What are the AHA/ACC guidelines on surgical intervention for 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

A comparison of surgical recommendations for aortic regurgitation is provided in the table below.

Table 2. Guidelines for Aortic Regurgitation Surgical Intervention (Open Table in a new window)

Aortic valve replacement (AVR) indications

Note:   STS guidelines recommend “valve replacement or valve repair”

AHA/ACC (2014) [4]

ESC/EACTS (2012) [42]

STS (2013) [9]

Symptomatic severe AR

Class I

Class I

Class I

Asymptomatic chronic severe AR and  left ventricular ejection fraction (LVEF) ≤50%

Class I

Class I

Class I

Severe AR when undergoing other cardiac surgery

Class I

Class I

Class I

Asymptomatic severe AR with normal LVEF (≥50%) but with severe LV dilation (LVESD >50mm)

Class IIa-Reasonable

Class IIa-Reasonable

Class IIa-Reasonable

Moderate AR when undergoing other cardiac surgery

Class IIa-Reasonable

 

Class IIb-Consider

Asymptomatic severe AR and normal LVEF (≥50%) but with progressive severe LV dilation (LVEDD >65 mm) if surgical risk is low

Class IIb-Consider

Class IIa-Reasonable

Class IIb-Consider

Not indicated for asymptomatic patients with mild, moderate, or severe AR and normal LV systolic function at rest when the degree of LV dilation is not moderate or severe

   

Class III

In 2015, the ACC/AHA released a guideline clarification statement addressing indications for early surgical intervention for associated enlargement or aneurysm of the ascending aorta in patients with bicuspid aortic valve (BAV) with the following recommendations: [43]

Intervention to repair or replace the aortic root (sinuses) or replace the ascending aorta is indicated in asymptomatic patients with BAV if the diameter of the aortic root or ascending aorta is ≥5.5 cm (Class I)

Iintervention to repair or replace the aortic root (sinuses) or replace the ascending aorta is reasonable in asymptomatic patients with BAV if the diameter of the aortic root or ascending aorta is ≥5.0 cm and an additional risk factor for dissection is present (eg, family history of aortic dissection or aortic growth rate ≥0.5 cm per year) or if the patient is at low surgical risk and the surgery is performed by an experienced aortic surgical team in a center with established expertise in these procedures. (Class IIa)

Replacement of the ascending aorta is reasonable in patients with BAV undergoing AVR because of severe aortic stenosis or aortic regurgitation when the diameter of the ascending aorta is >4.5 cm. (Class IIa)


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