Management of Aortic Stenosis: A Systematic Review of Clinical Practice Guidelines and Recommendations

AIMS: Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision making.METHODS AND RESULTS: Publications in MEDLINE and EMBASE between June 1st, 2010 and January 15th, 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigor of guideline development and extracted the recommendations.Of the 7 guidelines and recommendations retrieved, 5 showed considerable rigor of development. Those rigorously developed, agreed on the definition of severe AS and diverse hemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDT) and shared decision-making.Discrepancies exist in age and surgical risk cut-offs for recommending surgical (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS.CONCLUSIONS: Contemporary guidelines for aortic stenosis management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.