What is the role of valve replacement in the treatment of aortic regurgitation (AR)?

Updated: Nov 19, 2018
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Surgical treatment of AR usually requires replacement of the diseased valve with a prosthetic valve, although valve-sparing repair is increasingly possible with advances in surgical technique and technology. Such improvements have also enabled many patients, even those with severe LV dysfunction, to undergo valve surgery instead of cardiac transplantation. [35, 36, 37] Salih et al recommend early surgical closure for patients with VSD and AV prolapse for better post-repair outcomes and prevention of AR progression. [38]

In a retrospective analysis (995-2012), De Meester et al compared the prognosis of aortic valve (AV) repair to that of AV replacement (AVR) using a propensity score analysis and found similar operative mortality (2% vs 5%, respectively). [39] However, on Kaplan-Meier survival analysis, there was a significantly better overall 9-year survival after AV repair (87%) than after AVR (60%). Cox proportional survival analysis showed that treatment selection was an independent predictor of postoperative survival. [39] The investigators suggest these findings indicate that AVR should probably the preferred surgical intervention for correction of aortic regurgitation as feasible.


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