AHA/ACC Guideline for Aortic valve replacement

Aortic Stenosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Aortic Stenosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Cardiac Stress Test
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography
Cardiac Catheterization
Aortic Valve Area
Aortic Valve Area Calculation
Treatment
General Approach
Medical Therapy
Surgery
Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty
Transcatheter Aortic Valve Replacement (TAVR) TAVR vs SAVR Critical Pathway Patient Selection Imaging Evaluation Valve Types TAVR Procedure Post TAVR management AHA/ACC Guideline Recommendations
Follow Up
Prevention
Precautions and Prophylaxis
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
AHA/ACC Guideline for Aortic valve replacement On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of AHA/ACC Guideline for Aortic valve replacement All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on AHA/ACC Guideline for Aortic valve replacement
CDC on AHA/ACC Guideline for Aortic valve replacement
AHA/ACC Guideline for Aortic valve replacement in the news
Blogs on AHA/ACC Guideline for Aortic valve replacement
Directions to Hospitals Treating AHA/ACC Guideline for Aortic valve replacement
Risk calculators and risk factors for AHA/ACC Guideline for Aortic valve replacement

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]Tarek Nafee, M.D. [3]

Overview

AHA/ACC developed a guideline regarding timing and type of procedure for aortic valve replacement in 2014.

2014 AHA/ACC guideline

Timing of Intervention

Class I

"1. AVR is recommended with severe high-gradient AS who have symptoms by history or on exercise testing (stage D1)(Level of Evidence: B)"

"2. AVR is recommended for asymptomatic patients with severe AS (stage C2)and LVEF <50% (Level of Evidence: B)"

"3. AVR is indicated for patients with severe AS (stage C or D) when undergoing other cardiac surgery (Level of Evidence: B)"

Class IIa

"1. AVR is reasonable for asymptomatic patients with very severe AS (stage C1, aortic velocity ≥5.0 m/s) and low surgical risk (Level of Evidence: B)"

"2. AVR is reasonable in asymptomatic patients (stage C1) with severe AS and decreased exercise tolerance or an exercise fall in BP (Level of Evidence: B)"

"3. AVR is reasonable in symptomatic patients with low-flow/low-gradient severe AS with reduced LVEF (stage D2) with a low-dose dobutamine stress study that shows an aortic velocity ≥ 4.0 m/s (or mean pressure gradient ≥ 40 mm Hg) with a valve area ≤ 1.0 cm2 at any dobutamine dose (Level of Evidence: B)"

"4. AVR is reasonable in symptomatic patients who have low-flow/low-gradient severe AS (stage D3) who are normotensive and have an LVEF ≥50% if clinical, hemodynamic, and anatomic data support valve obstruction as the most likely cause of symptoms (Level of Evidence: C)"

"5. AVR is reasonable for patients with moderate AS (stage B) (aortic velocity 3.0–3.9 m/s) who are undergoing other cardiac surgery (Level of Evidence: C)"

Class IIb

"1. AVR may be considered for asymptomatic patients with severe AS (stage C1) and rapid disease progression and low surgical risk (Level of Evidence: C)"

Choice of Surgical or Transcatheter Intervention

Class I

"1. Surgical AVR is recommended in patients who meet an indication for AVR with low or intermediate surgical risk. (Level of Evidence: A)"

"2. For patients in whom [TAVR or high-risk surgical AVR is being considered, members of a Heart Valve Team should collaborate to provide optimal patient care (Level of Evidence: C)"

"3. TAVR is recommended in patients who meet an indication for AVR for AS who have a prohibitive surgical risk and a predicted post-TAVR survival >12 months (Level of Evidence: B)"

Class IIa

"1. TAVR is a reasonable alternative to surgical AVR in patients who meet an indication for AVR and who have high surgical risk (Level of Evidence: B)"

Class IIb

"1. Percutaneous aortic balloon dilation may be considered as a bridge to surgical or transcatheter AVR in severely symptomatic patients with severe AS. (Level of Evidence: C)"

Class III

"1. TAVR is not recommended in patients in whom existing comorbidities would preclude the expected benefit from correction of AS. (Level of Evidence: B)"