Acute aortic regurgitation surgical treatment: Difference between revisions
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==Indications for [[Aortic Valve Replacement]]/Repair(AVR) in Chronic [[Aortic Insufficiency]] as per ACC/AHA Guidelines(2006)== | |||
{{cquote|'''Class I''' | |||
#AVR is indicated for symptomatic patients with severe aortic insufficiency irrespective of left ventricular systolic function. | |||
#AVR is indicated for asymptomatic patients with chronic severe aortic insufficiency and [[left ventricular systolic dysfunction]] ([[ejection fraction]] 0.50 or less) at rest. | |||
#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. | |||
'''Class IIa''' | |||
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). | |||
'''Class IIb''' | |||
#AVR may be considered in patients with moderate aortic insufficiency while undergoing surgery on the ascending aorta. | |||
#AVR may be considered in patients with moderate aortic insufficiency while undergoing [[CABG]]. | |||
#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. | |||
'''Class III''' | |||
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).}} | |||
==Severe aortic insufficiency in patient after aortic valve replacement 1== | ==Severe aortic insufficiency in patient after aortic valve replacement 1== | ||
Revision as of 23:28, 27 March 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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.
| 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) | ||
Indications for Aortic Valve Replacement/Repair(AVR) in Chronic Aortic Insufficiency as per ACC/AHA Guidelines(2006)
| “ | Class I
Class IIa 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). Class IIb
Class III 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). |
” |
Severe aortic insufficiency in patient after aortic valve replacement 1
<googlevideo>-3829359717394053857&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 2
<googlevideo>-1139143783733805104&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 3
<googlevideo>-7501177211861270942&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 4
<googlevideo>-4027195456056520519&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 5
<googlevideo>3983126063629833286&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 6
<googlevideo>5313961274473108141&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 7
<googlevideo>-1049019986268408841&hl=en</googlevideo>
Severe aortic insufficiency in patient after aortic valve replacement 8
<googlevideo>1577454681656420080&hl=en</googlevideo>
References
- ↑ "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)". J. Am. Coll. Cardiol. 32 (5): 1486–588. 1998. PMID 9809971.