Table 2. Indications for surgery in aortic, mitral, and tricuspid valve disease (after [2]).
| Aortic stenosis | Recommendation grade and evidence level | |
| Symptomatic patient with severe aortic stenosis | I | B |
| Asymptomatic patient with severe aortic stenosis and reduced LVEF (<50%) or moderately to severely calcified valve and rapid hemodynamic progression or pathological exercise test with symptoms | IIa | C |
| Asymptomatic patient with severe aortic stenosis and pathological exercise test without symptoms (abnormal blood pressure regulation, ST/T-wave changes, VES) | IIb | C |
| Demonstration of ventricular salvoes/tachycardia | IIb | C |
| Aortic regurgitation | ||
| Symptomatic patient | I | B |
| Asymptomatic patient with LVEF <50% and/or end-systolic diameter >50 mm | I | B |
| Asymptomatic patient with LVEF 50%–60% and end-systolic diameter 45–50 mm, if symptoms arise during exercise test | IIa | C |
| Mitral stenosis | ||
| Markedly symptomatic patient (NYHA III–IV), valvuloplasty not possible, mitral valve opening area <1.5 cm2 | I | B |
| Not markedly symptomatic patient (NYHA I–II), valvuloplasty not possible, mitral valve opening area <1.0 cm2 | I | B |
| Mitral regurgitation | ||
| Symptomatic patient with severe chronic MR, LVEF >30% | I | B |
| Symptomatic patient with severe chronic MR, LVEF <30%, if reconstruction is possible | IIa | C |
| Asymptomatic patient with severe chronic MR, LVEF <60% and/or end-systolic lv diameter >45 mm | I | B |
| Asymptomatic patient with severe, chronic MR and paroxysmal or newly arisen persistent atrial fibrillation or systolic pulmonary arterial pressure at rest <50 mm hg or lvef >60% and end-systolic LV diameter >45 mm, but lack of contractile reserve on exercise testing | IIa | C |
| Tricuspid stenosis | ||
| Mean pressure gradient >5 mm Hg, and another cardiac surgical procedure is being performed simultaneously | IIa | C |
| Mean pressure gradient >5 mm Hg and severe right heart failure under maximal treatment | IIa | C |
| Tricuspid regurgitation | ||
| Severe regurgitation, as long as another valvular procedure is needed simultaneously | IIa | C |
| Severe regurgitation and severe right heart failure | IIa | C |
LVEF, left ventricular ejection fraction
VES, ventricular extrasystoles
MR, mitral regurgitation
LV, left ventricular
NYHA, New York Heart Association