Valve replacement surgery should be strongly considered for patients with aortic stenosis who meet any one of the following criteria:

  • Severe and high-gradient aortic stenosis that is symptomatic (i.e. decreased exercise tolerance, exertional dyspnea, exertional angina, exertional syncope or presyncope)
  • Severe aortic stenosis and an ejection fraction of < 50%
  • Severe aortic stenosis and getting another cardiac surgery (e.g. CABG)

Valve replacement surgery should be considered for patients with aortic stenosis who meet any one of the following criteria:

  • Any patient with very severe aortic stenosis and low surgical risk
  • Any patient with severe aortic stenosis and symptoms potentially from it (i.e. patients who have symptoms attributable to valve obstruction, decreased exercise tolerance or a drop in blood pressure during exercise)

Severity grading of aortic stenosis

By mean pressure gradient

  • Mild: 0 to 19 mmHg
  • Moderate: 20 to 39 mmHg
  • Severe: 40 to 59 mmHg
  • Very severe: ≥ 60 mmHg

By aortic valve area

  • Mild: > 1.5 cm2
  • Moderate: 1.0 to 1.5 cm2
  • Severe: ≤ 1.0 cm2
  • Very severe: ≤ 1.0 cm2

For other key measures of severity grading, see severity grading of aortic stenosis.

References

Matthew J Czarny and Jon R Resar. Diagnosis and Management of Valvular Aortic Stenosis. Clinical Medicine Insights: Cardiology 8(Suppl 1): 15–24 (2014)