Recommendations for aortic valvular surgery in asymptomatic patients with severe aortic stenosis
| European Society of Cardiology 20072 | American College of Cardiology/American Heart Association 20083 | |
| Need for other cardiac surgery (coronary arteries, ascending aorta, other heart valve) | IC | IC |
| Systolic left ventricular dysfunction (ejection fraction <50%) | IC | IC |
| Abnormal response to exercise: | ||
| Symptoms | IC | IIbC |
| Fall in blood pressure | IIaC | IIbC |
| Complex ventricular arrhythmias | IIbC | – |
| High likelihood of rapid progression: | ||
| Age, valve calcification, coronary artery disease | – | IIbC |
| Moderate-to-severe valve calcification and rate of peak jet velocity progression ≥0.3 m/s per year | IIaC | – |
| Very severe aortic stenosis (valve area <0.6 cm2 or mean gradient >60 mm Hg and peak jet velocity >5 m/s) if operative mortality <1% | – | IIbC |
| Severe left ventricular hypertrophy (>15 mm) without hypertension | IIbC | – |