Table 2.

Severe Aortic Stenosis Treatment Priorities During the COVID-19 Era

Urgent AVR

• Severe or unstable symptoms ○ Progressive or severe heart failure symptoms (NYHA functional class III or IV), including weight gain, rapidly decreasing exertional capacity, or dyspnea with minimal exertion ○ Progressive or severe angina ○ Syncope or new-onset pre-syncope ○ New decline in left ventricular ejection fraction

Consider AVR on the basis of local resources

• Moderate, stable symptoms ○ Heart failure symptoms (NYHA functional class II or III), including weight gain, reduced exertional capacity, or exertional dyspnea, that have remained stable and allow routine daily activities ○ Stable, mild angina ○ Chronic, stable left ventricular systolic dysfunction

Defer AVR during COVID-19 pandemic

• Mild, stable symptoms ○ Generalized fatigue ○ NYHA functional class II heart failure symptoms, including stable exertional dyspnea (allowing at least 1 flight of stairs)

AVR = aortic valve replacement; COVID-19 = coronavirus disease 2019; NYHA = New York Heart Association.