What are the ESC/EACTS guidelines for valve replacement in patients with aortic stenosis?

Updated: May 07, 2019
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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According to the ESC/EACTS guidelines, aortic valve replacement should be performed in all symptomatic patients with severe AS, regardless of left ventricular (LV) function, as survival is better with surgical treatment than with medical treatment. [5]  

Table 3. Indications for Aortic Valve Replacement in Aortic Stenosis (Open Table in a new window)



Symptomatic severe high-gradient AS (Stage D1)


Asymptomatic severe AS (Stage C2) with and LVEF <50%


Severe AS (Stage C or D) undergoing other cardiac surgery 


Asymptomatic, very severe AS (Stage C1, aortic velocity ≥5.0 m/s) and low surgical risk

Asymptomatic, severe AS (Stage C1) and decreased expercise tolerance or an exercise fall in blood pressure IIa
Symptomatic severe low flow/low gradient AS with reduced LVEF (Stage D2) with a low-dose dobutamine stress study with aortic velocity ≥4.0 m/s with a value are ≤1.0 cmat any dobutamine dose IIa
Symptomatic severe low flow/low gradient AS (Stage D3) who are normotensive and have an LVEF ≥50% if clinical, hemodynamic and anantomic data support valve obstruction as the most likely cause of symptoms IIa
Moderate AS (Stage B) who are undergoing other cardiac surgery IIa
Asymptomatic  severe AS (Stage C1) with rapid disease progression and low surgical risk IIb

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