Management Strategy for Patients with Severe AS

Management Strategy for Patients with Severe AS - Flowchart Aortic Stenosis Aortic Stenosis

«Flowchart»

Abnormal aortic valve with reduced systolic opening

Symptoms due to AS

No AS symptoms

End

AVR (SAVR or TAVI, see section 3.2.4.2)
(1)

Severe AS stage D1

V_max ≥4 m/s or
P_mean≥40 mm Hg

Severe AS stage D1

V_max ≥4 m/s or
P_mean≥40 mm Hg

V_max ≥4 m/s or _max ≥
P_mean≥40 mm Hg _mean ≥ Severe AS stage D1

V_max <4 m/s and AVA ≤1.0 cm²

_max ≤ ² V(max) <4 m/s

Severe AS stage D3
AVA_i≤0.6 cm²/m² and SVI <35 mL/m²

Severe AS stage D3
_i ≤ ² ² ²

Severe AS stage D2

DSE V_max ≥4 m/s at any flow rate

Severe AS stage D2

DSE V_max ≥4 m/s at any flow rate

Severe AS stage D2

DSE V_max ≥4 m/s at any flow rate

_max ≥

LVEF <50%

Yes

Yes Yes

No No

AS most likely cause of symptoms

Other cardiac surgery

AS stage C (V_max ≥4 m/s)

AS stage C _max ≥ AS stage C

AS stage B
V_max 3–3.9 m/s

AS stage B
_max AS stage B

SAVR
(2b)

AVR (SAVR or TAVI, see section 3.2.4.2) (1)

SAVR
(2a)

LVEF <50%

Other cardiac surgery

ETT with ↓ BP or ↓ ex. capacity

↓ ↓ ETT with ↓ BP or ↓ ex. capacity ↓ ↓

Vmax ≥5 m/s
OR
BNP >3x normal
OR
Rapid disease progression

≥
OR

OR
Vmax >=5 m/s

↓ LVEF to <60% on 3 serial studies

↓ ↓ LVEF to <60% on 3 serial studies ↓