Sandbox: TAVI - AUC: Difference between revisions

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__NOTOC__
__NOTOC__
{{TAVI - AUC}}
{{TAVI - AUC}}
{{CMG}},{{AE}}{{AKK}}
{{CMG}},{{AE}}{{AKK}}
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! style="width:10%" | '''AVR (TAVR or SAVR)'''  
! style="width:10%" | '''AVR (TAVR or SAVR)'''  
|-  
|-  
| - LVEF ≤50% - Vmax 4.0–4.9 m/sec - Negative exercise stress test - No predictors of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - High or intermediate surgical risk || bgcolor="LightGreen" | A (7) || bgcolor="LemonChiffon" | M (5)
| - LVEF ≤50%
- Vmax 4.0–4.9 m/sec - Negative exercise stress test
 
- No predictors of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - High or intermediate surgical risk  
| bgcolor="LightGreen" | A (7) || bgcolor="LemonChiffon" | M (5)
|-  
|-  
| - LVEF ≤50% - Vmax 4.0–4.9 m/sec - Negative exercise stress test - No predictors of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - Low surgical risk || bgcolor="LightGreen" | A (7) || bgcolor="LemonChiffon" | M (5)
| - LVEF ≤50%
- Vmax 4.0–4.9 m/sec - Negative exercise stress test
 
- No predictors of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - Low surgical risk  
| bgcolor="LightGreen" | A (7) || bgcolor="LemonChiffon" | M (5)
|-  
|-  
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec - High-risk profession (e.g., airline pilot) or lifestyle (e.g., competitive athlete) or anticipated prolonged time away from close medical supervision - Low surgical risk || bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)  
| - LVEF ≥50%
- Vmax 4.0–4.9 m/sec - High-risk profession (e.g., airline pilot) or lifestyle (e.g., competitive athlete) or anticipated prolonged time away from close medical supervision
 
- Low surgical risk  
| bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)  
|-  
|-  
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec - High-risk profession (e.g., airline pilot) or lifestyle (e.g., competitive athlete) or anticipated prolonged time away from close medical supervision - Low surgical risk || bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)  
| - LVEF ≥50%
- Vmax 4.0–4.9 m/sec - High-risk profession (e.g., airline pilot) or lifestyle (e.g., competitive athlete) or anticipated prolonged time away from close medical supervision
 
- Low surgical risk  
| bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)  
|-  
|-  
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec - Negative exercise stress test - ≥1 predictor(s) of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - High or intermediate surgical risk || bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)  
| - LVEF ≥50%
- Vmax 4.0–4.9 m/sec - Negative exercise stress test
 
- ≥1 predictor(s) of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - High or intermediate surgical risk  
| bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)  
|-  
|-  
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec - Negative exercise stress test - ≥1 predictor(s) of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - Low surgical risk || bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (8)
| - LVEF ≥50%
- Vmax 4.0–4.9 m/sec - Negative exercise stress test
 
- ≥1 predictor(s) of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - Low surgical risk  
| bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (8)
|-  
|-  
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec - Abnormal exercise stress test - High or intermediate surgical risk || bgcolor="LightCoral" | R (3) || bgcolor="LightGreen" | A (8)
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec
- Abnormal exercise stress test - High or intermediate surgical risk  
| bgcolor="LightCoral" | R (3) || bgcolor="LightGreen" | A (8)
|-  
|-  
| - LVEF ≥50% - Vmax 4.0–4.9 m/sec - Abnormal exercise stress test - Low surgical risk || bgcolor="LightCoral" | R (2) || bgcolor="LightGreen" | A (8)
| - LVEF ≥50%
- Vmax 4.0–4.9 m/sec - Abnormal exercise stress test
 
- Low surgical risk  
| bgcolor="LightCoral" | R (2) || bgcolor="LightGreen" | A (8)
|-  
|-  
| - LVEF ≥50% - Very severe AS (Vmax ≥5 m/sec or mean gradient ≥60 mmHg) - High or intermediate surgical risk || bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)
| - LVEF ≥50%
- Very severe AS (Vmax ≥5 m/sec or mean gradient ≥60 mmHg) - High or intermediate surgical risk  
| bgcolor="LemonChiffon" | M (4) || bgcolor="LightGreen" | A (7)
|-  
|-  
| - LVEF ≥50% - Very severe AS (Vmax ≥5 m/sec or mean gradient ≥60 mmHg) - Low surgical risk || bgcolor="LightCoral" | R (2) || bgcolor="LightGreen" | A (8)
| - LVEF ≥50%
- Very severe AS (Vmax ≥5 m/sec or mean gradient ≥60 mmHg) - Low surgical risk  
| bgcolor="LightCoral" | R (2) || bgcolor="LightGreen" | A (8)
|-  
|-  
| - LVEF <50% - Very severe AS (Vmax ≥4 m/sec or mean gradient ≥40 mmHg) - High or intermediate surgical risk || bgcolor="LightCoral" | R (2) || bgcolor="LightGreen" | A (8)
| - LVEF <50%
- Very severe AS (Vmax ≥4 m/sec or mean gradient ≥40 mmHg) - High or intermediate surgical risk  
| bgcolor="LightCoral" | R (2) || bgcolor="LightGreen" | A (8)
|-  
|-  
| - LVEF <50% - Very severe AS (Vmax ≥4 m/sec or mean gradient ≥40 mmHg) - Low surgical risk || bgcolor="LightCoral" | R (1) || bgcolor="LightGreen" | A (9)
| - LVEF <50%
- Very severe AS (Vmax ≥4 m/sec or mean gradient ≥40 mmHg) - Low surgical risk  
| bgcolor="LightCoral" | R (1) || bgcolor="LightGreen" | A (9)
|-  
|-  
| Undergoing another cardiac surgery or ascending aortic surgery || bgcolor="LightCoral" | R (1) || bgcolor="LightGreen" | A (9)
| - Undergoing another cardiac surgery or ascending aortic surgery || bgcolor="LightCoral" | R (1) || bgcolor="LightGreen" | A (9)
|-  
|-  
| A = Appropriate; AS = aortic stenosis; AVR = aortic valve replacement; BNP = b-type natriuretic peptide; LV = left ventricular/left ventricle; LVEF = left ventricular ejection fraction; M = May Be Appropriate; R = Rarely Appropriate; SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement; Vmax = peak aortic valve velocity. || ||
| colspan="3" | '''A''' = Appropriate; '''AS''' = aortic stenosis; '''AVR''' = aortic valve replacement; '''BNP''' = b-type natriuretic peptide; '''LV''' = left ventricular/left ventricle; '''LVEF''' = left ventricular ejection fraction; '''M''' = May Be Appropriate; '''R''' = Rarely Appropriate; '''SAVR''' = surgical aortic valve replacement; '''TAVR''' = transcatheter aortic valve replacement; '''Vmax''' = peak aortic valve velocity.  
|}
|}

Revision as of 02:17, 1 November 2017


Template:TAVI - AUC Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

ACC/AATS/AHA/ASE/EACTS/ HVS/SCA/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for the Treatment of Patients With Severe Aortic Stenosis

Asymptomatic, High-Gradient, Severe AS

Appropriate Use Median Score (1–9)

Indication No Intervention AVR (TAVR or SAVR)
- LVEF ≤50%

- Vmax 4.0–4.9 m/sec - Negative exercise stress test

- No predictors of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - High or intermediate surgical risk

A (7) M (5)
- LVEF ≤50%

- Vmax 4.0–4.9 m/sec - Negative exercise stress test

- No predictors of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - Low surgical risk

A (7) M (5)
- LVEF ≥50%

- Vmax 4.0–4.9 m/sec - High-risk profession (e.g., airline pilot) or lifestyle (e.g., competitive athlete) or anticipated prolonged time away from close medical supervision

- Low surgical risk

M (4) A (7)
- LVEF ≥50%

- Vmax 4.0–4.9 m/sec - High-risk profession (e.g., airline pilot) or lifestyle (e.g., competitive athlete) or anticipated prolonged time away from close medical supervision

- Low surgical risk

M (4) A (7)
- LVEF ≥50%

- Vmax 4.0–4.9 m/sec - Negative exercise stress test

- ≥1 predictor(s) of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - High or intermediate surgical risk

M (4) A (7)
- LVEF ≥50%

- Vmax 4.0–4.9 m/sec - Negative exercise stress test

- ≥1 predictor(s) of symptom onset or of rapid progression (e.g., DVmax >0.3 m/s/y, severe valve calcification, elevated BNP, or excessive LV hypertrophy in the absence of hypertension) - Low surgical risk

M (4) A (8)
- LVEF ≥50% - Vmax 4.0–4.9 m/sec

- Abnormal exercise stress test - High or intermediate surgical risk

R (3) A (8)
- LVEF ≥50%

- Vmax 4.0–4.9 m/sec - Abnormal exercise stress test

- Low surgical risk

R (2) A (8)
- LVEF ≥50%

- Very severe AS (Vmax ≥5 m/sec or mean gradient ≥60 mmHg) - High or intermediate surgical risk

M (4) A (7)
- LVEF ≥50%

- Very severe AS (Vmax ≥5 m/sec or mean gradient ≥60 mmHg) - Low surgical risk

R (2) A (8)
- LVEF <50%

- Very severe AS (Vmax ≥4 m/sec or mean gradient ≥40 mmHg) - High or intermediate surgical risk

R (2) A (8)
- LVEF <50%

- Very severe AS (Vmax ≥4 m/sec or mean gradient ≥40 mmHg) - Low surgical risk

R (1) A (9)
- Undergoing another cardiac surgery or ascending aortic surgery R (1) A (9)
A = Appropriate; AS = aortic stenosis; AVR = aortic valve replacement; BNP = b-type natriuretic peptide; LV = left ventricular/left ventricle; LVEF = left ventricular ejection fraction; M = May Be Appropriate; R = Rarely Appropriate; SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement; Vmax = peak aortic valve velocity.
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