What are the current guidelines for referring patients with aortic stenosis for surgical intervention?

Referral for surgical intervention in patients with aortic stenosis should be considered based on symptom status and echocardiographic findings.

• Offer surgery as the first-line intervention for adults with severe aortic stenosis who have an indication for surgery and are at low or intermediate surgical risk, provided they are suitable for surgery (by median sternotomy or minimally invasive surgery) ¹.
• Consider referring adults with symptomatic severe aortic stenosis for intervention ¹.
• Consider referral for intervention in adults with asymptomatic severe aortic stenosis if any of the following are present: peak aortic jet velocity (Vmax) >5 m/s on echocardiography, aortic valve area <0.6 cm², left ventricular ejection fraction (LVEF) <55%, B-type natriuretic peptide (BNP) or NT-proBNP levels more than twice the upper limit of normal, or symptoms unmasked on exercise testing ¹.
• Consider referral for adults with symptomatic low-gradient aortic stenosis and LVEF <50% if dobutamine stress echocardiography confirms severe stenosis (mean gradient >40 mmHg and valve area <1 cm²) ¹.
• If the severity of symptomatic aortic stenosis is uncertain, consider measuring aortic valve calcium score on cardiac CT ¹.
• Enhanced follow-up and further assessment (e.g., stress echocardiography) should be offered if mid-wall fibrosis is detected on cardiac MRI in adults with severe aortic stenosis ¹.

Transcatheter aortic valve implantation (TAVI) is recommended for adults with non-bicuspid severe aortic stenosis who are at high surgical risk or if surgery is unsuitable ¹.

Referral to a specialist is advised for adults with moderate or severe valve disease of any type, including aortic stenosis, to assess suitability for intervention ¹.