Aortic Stenosis Flashcards
What is the AVA for mild aortic stenosis
1.6-2.5 cm2
What is the AVA for moderate aortic stenosis
1.1-1.5 cm2
What is the AVA for severe aortic stenosis
<1 cm2
What is the mean gradient for mild aortic
<20 (mmHg)
What is the mean gradient for moderate aortic stenosis
20-39 (mmHg)
What is the mean gradient for severe aortic stenosis
> 40 (mmHg)
What is the peak velocity for mild aortic stenosis
2.0-2.9 (m/s)
What is the peak velocity for moderate aortic stenosis
3.0-3.9 (m/s)
What is the peak velocity for severe aortic stenosis
> 4
What are the values measured for aortic stenosis grading
Aortic valve area, mean gradient, peak velocity
Stage A aortic stenosis
At risk of AS (bicuspid or sclerotic valve with normal hemodynamics)
Stage B aortic stenosis
Progressive AS (mild-mod AS with normal LVEF, possible early diastolic dysfunction)
Stage C aortic stenosis
C1- asymptomatic severe AS mean gradient >40 mmHg
C2- asymptomatic severe AS-with LV dysfunction
Stage D aortic stenosis
D1- High gradient AS
D2- severe low-flow/low-gradient reduced LVEF
D3-severe low gradient AS normal LVEF or paradoxical low-flow AS
Class 1 Indication for AVR
symptomatic severe high gradient AS (D1)
Class 1b Indication for AVR
AVR indicated for asymptomatic severe AS with LVEF <50% (Stage C2)
What is the AVA for mild aortic stenosis
> 1.5
What is the AVA for moderate aortic stenosis
1.0 - 1.5
What is the AVA for severe aortic stenosis
<1.0
what are the class 1 indications for AVR
-Symptomatic severe high gradient AS (stage D1)
-Asymptomatic severe AS with LVEF <50% (Stage C2)
-Asymptomatic severe AS (Stage C1) undergoing cardiac surgery for other indications
-Symptomatic low-flow, low-gradient severe AS with normal EF
-Reasonable severe AS low surgical risk when exercise testing demonstrates decreased exercise tolerance of fall in SBP >10mmHg from baseline
What are the class 2a indications for AVR
-reasonable in asymptomatic patients with severe AS and low surgical risk when serum BNP >3x normal
-considered in severe asymptomatic AS and progressive decrease in LVEF to at least <60% on at least 3 imaging studies
what are the class 2B indications for AVR
may be considered in patients with moderate AS at the time of cardiac surgery for another indication
When is SAVR preferred
-patients <65yo or with life expectancy >20 years
-vascular anatomy or other factors preclude TF TAVI
-asymptomatic patients with class 2a indication for intervention such as abnormal exercise test, very severe AS, rapid progression or elevated BNP
When is TAVR preferred
-patients >80 years of age or with life expectancy <10 years
-symptomatic patients of any age with high or prohibitive surgical risk
