Shown below is an algorithm summarizing the choice of the intervention to [[aortic stenosis]] <ref name="2014 AHA">{{Cite web | last = | first = | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher = | date = | accessdate = 4 March 2014 }}</ref>
{{family tree | | | B01 | | | | | | B02 | | | | B01= '''High risk'''<ref name="Ben-DorPichard2010">{{cite journal|last1=Ben-Dor|first1=I.|last2=Pichard|first2=A. D.|last3=Gonzalez|first3=M. A.|last4=Weissman|first4=G.|last5=Li|first5=Y.|last6=Goldstein|first6=S. A.|last7=Okubagzi|first7=P.|last8=Syed|first8=A. I.|last9=Maluenda|first9=G.|last10=Collins|first10=S. D.|last11=Delhaye|first11=C.|last12=Wakabayashi|first12=K.|last13=Gaglia|first13=M. A.|last14=Torguson|first14=R.|last15=Xue|first15=Z.|last16=Satler|first16=L. F.|last17=Suddath|first17=W. O.|last18=Kent|first18=K. M.|last19=Lindsay|first19=J.|last20=Waksman|first20=R.|title=Correlates and Causes of Death in Patients With Severe Symptomatic Aortic Stenosis Who Are Not Eligible to Participate in a Clinical Trial of Transcatheter Aortic Valve Implantation|journal=Circulation|volume=122|issue=11_suppl_1|year=2010|pages=S37–S42|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.109.926873}}</ref>
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❑ STS Score<ref name="STS">{{Cite web | last = | first = | title = Online STS Risk Calculator | url = http://riskcalc.sts.org/ | publisher = | date = | accessdate = 7 March 2014 }}</ref> > 10 <br> ❑ EuroScore<ref name="www.euroscore.org">{{Cite web | last = | first = | title = http://www.euroscore.org/calc.html | url = http://www.euroscore.org/calc.html | publisher = | date = | accessdate = 7 March 2014 }}</ref> > 20| B02= '''Low to moderate risk'''<ref name="Ben-DorPichard2010">{{cite journal|last1=Ben-Dor|first1=I.|last2=Pichard|first2=A. D.|last3=Gonzalez|first3=M. A.|last4=Weissman|first4=G.|last5=Li|first5=Y.|last6=Goldstein|first6=S. A.|last7=Okubagzi|first7=P.|last8=Syed|first8=A. I.|last9=Maluenda|first9=G.|last10=Collins|first10=S. D.|last11=Delhaye|first11=C.|last12=Wakabayashi|first12=K.|last13=Gaglia|first13=M. A.|last14=Torguson|first14=R.|last15=Xue|first15=Z.|last16=Satler|first16=L. F.|last17=Suddath|first17=W. O.|last18=Kent|first18=K. M.|last19=Lindsay|first19=J.|last20=Waksman|first20=R.|title=Correlates and Causes of Death in Patients With Severe Symptomatic Aortic Stenosis Who Are Not Eligible to Participate in a Clinical Trial of Transcatheter Aortic Valve Implantation|journal=Circulation|volume=122|issue=11_suppl_1|year=2010|pages=S37–S42|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.109.926873}}</ref>
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❑ STS Score<ref name="STS">{{Cite web | last = | first = | title = Online STS Risk Calculator | url = http://riskcalc.sts.org/ | publisher = | date = | accessdate = 7 March 2014 }}</ref> < 10 <br> ❑ EuroScore<ref name="www.euroscore.org">{{Cite web | last = | first = | title = http://www.euroscore.org/calc.html | url = http://www.euroscore.org/calc.html | publisher = | date = | accessdate = 7 March 2014 }}</ref> < 20 }}
{{Family tree | E01 | | E02 | | E03 | | E04 | | E01=<div style=" text-align:left"> ❑ Give [[warfarin]] to achieve INR of 3.0 <br> ❑ Give [[aspirin]] 75-100 mg/d <br> ❑ Both long term </div> | E02=<div style=" text-align:left"> ❑ Give [[warfarin]] to achieve INR of 2.5 <br> ❑ Give [[aspirin]] 75-100 mg/d <br> ❑ Both long term </div>| E03= <div style=" text-align:left">❑ Give [[warfarin]] to achieve INR of 2.5 for 3 months <br> ❑ Then give [[aspirin]] 75-100 mg/d long term </div>| E04=<div style=" text-align:left"> ❑ Give [[clopidrogel]] 75 mg/d <br> ❑ Give [[aspirin]] 75-100 mg/d <br> ❑ Both for 6 months </div> }}
{{Family tree/end}}
<br>
❑ Either a bioprosthetic or mechanical valve is reasonable in patients between 60 and 70 years of age. ([[ACC AHA guidelines classification scheme|Class IIa; Level of Evidence: B]]).
==Do's==
❑ Give [[ACE inhibitors]] to control [[hypertension]] in patients with asymptomatic [[aortic stenosis]]. <ref name="Chambers2005">{{cite journal|last1=Chambers|first1=J.|title=The left ventricle in aortic stenosis: evidence for the use of ACE inhibitors|journal=Heart|volume=92|issue=3|year=2005|pages=420–423|issn=1355-6037|doi=10.1136/hrt.2005.074112}}</ref> <br>
❑ Exercise testing in asymptomatic patients with AS may be considered to elicit exercise-induced symptoms and abnormal blood pressure responses ([[ACC AHA guidelines classification scheme|Class IIb; Level of Evidence: B]]). <br>
❑ Dobutamine stress echocardiography is reasonable to evaluate patients with low-flow/low-gradient AS and LV dysfunction ([[Aortic stenosis stages|Stage D3]]) ([[ACC AHA guidelines classification scheme|Class IIa; Level of Evidence: B]]) <br>
❑ Aortic balloon valvotomy might be reasonable as a bridge to surgery in hemodynamically unstable adult patients with AS who are at high risk for [[AVR]] or cannot be performed because of serious comorbid conditions.([[ACC AHA guidelines classification scheme|Class IIb; Level of Evidence: C]]). <br>
==Don'ts==
❑ Do not perform a [[stress test]] in a symptomatic patient with [[aortic stenosis stages|stage D]] [[aortic stenosis]] ([[ACC AHA guidelines classification scheme|Class III; Level of Evidence: B]]). <br>
❑ Do not give [[statins]] to prevent hemodynamic progression in patients with mild to moderate [[calcific aortic valve disease]] ([[ACC AHA guidelines classification scheme|Class III; Level of Evidence: A]]). <br>
❑ [[Transcatheter aortic valve implantation|TAVR]] is not recommended in patients in whom existing comorbidities would preclude the expected benefit from correction of [[AS]] ([[ACC AHA guidelines classification scheme|Class III; Level of Evidence: B]])<br>
❑ Do not give [[vasodilators]] to patients with severe [[AS]] as they may cause severe [[hypotension]]. <br>
❑ [[Endocarditis prophylaxis]] is not indicated in patients with [[AR]]. <ref name="Bonow-2008">{{Cite journal | last1 = Bonow | first1 = RO. | last2 = Carabello | first2 = BA. | last3 = Chatterjee | first3 = K. | last4 = de Leon | first4 = AC. | last5 = Faxon | first5 = DP. | last6 = Freed | first6 = MD. | last7 = Gaasch | first7 = WH. | last8 = Lytle | first8 = BW. | last9 = Nishimura | first9 = RA. | title = 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. | journal = Circulation | volume = 118 | issue = 15 | pages = e523-661 | month = Oct | year = 2008 | doi = 10.1161/CIRCULATIONAHA.108.190748 | PMID = 18820172 }}</ref>
↑Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007). "Dopamine agonists and the risk of cardiac-valve regurgitation". N. Engl. J. Med. 356 (1): 29–38. doi:10.1056/NEJMoa062222. PMID17202453.CS1 maint: Multiple names: authors list (link)
↑Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007). "Valvular heart disease and the use of dopamine agonists for Parkinson's disease". N. Engl. J. Med. 356 (1): 39–46. doi:10.1056/NEJMoa054830. PMID17202454.CS1 maint: Multiple names: authors list (link)
↑Bonow, R. O.; Carabello, B. A.; Chatterjee, K.; de Leon, A. C.; Faxon, D. P.; Freed, M. D.; Gaasch, W. H.; Lytle, B. W.; Nishimura, R. A.; O'Gara, P. T.; O'Rourke, R. A.; Otto, C. M.; Shah, P. M.; Shanewise, J. S. (2008). "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. 118 (15): e523–e661. doi:10.1161/CIRCULATIONAHA.108.190748. ISSN0009-7322.