Aortic stenosis treatment guidelines
“Surgical intervention should be performed promptly once even minor symptoms occur.”
–C.M. Otto, University of Washington School of Medicine, Seattle, Washington1
European society of cardiology AS treatment guidelines2
According to the ESC/EACTS guidelines, severe AS is defined by the following echocardiographic characteristics:2
- Aortic valve area: < 1 cm2
- Indexed valve area < 0.6 cm2/m2 body surface area
- Mean transvalvular pressure: > 40 mmHg
- Velocity ratio: < 0.25
- Jet velocity: > 4.0 m/sec
The 2012 ESC/EACTS guidelines for AS recommend replacement for Class I patients, i.e. those with severe AS and symptoms. TAVI is indicated in patients with severe symptomatic AS who are not suitable for AVR as assessed by a “heart team” and should be considered in high risk patients who may still be suitable for surgery, but in whom TAVI is favored by a “heart team” based on the individual risk profile.2 The 2008 ACC/AHA guidelines recommend that AVR should be performed in virtually all symptomatic patients with severe AS. Both guidelines stress that age is not a contraindication to surgery.2,3
- Otto CM. Timing of aortic valve surgery. Heart 2000;84:211-8.
- Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-96.
- Bonow RO, Carabello BA, Chatterjee K, et al.; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines 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 (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008;118:e523-661.
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