Acute aortic regurgitation surgical treatment
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In the case of severe acute aortic insufficiency, all individuals should undergo emergency 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, especially if there is hypotension, pulmonary edema, or low cardiac output given the high mortality associated with the acute aortic insufficiency. Instead, replacement with an aortic valve homograft should be performed if feasible. Surgical approach depends on the cause for aortic insufficiency with valve repair/replacement in cases of valvular structural abnormalities to aortic root repair/replacement in cases of aortic dissection.
Patients may be temporarily managed before surgery with vasodilators such as nitroprusside and possibly inotropic agents such as dopamine or dobutamine to improve stoke volume and reduce left ventricular end-diastolic pressure[1]. Intra-aortic balloon pump is contraindicated as this would worsen aortic regurgitation by increasing after load.
In mild aortic insufficiency secondary to aortic dissection, valve can be repaired/replaced at the time of surgery for aortic dissection.
References
- ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 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 (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-04-07. Unknown parameter
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