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| {{SI}}
| | #Redirect [[Aortic regurgitation surgery indications#Indications for Surgery for Acute Aortic Regurgitation]] |
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| {{CMG}}
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| '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
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| {{Editor Join}}
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| The surgical treatment of choice for aortic insufficiency is [[aortic valve replacement]]. This is currently an open-heart procedure, requiring the individual to be placed on [[cardiopulmonary bypass]].
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| ==Acute Aortic Insufficiency==
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| In the case of severe acute aortic insufficiency, all individuals should undergo surgery if there are no absolute contraindications for surgery. Individuals with bacteremia with aortic valve endocarditis should not wait for treatment with antibiotics to take effect, given the high mortality associated with the acute aortic insufficiency. Instead, replacement with an [[artificial heart valve|aortic valve]] [[homograft]] should be performed if feasible.
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| ==Chronic Aortic Insufficiency==
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| Surgical treatment is controversial in asymptomatic patients. Surgery may be recommended if the [[ejection fraction]] falls below 50% or in the face of progressive and severe left ventricular dilatation. For both groups of patients, surgery before the development of worse aortic insufficiency [[ejection fracture]]/LV systolic dilatation, is expected to reduce the risk of [[sudden death]], and is associated with lower peri-operative mortality.
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| {| border="1" cellpadding="5" cellspacing="0" align="left"
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| |+ '''Indications for surgery for chronic severe aortic insufficiency'''<ref>{{cite journal |author= |title=ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease) |journal=J. Am. Coll. Cardiol. |volume=32 |issue=5 |pages=1486–588 |year=1998 |pmid=9809971 |doi=}}</ref>
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| |-----
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| ! style="background:#efefef;" width="150px" | Symptoms
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| ! style="background:#efefef;" width="100px" | Ejection fraction
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| ! style="background:#efefef;" width="150px" | Other information
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| |-----
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| | [[New York Heart Association Functional Classification|NYHA class]] III - IV
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| | ≥ 50 % ||
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| |-----
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| | NYHA class II || ≥ 50 %
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| | Progression of symptoms or worsening parameters on echocardiography
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| |-----
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| | CHA class ≥ II [[Angina pectoris|angina]] || ≥ 50 % ||
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| |-----
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| | Regardless of symptoms || 25 - 49 % ||
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| |-----
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| | colspan="3" | Cardiac surgery for other cause (ie: [[coronary artery disease|CAD]], other valvular disease, ascending aortic aneurysm)
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| |}
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| Majority of patients with severe aortic regurgitation requiring surgery undergo [[aortic valve replacement]] against [[aortic valve repair]] which are preformed at few surgical centers which have appropriate technical expertise and experience in selecting potential patients.
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| ==Indications for [[Aortic valve replacement]]/Repair(AVR) in Chronic [[Aortic Insufficiency]] as per 2006 ACC/AHA Guidelines==
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| {{cquote|'''Class I'''
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| #AVR is indicated for symptomatic patients with severe aortic insufficiency irrespective of left ventricular systolic function.
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| #AVR is indicated for asymptomatic patients with chronic severe aortic insufficiency and [[left ventricular systolic dysfunction]] ([[ejection fraction]] 0.50 or less) at rest.
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| #AVR is indicated for patients with chronic severe aortic insufficiency while undergoing [[coronary artery bypass graft]](CABG) or surgery on the aorta or other heart valves.
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| '''Class IIa'''
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| AVR is reasonable for asymptomatic patients with severe aortic insufficiency with normal left ventricular systolic function ([[ejection fraction]] greater than 0.50) but with severe left ventricular dilatation (end-diastolic dimension greater than 75 mm or end-systolic dimension greater than 55 mm).
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| '''Class IIb'''
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| #AVR may be considered in patients with moderate aortic insufficiency while undergoing surgery on the ascending aorta.
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| #AVR may be considered in patients with moderate aortic insufficiency while undergoing [[CABG]].
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| #AVR may be considered for asymptomatic patients with severe aortic insufficiency and normal left ventricular systolic function at rest ([[ejection fraction]] greater than 0.50) when the degree of left ventricular dilatation exceeds an end-diastolic dimension of 70mm or end-systolic dimension of 50 mm, when there is evidence of progressive left ventricular dilatation, declining exercise tolerance, or abnormal hemodynamic responses to exercise.
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| '''Class III'''
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| AVR is not indicated for asymptomatic patients with mild, moderate, or severe aortic insufficiency and normal left ventricular systolic function at rest ([[ejection fraction]] greater than 0.50) when the degree of dilatation is not moderate or severe (end-diastolic dimension less than 70 mm, end-systolic dimension less than 50 mm).}}
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| ==Severe aortic insufficiency in patient after aortic valve replacement 1==
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| <googlevideo>-3829359717394053857&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 2==
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| <googlevideo>-1139143783733805104&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 3==
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| <googlevideo>-7501177211861270942&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 4==
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| <googlevideo>-4027195456056520519&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 5==
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| <googlevideo>3983126063629833286&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 6==
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| <googlevideo>5313961274473108141&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 7==
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| <googlevideo>-1049019986268408841&hl=en</googlevideo>
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| ==Severe aortic insufficiency in patient after aortic valve replacement 8==
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| <googlevideo>1577454681656420080&hl=en</googlevideo>
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| ==References==
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| {{reflist|2}}
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| [[Category:Cardiology]]
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| {{WH}}
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| {{WS}}
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