Aortic stenosis
Also known as: aortic valve replacement · AS · TAVR
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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease
ACC/AHA · 2020
US guidance on aortic stenosis is contained within this single valvular heart disease guideline, which classifies each valve lesion by disease stage (A to D) based on symptoms, valve anatomy, severity of valve dysfunction and the ventricular and pulmonary vascular response. The aortic valve sections address diagnostic assessment, timing of intervention and the choice between surgical and transcatheter valve replacement. Metadata record only.
- Issued in December 2020 by the ACC/AHA Joint Committee on Clinical Practice Guidelines. source
- Supersedes the 2014 AHA/ACC valvular heart disease guideline and its 2017 focused update. source
- Uses a four-stage classification (A-D) of valve disease severity to frame evaluation and intervention decisions. source
2025 ESC/EACTS Guidelines for the management of valvular heart disease
ESC/EACTS · 2025
The current European guidance on aortic stenosis is part of the 2025 ESC/EACTS valvular heart disease guideline, released at ESC Congress 2025. For aortic stenosis specifically, the update sharpens the diagnostic criteria based on advances in imaging and revises the indications and timing for surgical versus transcatheter intervention. Metadata record only.
- Published 29 August 2025 by the ESC together with the European Association for Cardio-Thoracic Surgery; it updates the 2021 valvular heart disease guideline. source
- Highlights more clearly defined diagnostic criteria for specific valve pathologies including aortic stenosis, reflecting advances in imaging. source
- Reinforces the central role of the Heart Team and of Heart Valve Centres for complex patients, and revisits indications and timing for intervention. source
US vs EU key differences
- The 2025 ESC/EACTS guideline lowered the Heart Team age threshold for choosing TAVI over surgery from 75 to 70 years in anatomically suitable patients with tricuspid valves, regardless of surgical risk. source
- The 2020 US guideline instead uses age bands plus life expectancy: SAVR is favoured under 65 years or with life expectancy beyond 20 years, either TAVI or SAVR is acceptable between 65 and 80, and TAVI is favoured above 80 or with life expectancy under 10 years. source
- Asymptomatic severe aortic stenosis is treated more permissively in Europe: the 2025 ESC/EACTS guideline adds a new Class IIa recommendation for early intervention in asymptomatic severe high-gradient AS. source
- The 2020 US guideline confines intervention in asymptomatic patients to specific triggers — reduced ejection fraction, very severe stenosis, rapid progression, abnormal exercise testing or elevated natriuretic peptide — rather than a general early-intervention recommendation. source
What changed recently
- EU2021 → 20252025-08-29
Updating the 2021 ESC/EACTS guideline, the 2025 version lowers the age cut-off favouring transcatheter aortic valve implantation in tricuspid aortic stenosis from 75 to 70 years, tightens the echocardiographic criteria for grading stenosis severity, and lowers thresholds for intervening earlier.
source ↗curation confidence 90% - US2014 (with 2017 Focused Update) → 20202020-12-17
Replacing the 2014 guideline and its 2017 focused update, the 2020 document reframes the choice between surgical and transcatheter aortic valve replacement around patient age and life expectancy rather than surgical risk category, extends transcatheter replacement to selected bicuspid valve stenosis, and introduces primary and comprehensive valve centre requirements.
source ↗curation confidence 90%
See the full update feed for changes across every system.