Aortic Stenosis

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Introduction

Aortic Stenosis

Welcome to the cardiac surgery urgency assessment tool for Aortic Stenosis (9072).

This implementation is a temporary work around replacing the old CPS tool which ‘died’ sooner and more completely than expected.

It is planned that a more comprehensive, user friendly, environment will be created to improve the utility and look and feel. The goal is to ensure all patients undergoing elective or urgent cardiac surgery, and soon cardiological intervention, will be scored consistently.

Prioritisation

Aortic Stenosis

Valve severity
  • (Pk velocity 3.0-3.99m/s or AVA 1.0-1.5cm², or mean gradient 30-39mmHg)
  • (Pk velocity 4.0-4.99m/s or AVA 0.6-0.99cm², or mean gradient 40-59mmHg)
  • (Pk velocity > 5m/s or AVA < 0.6cm², or mean gradient > 60mmHg)
Symptoms related to the valve disease
  • (NYHA IIa, angina CCS I or presyncope)
  • (NYHA IIb or NYHA III, angina CCS II-III or syncope or recurrent presyncope, or requiring diuretic treatment for heart failure)
  • (On maximal ℞ for heart failure, unstable angina despite maximal ℞, recurrent syncope)
Cardiac dysfunction
  • (Normal LV function)
  • (e.g. Early LV dysfunction but EF>50%, severe LVH, Nt-BNP>300pg/ml or BNP>100pg/ml or >1.5X increase/year, abnormal TDI [Early LV dysfunction but EF > 50%, severe LVH, High BNPx2 upper limit of normal, abnormal TDI])
  • (LVEF 40-50% or Definite heart failure level BNP [LVEF 40-50%])
  • (LVEF < 40%, doubling of a definite heart failure level BNP [LVEF < 40%])
Disease progression
  • (No additional information)
  • ((> 15% deterioration in 2 measures over ≤ 1 year) (Leaflet calcification AND Pk vel > 0.3m/sec per year))
Additional AHA/ACC/ESC class 1 indication for surgery
Euroscore

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