ACC/AHA Guideline Summary: Indications for Aortic Valve replacement (AVR) in
Aortic Stenosis (AS)
Class I - There is evidence and/or general agreement that AVR is indicated in
patients with AS in the following settings
- Symptomatic Severe AS (see aortic valve,
- Severe AS in patients undergoing coronary artery bypass graft surgery or
surgery on the aorta or other heart valves.
- Severe AS with a left ventricular ejection fraction less than 50%
Class IIa - The weight of evidence or opinion is in favor of the usefulness
of AVR in patients with AS in the following setting:
- Moderate AS in patients undergoing coronary artery bypass graft surgery or
surgery on the aorta or other heart valves
Class IIb - The weight of evidence or opinion is less well established for
the usefulness of AVR in patients with AS in the following settings:
- Severe AS in asymptomatic patients who have an abnormal response to
exercise such as the development of symptoms or hypotension
- Severe AS in asymptomatic patients with a high likelihood of rapid
progression (as determined by age, valve calcification, and coronary heart
- Severe AS in asymptomatic patients in whom surgery might be delayed at the
time of symptom onset.
- Mild AS in patients undergoing CABG in whom there is evidence, such as
moderate to severe valve calcification, that progression may be rapid.
- Extremely severe AS (aortic valve area less than 0.6 cm2, mean gradient
greater than 60 mmHg, and aortic jet velocity greater than 5 m/sec) in
asymptomatic patients in whom the expected operative mortality is 1 percent or
Class III - There is evidence and / or general agreement that AVR for AS is
not useful in the following setting:
- for the prevention of cardiac death in asymptomatic patients who have none
of the class IIa or IIb findings.