Aortic Stenosis · SAVR vs TAVR

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Intervention indication + age/risk/access
   Does it meet an intervention indication? Age/surgical risk/access? (Intervention indications: symptomatic severe AS; or asymptomatic severe with LVEF <50%, need for other cardiac surgery, abnormal exercise test, very severe/rapid progression, raised BNP.)
   • Severe AS, asymptomatic with no indication → Asymptomatic no indication → follow up
   • Meets indication, <65 years or life expectancy >20 years → <65/long expectancy → SAVR
   • Meets indication, 65–80 years → 65–80 years → shared decision
   • Meets indication, >80 years/life expectancy <10 years or high/prohibitive surgical risk → >80/high-risk → TF-TAVR
2. [End] Asymptomatic no indication → follow up
   Asymptomatic severe AS with no indication → close follow-up (echo, symptoms, exercise test, BNP); intervene once an indication appears.
3. [End] <65/long expectancy → SAVR
   <65 years or life expectancy >20 years → surgical aortic valve replacement (SAVR, mechanical valve an option); access unsuitable for TAVR, need for concomitant CABG/other valve/ascending aorta ≥4.5 cm (bicuspid) → SAVR + the relevant procedure.
4. [End] 65–80 years → shared decision
   65–80 years → SAVR or transfemoral TF-TAVR are both Class I, Heart Team shared decision (anatomy, valve durability, lifetime management and reintervention risk).
5. [End] >80/high-risk → TF-TAVR
   >80 years/life expectancy <10 years or high/prohibitive surgical risk (expected post-procedure survival >12 months) → transfemoral TF-TAVR preferred.

Source guidelines & references

• Valvular heart disease management (2020 ACC/AHA; 2021 ESC/EACTS)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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