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The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines made further clarifications on which patients should get surgical or transcatheter aortic valve replacement (TAVR), the group announced in the latest guideline update.

Now surgery is recommended for symptomatic and asymptomatic aortic stenosis patients at (Class I recommendation). TAVR is a reasonable alternative for intermediate-risk patients who have symptoms (Class IIa recommendation).

Both surgery and TAVR are reasonable for peers in the high-risk category who have severe symptoms (Class I recommendation, previously Class IIa), according to the writing group led by co-chairs , of Mayo Clinic in Rochester, Minn., and , of Seattle's University of Washington.

Furthermore, valve choice is a decision best shared with the patient (Class I recommendation). The updated recommendations were published online in Circulation and the Journal of the American College of Cardiology.

Additionally, more patients undergoing aortic or mitral valve replacement can have the choice of a mechanical or tissue valve: the appropriate age range for either device widened from ages 60-70 to ages 50-70 years, meaning more options for those ages 50-60 (Class IIa recommendation).

"Uncertainty exists about the optimum type of prosthesis (mechanical or bioprosthetic) for patients 50 to 70 years of age. There are conflicting data on survival benefit of mechanical versus bioprosthetic valves in this age group, with equivalent stroke and thromboembolic outcomes. Patients receiving a mechanical valve incur greater risk of bleeding, and those undergoing bioprosthetic valve replacement more often require repeat valve surgery," according to guideline writers.

Meanwhile, it remains reasonable to give antibiotics before dental procedures to prevent bacteria from entering the bloodstream and resulting in infective endocarditis among those who have had previous valve surgery, previous infection, or abnormal valves. But while this recommendation stays at Class IIa, the level of relevant evidence was downgraded from B to C-Limited Data.

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