Recommendations for aortic valve replacement in asymptomatic severe AS
| Indication class | ACC/AHA guidelines3 | ESC Recommendations4 |
|---|---|---|
| ACC, American College of Cardiology; AHA, American Heart Association; AS, aortic stenosis; ESC, European Society of Cardiology; LV, left ventricle. | ||
| I | Patients undergoing coronary artery bypass surgery | Patients undergoing coronary artery bypass surgery |
| I | Patients undergoing surgery of the ascending aorta | Patients undergoing surgery of the ascending aorta |
| IIa | Patients with systolic left ventricular dysfunction | Patients with systolic left ventricular dysfunction |
| IIa | Patients with abnormal response to exercise (for example, hypotension) | Patients with abnormal response to exercise (development of symptoms, blood pressure fall, blood pressure rise <20 mm Hg, impaired exercise tolerance (<80%), new ST depression >2 mm, complex ventricular arrhythmias) |
| IIa | Patients with moderate to severe valve calcification, a peak jet velocity >4 m/s, and a rate of peak velocity progression ⩾0.3 m/s/year | |
| IIb | Patients with excessive LV hypertrophy (⩾15 mm) | Patients with severe LV hypertrophy (>15 mm) |
| Unless this is due to hypertension | ||
| IIb | Patients with ventricular tachycardia | Patients with complex ventricular arrhythmias for which no other cause can be identified |
| IIb | Patients with valve area <0.6 cm2 | |