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Indications for Aortic Valve Replacement

Shown below is an algorithm depicting the indications for aortic valve replacement (AVR) in chronic aortic regurgitation.

What is the severity of the aortic regurgitation?

Severe regurgitation ❑ Vena contracta >0.6 cm ❑ Jet/LVOT ≥ 65% ❑ Regurgitant volume ≥60 mL/beat ❑ Regurgitant fraction ≥50% ❑ Effective regurgitant orifice ≥ 0.30 cm² ❑ Holodiastolic flow reversal in the proximal abdominal aorta

Progressive regurgitation (Stage B) Mild ❑ Vena contracta <0.3 cm ❑ Jet/LVOT <25% ❑ Regurgitant volume <30 mL/beat ❑ Regurgitant fraction <30% ❑ Effective regurgitant orifice <0.10 cm²

Is the patient symptomatic?

Yes (Stage D)

No (Stage C)

Is the patient undergoing another surgery?

LVEF<50% (Stage C2)

The patient is undergoing another surgery

LVEF ≥ 50% LVESD > 50mm (Stage C2)

LVEF ≥ 50% LVEDD > 65mm Low surgical risk

LVEF ≥ 50% LVESD ≤ 50mm LVEDD ≤ 65mm

No

Yes

AVR (Class I)

AVR (Class I)

AVR (Class I)

AVR (Class IIa)

AVR (Class IIb)

Monitor the patient periodically

Monitor the patient periodically

AVR (Class IIa)