**Author details**

using port access technique or not. Although mini sternotomy is the most common approach, the outcomes after right anterior thoracotomy have satisfactory results [93]. The arterial cannulation sites are either aorta or femoral artery. The venous cannulation sites are right atrium, femoral vein or percutanous supeior vena cava with femoral vein. The incisions differ from 5 to 10 cm and small incisions may provide low infection rates [94]. This procedure has advantages such as less 1 surgical trauma, decreased pain and faster recovery. It reduces blood transfusions and shortens the length of hospital and ICU stay [95]. It is a safe operation and results lower incidence of atelectasis inthe cardiac ICU [96]. Port access aortic surgery also allows patients to be extubated earlier [97]. Avoidance of full sternotomy for patients prompts a comfortable postoperative period. Although the number of the aortic valve procedures increase worldwide, the ideal valve choice is still a debate. There are several options for valves. These are mechanical valve prosthesis, stented and stentless bioprosthetic valves, aortic homograft and pulmonary autograft. The use of these valves differs from patient to patient due to comorbidities and anticoagulant needs. The bioprosthetic valves are good alternatives

**Class I**

*C)*

*Evidence: C)*

398 Calcific Aortic Valve Disease

*Evidence: C)* **Class IIa**

*Evidence: B)* **Class IIb**

**Class III**

AVR is indicated for symptomatic patients with severeAS.\* *(Level of Evidence: B)*

developmentofsymptoms or asymptomatic hypotension). *(Level of Evidence: C)*

severevalve calcification,that progression may be rapid. *(Level of Evidence: C)*

findingslisted underthe class IIa/IIb recommendations. *(Level of Evidence: B)*

mortalityis 1.0%or less. *(Level of Evidence: C)*

**Table 2.** Indications for Aortic Valve Replacement.

AVR is indicated for patientswith severe AS\* undergoing coronaryartery bypass graft surgery(CABG). *(Level of*

AVR is indicated for patientswith severe AS\* undergoing surgeryon the aorta or other heartvalves. *(Level of Evidence:*

AVR is recommended for patientswith severe AS\* and LV systolicdysfunction (ejection fractionless than 0.50). *(Level of*

AVR is reasonable for patients with moderate AS\*undergoingCABG or surgery on the aorta or other heart valves(see Section3.7 on combined multiple valve disease and Section10.4 on AVRin patients undergoing CABG). *(Level of*

AVR may be considered for asymptomatic patientswith severeAS\* and abnormal response to exercise (e.g.,

AVR may be considered for adults with severe asymptomaticAS\* if there is a high likelihood of rapid progression (age,calcification, and CAD) or if surgery might be delayed at thetime of symptom onset. *(Level of Evidence: C)* AVR may beconsidered in patients undergoing CABG who havemild AS\* whenthere is evidence, such as moderate to

AVRmay be considered for asymptomatic patients with extremelysevereAS (aortic valve area less than 0.6 cm2, mean gradientgreaterthan 60 mm Hg, and jet velocity greater than 5.0 m persecond)when the patient's expected operative

AVR is not useful for the prevention of sudden deathin asymptomaticpatients with AS who have none of the

Fahrettin Oz1 , Fatih Tufan2 , Ahmet Ekmekci3 , Omer A. Sayın<sup>4</sup> and Huseyin Oflaz1

1 Istanbul University, Istanbul School of Medicine, Department of Cardiology, Turkey

2 Istanbul University, Istanbul School of Medicine, Department of Internal Medicine, Divi‐ sion of Geriatrics, Turkey

3 Istanbul University, Istanbul School of Medicine, Department of Internal Medicine, Turkey

4 Istanbul University, Istanbul School of Medicine, Department of Cardiovascular Surgery, Turkey
