ESC/EACTS Valvular heart disease guidelines

Guidelines for aortic valve replacement
in patients with severe aortic stenosis

From the 2017 ESC/EACTS guidelines for the management of valvular heart disease¹

Intervention is indicated in symptomatic patients with:

Severe, high-gradient aortic stenosis

• Aortic valve area (AVA) <1cm² AND mean gradient ≥40mmHg or peak velocity ≥4.0 m/s
• Non-reversible high flow status with gradient aortic stenosis also considered severe

Severe, low flow, low-gradient aortic stenosis with reduced ejection fraction and evidence of flow (contractile) reserve excluding pseudo-severe aortic stenosis.

• AVA <1cm² AND mean gradient <40 mmHg AND peak velocity <4.0 m/s
• Reduced ejection fraction <50% Stroke Volume Index (SVi) ≤35 mL/m²
• Dobutamine Echo with evidence of flow reserve excluding pseudo-severe aortic stenosis

Management of severe aortic stenosis¹

AS = Aortic Stenosis; LVFT = Left Ventricular Ejection Fraction; SAVR = Surgical Aortic Valve Replacement; TAVI = Transcatheter Aortic Valve Implantation.

^a Surgery should be considered (lla C) if one of the following is present: peak velocity > 5.5m/s; severe valve calcification + peak velocity progression ≥ 0.3m/s per year; markedly elevated neurohormones (> threefold age-and sex-corrected normal range) without other explanation; severe pulmonary hypertension (systolic pulmonary artery pressure > 60 mmHG).

^b See tables of recommendation in ESC/EACTS guidelines published here

¹ Reference: Baumgartner, H., et al. (2017).2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, Volume 38, Issue 36.21 September 2017. Pages 2739-2791.
https://doi.org/10.1093/eurheartj/ehx391