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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...

Pathway Overview

9 steps

Algorithm Steps

9 total

  1. 01Start

    Severe Aortic Stenosis

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

  2. 02Decision

    Symptomatic?

    Dyspnea, angina, syncope

  3. If Yes
    1. 03Action

      Intervention Recommended

      Class I for symptomatic severe AS

    2. 04Decision

      Valve Selection - 2025 Update

      Age and anatomy assessment

    3. 05Action

      TAVI Recommended

      Age ≥70 + Tricuspid AV + TF access

      • 2025 Update: Age lowered from 75 to 70
      • Class I, LOE A
      • Evidence: DEDICATE, NOTION-2
    4. 06Action

      Heart Team Decision

      Individualized factors

      • Life expectancy
      • Comorbidities
      • Anatomy
      • Local expertise
      • Lifetime trajectory
    5. 07Outcome

      Intervention Performed

      Follow-up per guidelines

    6. 08Action

      SAVR Recommended

      Age <70 OR Bicuspid OR Non-TF

      • Bicuspid: TAVI only Class IIb
      • Young patients: durability concerns
      • Concomitant surgery needed
    7. Path rejoins step 06Shared downstream outcome
    If No
    1. 09Action

      Asymptomatic - Assess Risk

      Consider intervention if:

      • Very severe (Vmax ≥5 m/s)
      • LVEF <55%
      • Low surgical risk
      • BNP elevation
      • Rapid progression
    2. Path rejoins step 04Shared downstream outcome

Guideline Source

2025 ESC/EACTS Guidelines for Valvular Heart Disease

DOI: 10.1093/eurheartj/ehab395View Guideline

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

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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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