Patient selection: severe aortic stenosis
Parameters:
(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.
