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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)