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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.
Abbreviations: LVEF: left ventricular ejection fraction; LVEDD: left ventricular end diastolic diameter; LVESV: left ventricular end systolic diameter
| What is the severity of the aortic regurgitation? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Severe regurgitation ❑ Vena contracta >0.6 cm ❑ Doppler jet width ≥ 65% of LVOT ❑ Regurgitant volume ≥60 mL/beat ❑ Regurgitant fraction ≥50% ❑ Effective regurgitant orifice ≥ 0.30 cm² ❑ Holodiastolic flow reversal in the proximal abdominal aorta ❑ Left ventricle dilatation | Progressive regurgitation (Stage B) ❑ Vena contracta <0.6 cm ❑ Regurgitant volume <60 mL/beat ❑ Regurgitant fraction <50% ❑ Effective regurgitant orifice <0.30 cm² | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the patient symptomatic? | Is the patient undergoing another surgery? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes (Stage D) | No (Stage C) | No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ LVEF<50% (Stage C2) | ❑ The patient is undergoing another surgery | ❑ LVEF ≥ 50% AND ❑ LVESD > 50mm (Stage C2) | ❑ LVEF ≥ 50% AND ❑ LVEDD > 65mm AND ❑ Low surgical risk | ❑ LVEF ≥ 50% AND ❑ LVESD ≤ 50mm AND ❑ LVEDD ≤ 65mm | ❑ Perform a periodic echocardiogram (Class I; Level of Evidence:B)
❑ Control hypertension preferably with
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| AVR (Class I) | AVR (Class I) | AVR (Class I) | AVR (Class IIa) | AVR (Class IIb) | ❑ Perform a periodic echocardiogram every 6 - 12 months (Class I, level of evidence C) ❑ Control hypertension preferably with
| AVR (Class IIa) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acute AR
| What is the cause of acute AR? | |||||||||||||||||||||||||||||
| Infective endocarditis | Aortic dissection | ||||||||||||||||||||||||||||
Does the patient have AR related heart failure symptoms? | Emergent surgery[1] | ||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||
Schedule for early aortic valve replacement (Class I, level of evidence B)[1][2] Click here for more details | |||||||||||||||||||||||||||||
- ↑ 1.0 1.1 "http://circ.ahajournals.org/content/121/13/e266.full". External link in
|title=(help) - ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=ignored (help)