated.
| Abnormal aortic valve AND Reduction in systolic opening | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Severe aortic stenosis: Vmax≥4m/s AND ΔPmean≥40 mmHg | Vmax3-3.9 m/s AND ΔPmean20-39 mmHg | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the patient symptomatic? | Is the patient symptomatic? | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes (Stage D1) | No (Stage C) | Yes | No (Stage B) | ||||||||||||||||||||||||||||||||||||||||||||||||
| LVEF <50% (Stage C2) | Is LVEF <50%? | The patient is undergoing another cardiac surgery | |||||||||||||||||||||||||||||||||||||||||||||||||
| The patient is undergoing another cardiac surgery | Yes | No | |||||||||||||||||||||||||||||||||||||||||||||||||
| Vmax≥5m/s AND ΔPmean≥60 mmHg (Very severe stage C1) AND Low surgical risk | Dobutamine stress echocardiography: Aortic valve area ≤1 cm2 AND Vmax≥4 ms (Stage D2) | Aortic valve area ≤1 cm2 AND LVEF ≥50% (Stage D3) | |||||||||||||||||||||||||||||||||||||||||||||||||
| Abnormal exercise treadmill test | The symptoms are likely the result of the aortic stenosis | ||||||||||||||||||||||||||||||||||||||||||||||||||
| ΔVmax>0.3 m/s/y AND Low surgical risk | |||||||||||||||||||||||||||||||||||||||||||||||||||
| AVR (Class I) | AVR (Class IIa) | AVR (Class IIb) | AVR (Class IIa) | AVR (Class IIa) | AVR (Class IIa) | ||||||||||||||||||||||||||||||||||||||||||||||
Management of Hypertension
Patients with aortic stenosis who are either in stage A, stage B, or stage C should be treated for hypertension (Class I; level of evidence B).