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Aortic Stenosis Management (ESC/EACTS 2025)

Aortic Stenosis Management (ESC/EACTS 2025): Severe Aortic Stenosis → Symptomatic? → Intervention Recommended → Valve Selection - 2025 Update → TAVI Rec...

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. Start

    Severe Aortic Stenosis

    AVA <1.0 cm², Mean grad ≥40, Vmax ≥4.0 m/s

    1. Decision

      Symptomatic?

      Dyspnea, angina, syncope

      If Yes:

      1. Action

        Intervention Recommended

        Class I for symptomatic severe AS

        1. Decision

          Valve Selection - 2025 Update

          Age and anatomy assessment

          1. Action

            TAVI Recommended

            Age ≥70 + Tricuspid AV + TF access

            • 2025 Update: Age lowered from 75 to 70
            • Class I, LOE A
            • Evidence: DEDICATE, NOTION-2
            1. Action

              Heart Team Decision

              Individualized factors

              • Life expectancy
              • Comorbidities
              • Anatomy
              • Local expertise
              • Lifetime trajectory
              1. Outcome

                Intervention Performed

                Follow-up per guidelines

          2. Action

            SAVR Recommended

            Age <70 OR Bicuspid OR Non-TF

            • Bicuspid: TAVI only Class IIb
            • Young patients: durability concerns
            • Concomitant surgery needed

      If No:

      1. Action

        Asymptomatic - Assess Risk

        Consider intervention if:

        • Very severe (Vmax ≥5 m/s)
        • LVEF <55%
        • Low surgical risk
        • BNP elevation
        • Rapid progression

Guideline Source

2025 ESC/EACTS Guidelines for Valvular Heart Disease

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Age cutoffs are guides, not absolute
  • Bicuspid AS has different considerations
  • Heart Team decision always required

Contraindicated Populations

pediatric

Applicable Regions

EUUS

EU: ESC/EACTS 2025: TAVI age ≥70 (lowered from 75)

US: ACC/AHA Heart Team approach

Version 1Next review: 2029-01-01

Frequently Asked Questions

What is the Aortic Stenosis Management (ESC/EACTS 2025)?

The Aortic Stenosis Management (ESC/EACTS 2025) is a management clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2025 ESC/EACTS Guidelines for Valvular Heart Disease.

What guideline is the Aortic Stenosis Management (ESC/EACTS 2025) based on?

This algorithm is based on 2025 ESC/EACTS Guidelines for Valvular Heart Disease (DOI: 10.1093/eurheartj/ehab395).

What are the limitations of the Aortic Stenosis Management (ESC/EACTS 2025)?

Known limitations include: Age cutoffs are guides, not absolute; Bicuspid AS has different considerations; Heart Team decision always required. Individual patient factors may require deviation from these recommendations.

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