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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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||