Treatment of Severe Aortic Stenosis with Haemodynamic Instability or Urgent High-Risk Non-Cardiac Surgery

This protocol covers a high-acuity subset of severe aortic stenosis where standard timing for definitive intervention cannot be followed — specifically patients who are haemodynamically unstable, and those who require urgent high-risk surgery for a non-cardiac condition.

Clinical scenario

Severe aortic stenosis presenting with haemodynamic instability, or severe aortic stenosis in a patient who requires urgent high-risk non-cardiac surgery and cannot safely wait for standard valve management pathways.

Approach

In carefully selected patients, an interventional bridging procedure may be considered to stabilise the patient and allow progression to definitive valve intervention. The complete patient-selection criteria, procedural pathway, and the route to definitive management are detailed in the full protocol.

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References

DOI: 10.1093/eurheartj/ehaf194

Balloon aortic valvotomy may be considered as a bridge to SAVR or TAVI in haemodynamically unstable patients, and (if feasible) in those with severe AS who require urgent high-risk NCS.
Balloon aortic valvuloplasty may be rarely considered as a bridge to TAVI or SAVR in carefully selected patients with decompensated AS, and in those with severe AS who require urgent high-risk non-cardiac surgery (NCS).

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