From the Guidelines
Patients with severe aortic stenosis (AS) who are symptomatic or have reduced ventricular systolic function should be referred for diagnosis and treatment.
Key Considerations for Referral
- Symptomatic patients: Those with symptoms such as chest pain, syncope, or heart failure should be referred for evaluation and treatment 1.
- Asymptomatic patients with severe AS: Patients with severe AS who are asymptomatic but have reduced ventricular systolic function or other high-risk features should also be referred for evaluation and treatment 1.
- Multidisciplinary team evaluation: All patients with severe valvular heart disease being considered for valve intervention should be evaluated by a multidisciplinary team, with either referral to or consultation with a Primary or Comprehensive Valve Center 1.
Treatment Options
- Surgical aortic valve replacement (SAVR): SAVR is recommended for patients with symptomatic severe AS who are at low or intermediate surgical risk 1.
- Transcatheter aortic valve replacement (TAVR): TAVR is recommended for patients with symptomatic severe AS who have a prohibitive surgical risk and a predicted post-TAVR survival >12 months, or for those who are at high surgical risk 1.
- Balloon aortic valvuloplasty: Balloon aortic valvuloplasty may be considered as a bridge to surgical or transcatheter AVR in severely symptomatic patients with severe AS 1.
Important Factors in Decision-Making
- Patient risk profile: The decision to refer a patient for SAVR or TAVR should be based on a comprehensive evaluation of their risk profile, including their surgical risk, comorbidities, and predicted post-procedure survival 1.
- Shared decision-making: The choice of treatment should be a shared decision-making process between the patient, their family, and the healthcare team, taking into account the patient's values, preferences, and goals 1.
From the Research
Patient Referral for Aortic Valve Stenosis Diagnosis and Treatment
The following patients should be referred for aortic valve stenosis (AS) diagnosis and treatment:
- Symptomatic patients with evidence of significant aortic stenosis on echocardiography 2
- Asymptomatic patients with left ventricular systolic dysfunction, abnormal exercise stress test, high degree of stenosis, rapid disease progression, or elevated serum B-type natriuretic peptide level 3
- Patients with severe aortic stenosis without apparent symptoms 2
- Patients with symptomatic moderate and severe aortic stenosis 2
- Patients with left ventricular systolic dysfunction 2, 3
Referral to Surgery or Transcatheter Aortic Valve Implantation
The decision to refer a patient to surgery or transcatheter aortic valve implantation (TAVI) should be made by a multidisciplinary heart team, taking into account clinical and anatomical factors, as well as lifetime management considerations 4
- Surgical valve replacement is the standard of care for patients at low to moderate surgical risk 2
- TAVI may be considered in patients at high or prohibitive surgical risk 2
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of aortic stenosis are crucial to improve patient outcomes 5