Severe Aortic Valve Disease

Trans-catheter Aortic Valve Replacement (TAVR) in patients with aortic valve disease

Consideration criteria:

• Symptomatic calcific aortic stenosis w/ NYHA functional ≥class II symptoms
• Echo metrics: Mean gradient >40 mmHg OR Jet velocity > 4.0m/sec AND Initial AoVA < 0.8 cm² or indexed EOA < 0.5 cm²/m²

Testing before referral:

• Trans-thoracic echocardiogram assess: valve metrics, annulus size.
• Cardiac catheterization assess: significant CAD requiring revascularization and AoV.
• Send images in DICOM format to:

Process after referral:

• CT: gated coronary, abdomen and pelvis following specific TAVR protocol to assess valve & peripheral anatomy for peripheral approaches.
• Determination of Surgical Mortality Risk
• Evaluation by two cardiac surgeons. One may be performed prior to referral.
• Multidisciplinary conference to review all testing and determine treatment options