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Flashcards in AHA aortic valve guidelines Deck (19):

What are class I indications for Aortic Regurgitation

1. Symptomatic patients with severe AR irrespective of LV systolic function
2. AVR for asymptomatic patients with severe AR and LV systolic (EF < 50%) at rest
3. AVR in pts with chronic severe AR with normal LV systolic function (EF > 50%) but with severe LV dilation (LVEDD > 75mm) or end0systolic dimension > 55mm)


Class I indications for aortic valve endocarditis

1. Severe heart failure or cardiogenic shock doe to aortic valve dysfunction when there is a reasonable likelihood of recovery with quality of life
2. Annular or aortic abscesses
3. Heart block
4. Fungal endocarditis
5. Infections resistant to antiobiotic therapy


What are TTE recommendations for asymptomatic aortic disease

every 6 months for severe AS/AR
every 1 to 2 years for moderate AS/AR
every 3 to 5 years for mild AS or AR


What are indications for Dobutamine stress echo

In patients with low-flow/low gradient AS and LV dysfunctino for possible AVR and TVR
Cardiac cath for hemodynamic measurements with infusion of dobtamine can be useful for evaluation of simlar pts


When is a biological valve recommended

pts age greater then or equal to 65 years without risk factors for thromboembolism
pts who will not take anticogulation, either warfarin or the direct factor Xa or who have major medical contraindications against anticoaulation


What is Kaplan-Meier actuarial method

the number at risk at each interval are indicated
This usually overestimates the actual event probability for an individual pt


What is actual statistical method

the cumulative incidence (or observed cumulative frequency) of an actual event


What is Class 1 indication for aortic root enlargement

When aortic annulus does not allow implantation of a heart valve with EAO index > 0.65cm2 m2

It's a IIB when the implantation does not allow a 0.85cm2/m2


What are class 1 indications for Homograft replacement of the aortic valve

Patients with extensive active endocarditic destruction of the aortic annulus
A total root replacement is recommended


What are class I indications for Pulmonary autograft (Ross procedure)

Infants and small children for who no satisfactory alternative valve substitute exists


What are class III indications for Ross

middle-aged adults when suitable alternatives to autorgraft replacement of the aortic valve is available.
pts with Bicuspid Valve
Aortic Insufficiency
Aortic Dilation


What are class 1 indications for Balloon aortic vaculoplasty

There are none...
It's all class class IIA or IIb
IIa---bridge to AVR in hemodynamically unstable pts with severe AS where immediate AVR is not possible
Bridge to TAVR
also as a contribution of AS to symptomatology is unclear such as chronic pulmonary disease or poor LV function


Class I indications for TAVR

Transfemoral, trans-aortic, trans-axillary, or transapical---predicted surgical mortality greater > 15% and an STS score greater then 8% by 2 independent surgical assesments?


What are size indications for repair for Loeys-Dietz syndrome



How do you determine the ratio for the size to operate?

Cross sectional area of the root in square centimeters divided by the patients height in meters and exceeding 10 may be considered an indication for surgery


What are considerations in pregnant patients

Female with connective tissue disorder who are considering pregnancy a prophylactic repair may be considered when the root exceeds 4.0 cm


What is indication for ascending aorta procedures in bicuspid valve

Diameter of 5.0 cm unless a family history of of aortic dissection, then 4.5cm


For patients undergoing cardiac surgery other than for aortic indications what is recommendations for repair

4.5 cm


What are Class I indications for Aortic Stenosis

1. AVR in pts with severe AS at the onset of symptoms of dyspnea, angina or syncope
2. Regardless of symptoms, with the identification of left ventricular systolic dysfunction (EF < 50%)
3. Severe AS who are scheduled to undergo CABG, or other cardiac valve surgery.

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