AHA aortic valve guidelines

Question 1

What are class I indications for Aortic Regurgitation

Answer 1

1. Symptomatic patients with severe AR irrespective of LV systolic function
2. AVR for asymptomatic patients with severe AR and LV systolic (EF < 50%) at rest
3. AVR in pts with chronic severe AR with normal LV systolic function (EF > 50%) but with severe LV dilation (LVEDD > 75mm) or end0systolic dimension > 55mm)

Question 2

Class I indications for aortic valve endocarditis

Answer 2

1. Severe heart failure or cardiogenic shock doe to aortic valve dysfunction when there is a reasonable likelihood of recovery with quality of life
2. Annular or aortic abscesses
3. Heart block
4. Fungal endocarditis
5. Infections resistant to antiobiotic therapy

Question 3

What are TTE recommendations for asymptomatic aortic disease

Answer 3

every 6 months for severe AS/AR
every 1 to 2 years for moderate AS/AR
every 3 to 5 years for mild AS or AR

Question 4

What are indications for Dobutamine stress echo

Answer 4

In patients with low-flow/low gradient AS and LV dysfunctino for possible AVR and TVR
Cardiac cath for hemodynamic measurements with infusion of dobtamine can be useful for evaluation of simlar pts

Question 5

When is a biological valve recommended

Answer 5

pts age greater then or equal to 65 years without risk factors for thromboembolism
pts who will not take anticogulation, either warfarin or the direct factor Xa or who have major medical contraindications against anticoaulation

Question 6

What is Kaplan-Meier actuarial method

Answer 6

the number at risk at each interval are indicated

This usually overestimates the actual event probability for an individual pt

Question 7

What is actual statistical method

Answer 7

the cumulative incidence (or observed cumulative frequency) of an actual event

Question 8

What is Class 1 indication for aortic root enlargement

Answer 8

When aortic annulus does not allow implantation of a heart valve with EAO index > 0.65cm2 m2

It’s a IIB when the implantation does not allow a 0.85cm2/m2

Question 9

What are class 1 indications for Homograft replacement of the aortic valve

Answer 9

Patients with extensive active endocarditic destruction of the aortic annulus
A total root replacement is recommended

Question 10

What are class I indications for Pulmonary autograft (Ross procedure)

Answer 10

Infants and small children for who no satisfactory alternative valve substitute exists

Question 11

What are class III indications for Ross

Answer 11

middle-aged adults when suitable alternatives to autorgraft replacement of the aortic valve is available.
pts with Bicuspid Valve
Aortic Insufficiency
Aortic Dilation

Question 12

What are class 1 indications for Balloon aortic vaculoplasty

Answer 12

There are none…
It’s all class class IIA or IIb
IIa—bridge to AVR in hemodynamically unstable pts with severe AS where immediate AVR is not possible
Bridge to TAVR
also as a contribution of AS to symptomatology is unclear such as chronic pulmonary disease or poor LV function

Question 13

Class I indications for TAVR

Answer 13

Transfemoral, trans-aortic, trans-axillary, or transapical—predicted surgical mortality greater > 15% and an STS score greater then 8% by 2 independent surgical assesments?

Question 14

What are size indications for repair for Loeys-Dietz syndrome

Answer 14

4.2cm

Question 15

How do you determine the ratio for the size to operate?

Answer 15

Cross sectional area of the root in square centimeters divided by the patients height in meters and exceeding 10 may be considered an indication for surgery

Question 16

What are considerations in pregnant patients

Answer 16

Female with connective tissue disorder who are considering pregnancy a prophylactic repair may be considered when the root exceeds 4.0 cm

Question 17

What is indication for ascending aorta procedures in bicuspid valve

Answer 17

Diameter of 5.0 cm unless a family history of of aortic dissection, then 4.5cm

Question 18

For patients undergoing cardiac surgery other than for aortic indications what is recommendations for repair

Answer 18

4.5 cm

Question 19

What are Class I indications for Aortic Stenosis

Answer 19

1. AVR in pts with severe AS at the onset of symptoms of dyspnea, angina or syncope
2. Regardless of symptoms, with the identification of left ventricular systolic dysfunction (EF < 50%)
3. Severe AS who are scheduled to undergo CABG, or other cardiac valve surgery.