From the Guidelines
Surgical intervention, specifically aortic valve replacement, is the primary treatment for symptomatic aortic regurgitation, as it significantly improves morbidity, mortality, and quality of life. The decision to proceed with surgery should be made by a heart valve team, taking into account the patient's overall health and surgical risk 1.
Key Considerations
- Patients with severe symptoms (NYHA class III or IV) or signs of left ventricular dysfunction should be referred for valve replacement surgery without delay 1.
- Medical therapy, including ACE inhibitors and vasodilators, can be used as a bridge to surgery or for patients who are not surgical candidates, but it is not a substitute for surgical intervention 1.
- Regular echocardiographic monitoring is essential for asymptomatic patients with severe regurgitation, typically every 6-12 months, to assess left ventricular size and function 1.
Medical Therapy
- ACE inhibitors, such as enalapril, can be used to reduce regurgitant volume by decreasing peripheral vascular resistance 1.
- Vasodilators, such as hydralazine, can also be used to reduce regurgitant volume, but their use should be cautious in patients with severe aortic regurgitation 1.
- Diuretics, such as furosemide, may be used to manage fluid overload and pulmonary congestion 1.
Surgical Intervention
- Aortic valve replacement is the mainstay treatment for symptomatic aortic regurgitation, and it can be performed with or without aortic root surgery 1.
- Percutaneous intervention, particularly TAVI, may be feasible for patients with symptomatic aortic regurgitation associated with mitral stenosis 1.
- The use of STS-PROM is recommended for comprehensive surgical risk assessment 1.
From the Research
Treatment for Symptomatic Aortic Regurgitation
The treatment for symptomatic aortic regurgitation typically involves surgical intervention, with medical therapy playing a supportive role.
- Aortic valve replacement (AVR) is often the primary treatment for symptomatic aortic regurgitation, as it can significantly improve symptoms and outcomes 2.
- Medical treatment may be used to improve the hemodynamic state temporarily before surgery or as a long-term treatment if AVR is contraindicated due to cardiac or noncardiac factors 2.
- Vasodilators, such as nifedipine, can reduce the regurgitant volume and decrease left ventricular afterload, but their use is generally limited to patients with severe heart failure or as a bridge to surgery 2, 3.
- Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially calcium-channel blockers may be recommended for chronic aortic regurgitation to control hypertension and delay left ventricular dysfunction 4.
Medical Management
Medical management of symptomatic aortic regurgitation aims to control symptoms and improve quality of life.
- Vasodilator therapy, such as nifedipine, can reduce left ventricular volume and mass and improve left ventricular performance in patients with aortic regurgitation 5, 3.
- ACE inhibitors are particularly useful for hypertensive patients with aortic regurgitation, while beta-blockers may be indicated to slow the rate of aortic dilatation and delay the need for surgery in patients with aortic root disease 2.
- However, the use of beta-blockers is cautioned against due to their potential negative effects 4.
Surgical Intervention
Surgical intervention is often necessary for symptomatic aortic regurgitation.