The document outlines guidelines for aortic valve replacement (AVR) surgery for patients with aortic stenosis. It recommends clinical follow up for asymptomatic patients with mild aortic stenosis defined as a maximum jet velocity of 3-3.9 m/sec or a transvalvular gradient of 20-39 mmHg. For symptomatic patients or those with more severe stenosis defined as a maximum jet velocity over 4 m/sec or a transvalvular gradient over 40 mmHg, it recommends AVR surgery.

1. AORTIC STENOSIS –INDICATIONS
FOR AVR
V max 3-3.9 m/sec
=20-39 mmHg
ASYMPTOMATIC CLINICAL FOLLOW UP
IF GOING FOR CARDIAC SURGERY AVR
SYMPTOMATIC LVEF >50% AVA <1 cm 2 AVR
EF<50% AVA <1cm2
DSE Vmax >4m/sec AVR
V max >4 m/sec
Delta >40 mmHg
SEVERE AS
ASYMPTOMATIC CLINICAL FOLLOW UP
IF GOING FOR CARDIAC SURGERY AVR
TMT + VE AVR
EF < 50% AVR
FOLLOW UP Vmax increase >.3 m/sec AVR
SYMPTOMATIC AVR
V max > 5 m/sec ---- AVR