Your patients rely on you to know when to act1

Regardless of symptoms, your patients with severe aortic stenosis (AS) have a chance for optimal outcomes with TAVR—including low-risk and asymptomatic patients. Explore the eligibility of TAVR.2,3

Hank | Age 68: HG-LEF

Severe AS, asymptomatic

Hank, age 68, a intermediate surgical risk patient eligible for TAVR

About Hank
Hank is a recent widower who volunteers at his local animal shelter on the weekends.

Medical history

Hank was diagnosed with severe AS but was not referred at the time due to his comorbidities. However, he was re-evaluated by a new cardiologist after his retired.

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Comorbidities

Diabetes, CKD, and COPD


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Medications

Metformin, sulfonylurea, empagliflozin, and tiotropium/olodaterol

AS=aortic stenosis; CKD=chronic kidney disease; COPD=chronic obstructive pulmonary disease; HG-LEF=high gradient, low ejection fraction.

AVA
0.6 cm2
Gradient
48 mmHg
LVEF
35%
Peak velocity
4.2 m/s

Would you conduct further evaluation of this patient?

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVA=aortic valve area; HG-LEF=high gradient, low ejection fraction; LVEF=left ventricular ejection fraction.

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Diagnosis:

Severe AS
Stage C2

Intermediate surgical risk

Treatment considerations

AVR is associated with a survival benefit in patients with HG-LEF severe AS.6 Further, patients with C2 subtype have a class I indication for AVR in the ACC/AHA Guideline.1


All patients with severe AS should be referred for evaluation, regardless of symptom presentation.1

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; HG-LEF=high gradient, low ejection fraction.

Anne | Age 85: LG-LEF

Severe AS, symptoms include presyncope

Anne, age 85, a high surgical risk patient eligible for TAVR

About Anne
Anne is a colon cancer survivor who has never missed a monthly video chat with friends from her patient support group.

Medical history

Anne was diagnosed after being admitted to the emergency department upon feeling faint at a family dinner. She received an echo several years ago but AS was not identified; only gradient was considered.

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Comorbidities

Atrial fibrillation, CKD, and hypertension

  • BP: 138/70 mmHg

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Medications

Hydrochlorothiazide, amlodipine, metoprolol, and rivaroxaban

AS=aortic stenosis; BP=blood pressure; CKD=chronic kidney disease; LG-LEF=low gradient, low ejection fraction.

AVA
0.8 cm2
Gradient
26 mmHg
LVEF
37%
LVSVi
30 mL/m2
Peak velocity
2.8 m/s

Would you conduct further evaluation of this patient?

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVA=aortic valve area; LG-LEF=low gradient, low ejection fraction; LVEF=left ventricular ejection fraction; LVSVi=left ventricular stroke volume index.

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Diagnosis:

Severe AS
Stage D2

High surgical risk

Treatment considerations

AVR is associated with a survival benefit in patients with LG-LEF symptomatic severe AS.6 Furthermore, TAVR is associated with improved survival in patients with symptomatic severe AS and CKD regardless of stage and protects from further decline in renal function over one year of follow-up.7-10 Patients with D2 LG subtype have a class I indication for AVR in the ACC/AHA Guideline.1


Comorbidities should not act as barriers to referring appropriate patients to a Heart Valve Team.11

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; CKD=chronic kidney disease; LG-LEF=low gradient, low ejection fraction.

Charles | Age 67: HG-NEF

Severe AS, symptoms include fatigue and dyspnea

Charles, age 67, a low surgical risk patient eligible for TAVR

About Charles
Charles is a former high school teacher and swim coach who recently retired after 42 years.

Medical history

Charles was diagnosed with moderate AS after a heart murmur was detected and received regular follow-up. He initially denied symptoms, but upon further questioning revealed that he stopped swimming for exercise because he felt tired and short of breath with even moderate exertion.

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Comorbidities

Diabetic nephropathy and coronary artery disease


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Medications

Metformin, sulfonylurea, simvastatin, and empagliflozin

AS=aortic stenosis; HG-NEF=high gradient, normal ejection fraction.

AVA
0.5 cm2
Gradient
52 mmHg
LVEF
66%
Peak velocity
4.3 m/s

Would you conduct further evaluation of this patient?

AS=aortic stenosis; AVA=aortic valve area; HG-NEF=high gradient, normal ejection fraction; LVEF=left ventricular ejection fraction.

Icon of a heart

Diagnosis:

Severe AS
Stage D1

Low surgical risk

Treatment considerations

AVR is associated with a survival benefit in patients with HG-NEF symptomatic severe AS.6 Patients with D1 subtype have a class I indication for AVR in the ACC/AHA Guideline.1


Comorbidities should not act as barriers to referring appropriate patients to a Heart Valve Team.11

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; HG-NEF=high gradient, normal ejection fraction.

Marie | Age 75: LG-NEF

Severe AS, symptoms include dyspnea

Marie, age 75, a low surgical risk patient eligible for TAVR

About Marie
Marie is a grandmother of 8 who enjoys hosting Sunday dinners for her family.

Medical history

Marie was diagnosed upon referral to a Heart Valve Team, where MSCT determined her calcium score was 1683 Agatston units. She received an echo previously, but AS was not indicated and gradient was noted as normal.

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Comorbidities

Asthma and osteoporosis

  • Uses a walker due to hip fracture

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Medications

Fluticasone inhaler, albuterol rescue inhaler, and alendronate

AS=aortic stenosis; LG-NEF=low gradient, normal ejection fraction; MSCT=multislice computed tomography.

AVA
0.9 cm2
Peak velocity
3.5 m/s
LVEF
70%
LVSVi
27 mL/m2
Gradient
25 mmHg

Would you conduct further evaluation of this patient?

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVA=aortic valve area; LF-LG=low flow, low gradient; LG-NEF=low gradient, normal ejection fraction; LVEF=left ventricular ejection fraction; LVSVi=left ventricular stroke volume index.

Icon of a heart

Diagnosis:

Severe AS
Stage D3

Low surgical risk

Treatment considerations

AVR is associated with a survival benefit in patients with LG-NEF symptomatic severe AS.6 Patients with D3 subtype have a class I indication for AVR in the ACC/AHA Guideline.1


Comorbidities should not act as barriers to referring appropriate patients to a Heart Valve Team.11

ACC=American College of Cardiology; AHA=American Heart Association; AS=aortic stenosis; AVR=aortic valve replacement; LG-NEF=low gradient, normal ejection fraction.

These are portrayals of typical TAVR patients and not real patients.

A robust body of evidence demonstrates the life-changing benefits of prompt AVR compared to clinical surveillance3,4

A real-world meta-analysis of over 1400 asymptomatic severe AS patients demonstrated:

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Early AVR significantly reduced rates of stroke
(pooled rate 4.5% vs 7.2%; HR: 0.62; 95% CI: 0.40-0.97; I2=0%; P=0.03)4


The EARLY TAVR trial showed that prompt treatment with TAVR by Edwards was superior to clinical surveillance:

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reduction in the risk of the composite endpoint: death, stroke, or unplanned cardiovascular hospitalization* through 5 years (HR: 0.50; P<0.0001)3

*Includes any unplanned cardiovascular hospitalization and any aortic valve intervention or reintervention within 6 months.3

THE EARLY TAVR TRIAL REINFORCES THE NEED FOR PROMPT REFERRAL UPON SEVERE AS DIAGNOSIS3,5

Learn more about the outcomes.

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References: 1.Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72-e227. 2.Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-1705. 3.Généreux P, Schwartz A, Oldemeyer JB, et al. Transcatheter aortic-valve replacement for asymptomatic severe aortic stenosis. N Engl J Med. 2025;392(3):217-227. 4.Généreux P, Banovic M, Kang DH, et al. Aortic valve replacement vs clinical surveillance in asymptomatic severe aortic stenosis: a systematic review and meta-analysis. J Am Coll Cardiol. 2025;85(9):912-922. 5.Lindman BR, Pibarot P, Schwartz A, et al. Cardiac biomarkers in patients with asymptomatic severe aortic stenosis: analysis from the EARLY TAVR trial. Circulation. Published online March 31, 2025. doi:10.1161/CIRCULATIONAHA.125.074425 6.Li SX, Patel NK, Flannery LD, et al. Trends in utilization of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2022;79(9):864-877. 7.Mentias A, Desai MY, Saad M, et al. Management of aortic stenosis in patients with end-stage renal disease on hemodialysis. Circ Cardiovasc Interv. 2020;13(8):e009252. 8.Steinmetz T, Witberg G, Chagnac A, et al. Transcatheter aortic valve implantation versus conservative treatment in chronic kidney disease patients. EuroIntervention. 2018;14(5):e503-e510. 9.Bohbot Y, Candellier A, Diouf M, et al. Severe aortic stenosis and chronic kidney disease: outcomes and impact of aortic valve replacement. J Am Heart Assoc. 2020;9(19):e017190. 10.Cubeddu RJ, Asher CR, Lowry AM, et al. Impact of transcatheter aortic valve replacement on severity of chronic kidney disease. J Am Coll Cardiol. 2020;76(12):1410-1421. 11.Feldman DR, Romashko MD, Koethe B, et al. Comorbidity burden and adverse outcomes after transcatheter aortic valve replacement. J Am Heart Assoc. 2021;10(10):e018978. 12.Otto CM. Timing of aortic valve surgery. Heart. 2000;84(2):211-218. 13.Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(4):372-392. 14.Hung J, Klassen SL, Bermejo J, Chambers JB. Take home messages with cases from focused update on echocardiographic assessment of aortic stenosis. Heart. 2018;104(16):1317-1322.

Patients and/or clinicians quoted on this website have received compensation from Edwards Lifesciences.