Aortic stenosis
Aortic Stenosis Grades of Severity as Assessed Using Echocardiography and Computed Tomography (calcium scoring)
Parameters
sclerosis
mild AS
moderate AS
severe AS
Peak velocity (m/sec)
< 2.5
2.5–3
3–4
> 4
Mean gradient (mmHg)
Normal
< 20
20–40
> 40
Aortic Valve Area (cm²)
Normal
≥ 1.5
1–1.5
< 1
Aortic Valve Area index (cm²/m²)
Normal
≥ 0.85
0.6–0.85
< 6
Doppler velocity index
> 0.5
0.25–0.5
< 0.25
Calcium scoring (Agatston Units, AU)
Male: 2,065, Female: 1,275
Factors to be considered when selecting the mode of intervention for aortic stenosis.
Favor SAVR
Favor TAVR
Age
< 70
≥ 70
Anatomic features
Hostile annulus or LVOT calcification
Bicuspid aortic valve
Annulus dimensions unsuitable for TAVI
Risk of coronary obstruction
Transfemoral access suitable for TAVI
Porcelain aorta
Intact coronary artery bypass grafts
Severe chest deformity or scoliosis
Concomitant conditions
Other relevant primary VHD
Complex CAD
Aortic root or ascending aortic aneurysm
Septal hypertrophy requiring myectomy
Comorbidities or cardiac conditions increasing surgical risk
Frailty
Sequelae of chest radiation
Lifetime Management
Anticipated repeat procedure options and risks, when selecting modality and valve type at index procedure
Redo SAVR: risk of redo surgery
SAVR after TAVI: increased risk associated with THV explantation
Valve-in-valve TAVI: risk of coronary obstruction, impaired coronary access, prosthesis-patient mismatch
References
1) Messika-Zeitoun D, Lloyd G. Aortic valve stenosis: evaluation and management of patients with discordant grading. E-Journal of Cardiology Practice. 2018;15(26). Available from: https://www.escardio.org/communities/councils/cardiology-practice/scientific-documents-and-publications/ejournal/volume-15/Aortic-valve-stenosis-evaluation-and-management-of-patients-with-discordant-grading/
2) Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, Ajmone Marsan N, Barili F, Bonaros N, Cosyns B, De Paulis R, Gamra H, Jahangiri M, Jeppsson A, Klautz RJM, Mores B, Pérez-David E, Pöss J, Prendergast BD, Rocca B, Rossello X, Suzuki M, Thiele H, Tribouilloy CM, Wojakowski W; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025 Nov 21;46(44):4635-4736. doi: 10.1093/eurheartj/ehaf194. PMID: 40878295.