Vahanian et al developed an algorithm to manage a patient with severe aortic stenosis (AS). This can help to identify a patient who may benefit from surgery from one who may not. The authors are from Bichat Hospital in Paris and the University of Washington in Seattle.


Patient selection: severe aortic stenosis



(1) symptomatic

(2) contraindications to surgery or high risk surgery

(3) limited life expectancy

(4) left ventricular ejection fraction (LVEF)

(5) markedly calcified valve and increase in peak jet velocity >= 0.3 meter/sec in one year

(6) physically active

(7) exercise test


Surgery indicated if:

(1) symptomatic and no contraindications to surgery

(2) asymptomatic and LEVF < 50%

(3) asymptomatic, LEVF >= 50%, markedly calcified valve

(4) asymptomatic, LEVEF >= 50%, valve not markedly calcified, physically active, abnormal exercise test


Trans-catheter aortic valve implantation (TAVI) indicated if:

(1) symptomatic, contraindications to surgery and life expectancy not limited


Medical therapy indicated if:

(1) symptomatic, contraindications to surgery and limited life expectancy


Else re-evaluate in 6-12 months OR if symptoms develop.


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