AHA: AR

Question 1

class 3 recommendation(s) for AVI choice (TAVI v SAVR) in isolated severe AR

Answer 1

NOT TAVI
(3: HARM)

assuming SAVR candidate

“7. In patients with isolated severe AR who have indications for SAVR and are candidates for surgery, TAVI should not be performed.”

Question 2

regurgitant jet width (% of LVOT) in mild AR

Answer 2

<25

%

Question 3

vena contracta in mild AR

Answer 3

<0.3

cm

Question 4

RVol/V_regurg in mild AR

regurgitant volume

Answer 4

<30

mL/beat

Question 5

RF in mild AR

regurgitant fraction

Answer 5

<30

%

Question 6

EROA in mild AR

effective regurgitant orifice area

Answer 6

<0.1

cm²

Question 7

grade in mild AR

Answer 7

1+

Question 8

prox abd Ao/desc Ao flow reversal in mild AR

AHA: prox abd / ASE: desc Ao

Answer 8

brief, early

only specified in ASE

AHA does not mention for mild/mod; ASE does not mention for mod

Question 9

regurgitant jet width (% of LVOT) in moderate AR

Answer 9

25-65

%

Question 10

vena contracta in moderate AR

Answer 10

0.3-0.6

cm

Question 11

RVol/V_regurg in moderate AR

regurgitant volume

Answer 11

30-60

mL/beat

Question 12

RF in moderate AR

regurgitant fraction

Answer 12

30-50

%

Question 13

EROA in moderate AR

effective regurgitant orifice area

Answer 13

0.1-0.3

cm²

Question 14

grade in moderate AR

Answer 14

2+

Question 15

prox abd Ao/desc Ao flow reversal in moderate AR

AHA: prox abd / ASE: desc Ao

Answer 15

N/A

AHA does not mention for mild/mod; ASE does not mention for mod

Question 16

regurgitant jet width (% of LVOT) in severe AR

Answer 16

≥65

%

Question 17

vena contracta in severe AR

Answer 17

>0.6

cm

Question 18

RVol/V_regurg in severe AR

regurgitant volume

Answer 18

≥60

mL/beat

Question 19

RF in severe AR

regurgitant fraction

Answer 19

≥50

%

Question 20

EROA in severe AR

effective regurgitant orifice area

Answer 20

≥0.3

cm²

Question 21

grade in severe AR

Answer 21

3-4+

Question 22

prox abd Ao/desc Ao flow reversal in severe AR

AHA: prox abd / ASE: desc Ao

Answer 22

holodiastolic

AHA does not mention for mild/mod; ASE does not mention for mod

Question 23

aortic valve

regurgitant jet width (% of LVOT) <25 %

Answer 23

mild AR

Question 24

aortic valve

vena contracta <0.3 cm

Answer 24

mild AR

Question 25

# aortic valve RVol/V_regurg \<30 mL/beat | regurgitant volume

Answer 25

mild AR

Question 26

# aortic valve RF \<30 % | regurgitant fraction

Answer 26

mild AR

Question 27

# aortic valve EROA \<0.1 cm² | effective regurgitant orifice area

Answer 27

mild AR

Question 28

# aortic valve 1+ grade regurg

Answer 28

mild AR

Question 29

# aortic valve regurgitant jet width (% of LVOT) = 25-65 %

Answer 29

moderate AR

Question 30

# aortic valve vena contracta = 0.3-0.6 cm

Answer 30

moderate AR

Question 31

# aortic valve RVol/V_regurg = 30-60 mL/beat | regurgitant volume

Answer 31

moderate AR

Question 32

# aortic valve RF = 30-50 % | regurgitant fraction

Answer 32

moderate AR

Question 33

# aortic valve EROA = 0.1-0.3 cm² | effective regurgitant orifice area

Answer 33

moderate AR

Question 34

# aortic valve 2+ grade regurg

Answer 34

moderate AR

Question 35

# aortic valve regurgitant jet width (% of LVOT) ≥65 %

Answer 35

severe AR

Question 36

# aortic valve vena contracta \>0.6 cm

Answer 36

severe AR

Question 37

# aortic valve RVol/V_regurg ≥60 mL/beat | regurgitant volume

Answer 37

severe AR

Question 38

# aortic valve RF ≥50 % | regurgitant fraction

Answer 38

severe AR

Question 39

# aortic valve EROA ≥0.3 cm² | effective regurgitant orifice area

Answer 39

severe AR

Question 40

# aortic valve 3-4+ grade regurg

Answer 40

severe AR

Question 41

Is degenerative or rheumatic AR more common?

Answer 41

neither ~50/50

Question 42

indication(s) for intervention in moderate AR

Answer 42

- concomitant \<3 surg (2a) *regardless of sx status* ## Footnote "In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable."

Question 43

indication(s) for intervention in moderate AR | (1)

Answer 43

- concomitant \<3 surg (2a) *regardless of sx status* ## Footnote "In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable."

Question 44

indication(s) for intervention in asx moderate AR

Answer 44

- concomitant \<3 surg (2a) *regardless of sx status* ## Footnote "In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable."

Question 45

indication(s) for intervention in sx moderate AR

Answer 45

- concomitant \<3 surg (2a) *regardless of sx status* ## Footnote "In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable."

Question 46

indication(s) for intervention in sx severe AR

Answer 46

YES severe + sx = indicated (1) | regardless of EF ## Footnote "1. In symptomatic patients with severe AR (Stage D), aortic valve surgery is indicated regardless of LV systolic function." (1)

Question 47

indication(s) for intervention in sx severe AR | (1)

Answer 47

YES severe + sx = indicated (1) | regardless of EF ## Footnote "1. In symptomatic patients with severe AR (Stage D), aortic valve surgery is indicated regardless of LV systolic function." (1)

Question 48

indication(s) for intervention in asx severe AR

Answer 48

- EF≤55% if no other cause identified (1) - concomitant \<3 surg (1) - EF>55% BUT LVESD>50mm / 25mm/m² (2a) OR if low-risk AND EF>55%: - BUT progressive ↓ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 49

mgmt of asx severe AR + EF=55%

Answer 49

AVR - EF≤55% if no other cause identified (1)

Question 50

mgmt of asx severe AR + concomitant \<3 surg

Answer 50

AVR - concomitant \<3 surg (1)

Question 51

mgmt of asx severe AR + EF=65% + LVESD=55mm

Answer 51

AVR - EF>55% BUT LVESD>50mm / 25mm/m² (2a)

Question 52

indication(s) for intervention in asx severe AR | (5)

Answer 52

- EF≤55% if no other cause identified (1) - concomitant \<3 surg (1) - EF>55% BUT LVESD>50mm / 25mm/m² (2a) OR if low-risk AND EF>55%: - BUT progressive ￬ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 53

class 1 indication(s) for intervention in asx severe AR | (2)

Answer 53

- EF≤55% if no other cause identified (1) - concomitant \<3 surg (1)

Question 54

class 2 indication(s) for intervention in asx severe AR

Answer 54

- EF>55% BUT LVESD>50mm / 25mm/m² (2a) OR if low-risk AND EF>55%: - BUT progressive ￬ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 55

class 1 indication(s) for intervention in asx severe AR

Answer 55

- EF≤55% if no other cause identified (1) - concomitant \<3 surg (1)

Question 56

class 2 indication(s) for intervention in asx severe AR | (3)

Answer 56

- EF>55% BUT LVESD>50mm / 25mm/m² (2a) OR if low-risk AND EF>55%: - BUT progressive ￬ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 57

class 2b indication(s) for intervention in asx severe AR

Answer 57

low-risk AND EF>55%: - BUT progressive ￬ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 58

class 2a indication(s) for intervention in asx severe AR

Answer 58

- EF>55% BUT LVESD>50mm / 25mm/m² (2a)

Question 59

class 2a indication(s) for intervention in asx severe AR | (1)

Answer 59

- EF>55% BUT LVESD>50mm / 25mm/m² (2a)

Question 60

class 2b indication(s) for intervention in asx severe AR | (2)

Answer 60

low-risk AND EF>55%: - BUT progressive ￬ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 61

indication(s) for intervention in severe AR

Answer 61

- sx (1) - asx + EF≤55% if no other cause identified (1) - concomitant \<3 surg (1) *regardless of sx status* - asx + EF>55% BUT LVESD>50mm / 25mm/m² (2a) OR asx + low-risk AND EF>55%: - BUT progressive ￬ EF on 3 studies to 55-60% (2b) - BUT progressive ￪ LVEDD on 3 studies to \>65mm (2b)

Question 62

LVESD threshold for intervention on severe AR

Answer 62

>50mm / 25mm/m² (in asx with EF>55%)

Question 63

LVEDD threshold for intervention on severe AR

Answer 63

\>65mm (progressive on 3 studies in asx + low-risk AND EF>55%)

Question 64

ONLY indication for intervention in moderate AR

Answer 64

- concomitant \<3 surg (2a) *regardless of sx status*

Question 65

class 3 recommendation for severe AR intervention

Answer 65

NOT TAVI (3: HARM) | assuming SAVR candidate ## Footnote "7. In patients with isolated severe AR who have indications for SAVR and are candidates for surgery, TAVI should not be performed."