Aortic Stenosis Management & Valve Replacement Guide
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18 cards
Question: What are the hemodynamic criteria that define severe aortic stenosis (AS) stage D1 (high-gradient severe AS)?
Answer: Vmax ≥4 m/s or peak pressure gradient (ΔPmax) ≥40 mm Hg; or AVA ≤1.0 cm² with Vmax <4 m/s and LVEF <50%.
Question: Which symptoms in adults with severe high-gradient AS (stage D1) indicate that aortic valve replacement (AVR) is indicated?
Answer: Exertional dyspnea, heart failure, angina, syncope, or presyncope by history or on exercise testing.
Question: In an asymptomatic patient with severe AS, what left ventricular ejection fraction (LVEF) threshold makes AVR indicated?
Answer: LVEF <50% (stage C2).
Question: When is AVR indicated during other cardiac surgery in patients with asymptomatic severe AS?
Answer: If the patient has asymptomatic severe AS (stage C1) and is undergoing cardiac surgery for other indications, AVR is indicated.
Question: For symptomatic patients with low-flow, low-gradient severe AS and reduced LVEF (stage D2), what is the recommendation regarding AVR?
Answer: AVR is recommended.
Question: For symptomatic patients with low-flow, low-gradient severe AS and normal LVEF (stage D3), when is AVR recommended?
Answer: AVR is recommended if AS is the most likely cause of the symptoms.
Question: In apparently asymptomatic patients with severe AS (stage C1) and low surgical risk, what exercise test findings make AVR reasonable?
Answer: Decreased exercise tolerance (normalized for age and sex) or a fall in systolic blood pressure of ≥10 mm Hg from baseline to peak exercise (Class 2a).
Question: When is AVR reasonable in asymptomatic patients with very severe AS?
Answer: When aortic velocity ≥5 m/s and the patient has low surgical risk (Class 2a).
Question: What BNP level makes AVR reasonable in apparently asymptomatic severe AS patients (stage C1) with low surgical risk?
Answer: A serum B-type natriuretic peptide (BNP) level greater than three times normal (Class 2a).
Question: What rate of change in aortic velocity on serial testing supports reasonable consideration of AVR in asymptomatic high-gradient severe AS (stage C1) w
Answer: An increase in aortic velocity ≥0.3 m/s per year (Class 2a).