Indications for aortic valve replacement in patients with aortic stenosis

Arrows show the decision pathways that result in a recommendation for AVR. Periodic monitoring is indicated for all patients in whom AVR is not yet indicated, including those with asymptomatic AS (stage D or C) and those with low gradient AS (stage D2 or D3) who do not meet the criteria for intervention.
For the strength of recommendations: Class I means the procedure/treatment should be performed/administered. Class IIa means it is reasonable to perform procedure/administer treatment. Class IIb means the procedure/treatment may be considered. Class III means that procedure or treatment is not useful/effective and may be harmful.
For the level of evidence: Level A means multiple populations evaluated; data derived from multiple randomized clinical trials or meta-analyses. Level B means limited populations evaluated; data derived from a single randomized trial or nonrandomized studies. Level C means very limited populations evaluated; only consensus opinion of experts, case studies, or standard of care.