Acute aortic regurgitation surgical treatment

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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.

Acute Aortic Insufficiency

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 aortic valve homograft should be performed if feasible.

Chronic Aortic Insufficiency

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.

Indications for surgery for chronic severe aortic insufficiency

Symptoms	Ejection fraction	Other information
NYHA class III - IV	≥ 50 %
NYHA class II	≥ 50 %	Progression of symptoms or worsening parameters on echocardiography
CHA class ≥ II angina	≥ 50 %
Regardless of symptoms	25 - 49 %
Cardiac surgery for other cause (ie: CAD, other valvular disease, ascending aortic aneurysm)

Severe aortic insufficiency in patient after aortic valve replacement 1

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Severe aortic insufficiency in patient after aortic valve replacement 2

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Severe aortic insufficiency in patient after aortic valve replacement 3

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Severe aortic insufficiency in patient after aortic valve replacement 4

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Severe aortic insufficiency in patient after aortic valve replacement 5

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Severe aortic insufficiency in patient after aortic valve replacement 6

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Severe aortic insufficiency in patient after aortic valve replacement 7

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Severe aortic insufficiency in patient after aortic valve replacement 8

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