Version June 2024
| Recommendations | Class of recommendation | Level of evidence |
| AVR is recommended for symptomatic patients with severe high-gradient AS who have symptoms by history or on exercise testing (stage D1) | I | B |
| AVR is recommended for asymptomatic patients with severe AS (stage C2) and LVEF <50% | I | B |
| AVR is indicated for patients with severe AS (stage C or D) when undergoing other cardiac surgery | I | B |
| AVR is reasonable for asymptomatic patients with very severe AS (stage C1, aortic velocity ≥5.0 m/s) and low surgical risk | IIa | B |
| AVR is reasonable in asymptomatic patients (stage C1) with severe AS and decreased exercise tolerance or an exercise fall in BP | IIa | B |
| AVR is reasonable in symptomatic patients with low flow, low gradient severe AS with reduced LVEF (stage D2) with a low-dose dobutamine stress study that shows an aortic velocity ≥4.0 m/s (or mean pressure gradient ≥40 mmHg) with a valve area ≤1.0 cm2 at any dobutamine dose | IIa | B |
| AVR is reasonable in symptomatic patients who have low flow, low gradient severe AS (stage D3) who are normotensive and have an LVEF ≥50% if clinical, hemodynamic, and anatomic data support valve obstruction as the most likely cause of symptoms | IIa | C |
| AVR is reasonable for patients with moderate AS (stage B) (aortic velocity 3.0 to 3.9 m/s) who are undergoing other cardiac surgery | IIa | C |
| AVR may be considered for asymptomatic patients with severe AS (stage C1), rapid disease progression, and low surgical risk | IIb | C |
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