Skip to main content

Advertisement

Log in

Contemporary reviews by surgeon: timing of operation for chronic aortic regurgitation

  • Current Topics Review Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

The timing of operation for severe chronic and asymptomatic aortic regurgitation remains problematic, though the present trend is to prefer early surgery. In this article, we review recent reports, mainly published after 2006, regarding indications for surgical treatment for pure chronic AR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Matsuda H, et al. Guidelines for surgical and interventional treatment of valvular disease: a report of the Japanese Circulation Society, the Japanese Association for Thoracic Surgery, the Society for Cardiovascular Surgery and Japanese College of Cardiology Task Force on Practice Guidelines (writing committee to revise the 2001 guidelines). 2007. http://www.j-circ.or.jp/guideline/index.htm.

  2. Bonow RO, Carabello BA, Chatterjee K, Leon AC, de Faxon DP Jr, Freed MD, et al. 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. 2008;118:e523–661.

    Article  PubMed  Google Scholar 

  3. Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–68.

    PubMed  Google Scholar 

  4. Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, European Association of Echocardiography, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:223–44.

    Article  PubMed  Google Scholar 

  5. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, American Society of Echocardiography, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.

    Article  PubMed  Google Scholar 

  6. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, American Society of Echocardiography’s Nomenclature and Standards Committee, Task Force on Chamber Quantification, American College of Cardiology Echocardiography Committee, American Heart Association; European Association of Echocardiography, European Society of Cardiology, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108.

    Article  PubMed  Google Scholar 

  7. Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M, European Association of Echocardiography, et al. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008;9:438–48.

    Article  PubMed  Google Scholar 

  8. Borer JS, Hochreiter C, Herrold EM, Supino P, Aschermann M, Wencker D, et al. Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance. Circulation. 1998;97:525–34.

    Article  PubMed  CAS  Google Scholar 

  9. Detaint D, Messika-Zeitoun D, Maalouf J, Tribouilloy C, Mahoney DW, Tajik AJ, et al. Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study. JACC Cardiovasc Imaging. 2008;1:1–11.

    Article  PubMed  Google Scholar 

  10. Borow KM, Green LH, Mann T, Sloss LJ, Braunwald E, Collins JJ, et al. End systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation. Am J Med. 1980;68:655–63.

    Article  PubMed  CAS  Google Scholar 

  11. Carabello BA, Williams H, Gash AK, Kent R, Belber D, Maurer A, et al. Hemodynamic predictors of outcome in patients undergoing valve replacement. Circulation. 1986;74:1309–16. (Erratum in: Circulation 1987; 75:650).

    Article  PubMed  CAS  Google Scholar 

  12. Detaint D, Maalouf J, Tribouilloy C, Mahoney DW, Schaff HV, Tajik AJ, et al. Congestive heart failure complicating aortic regurgitation with medical and surgical management: a prospective study of traditional and quantitative echocardiographic markers. J Thorac Cardiovasc Surg. 2008;136:1549–57.

    Article  PubMed  Google Scholar 

  13. Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation. 1999;99:1851–7.

    Article  PubMed  CAS  Google Scholar 

  14. Cho SH, Byun CS, Kim KW, Chang BC, Yoo KJ, Lee S. Preoperative indexed left ventricular dimensions to predict early recovery of left ventricular function after aortic valve replacement for chronic aortic regurgitation. Circ J. 2010;74:2340–5.

    Article  PubMed  Google Scholar 

  15. Sambola A, Tornos P, Ferreira-Gonzalez I, Evangelista A. Prognostic value of preoperative indexed end-systolic left ventricle diameter in the outcome after surgery in patients with chronic aortic regurgitation. Am Heart J. 2008;155:1114–20.

    Article  PubMed  Google Scholar 

  16. Brown ML, Schaff HV, Suri RM, Li Z, Sundt TM, Dearani JA, et al. Indexed left ventricular dimensions best predict survival after aortic valve replacement in patients with aortic valve regurgitation. Ann Thorac Surg. 2009;87:1170–5. (discussion 1175–1176. Erratum in: Ann Thorac Surg 2009; 88:710).

    Article  PubMed  Google Scholar 

  17. Turk R, Varadarajan P, Kamath A, Sampat U, Khandhar S, Patel R, et al. Survival benefit of aortic valve replacement in older patients with asymptomatic chronic severe aortic regurgitation. Ann Thorac Surg. 2010;89:731–7.

    Article  PubMed  Google Scholar 

  18. Ruel M, Kapila V, Price J, Kulik A, Burwash IG, Mesana TG. Natural history and predictors of outcome in patients with concomitant functional mitral regurgitation at the time of aortic valve replacement. Circulation. 2006;114(1 Suppl):I541–6.

    PubMed  Google Scholar 

  19. Pai RG, Varadarajan P. Prognostic implications of mitral regurgitation in patients with severe aortic regurgitation. Circulation. 2010;122(Suppl 1):S43–6.

    Article  PubMed  Google Scholar 

  20. Khandhar S, Varadarajan P, Turk R, Sampat U, Patel R, Kamath A, et al. Survival benefit of aortic valve replacement in patients with severe aortic regurgitation and pulmonary hypertension. Ann Thorac Surg. 2009;88:752–6.

    Article  PubMed  Google Scholar 

  21. Weber M, Hausen M, Arnold R, Moellmann H, Nef H, Elsaesser A, et al. Diagnostic and prognostic value of N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with chronic aortic regurgitation. Int J Cardiol. 2008;127:321–7.

    Article  PubMed  Google Scholar 

  22. Gerber IL, Stewart RA, French JK, Legget ME, Greaves SC, West TM, Kerr AJ, Richards AM, White HD. Associations between plasma natriuretic peptide levels, symptoms, and left ventricular function in patients with chronic aortic regurgitation. Am J Cardiol. 2003;92:755–8. (Erratum in: Am J Cardiol. 2004; 93:526).

    Article  PubMed  CAS  Google Scholar 

  23. Pizarro R, Bazzino OO, Oberti PF, Falconi ML, Arias AM, Krauss JG, et al. Prospective validation of the prognostic usefulness of B-type natriuretic peptide in asymptomatic patients with chronic severe aortic regurgitation. J Am Coll Cardiol. 2011;58:1705–14.

    Article  PubMed  CAS  Google Scholar 

  24. Bhudia SK, McCarthy PM, Kumpati GS, Helou J, Hoercher KJ, Rajeswaran J, et al. Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunction. J Am Coll Cardiol. 2007;49:1465–71.

    Article  PubMed  Google Scholar 

  25. Taniguchi K, Nakano S, Hirose H, Matsuda H, Shirakura R, Sakai K, et al. Preoperative left ventricular function: minimal requirement for successful late results of valve replacement for aortic regurgitation. J Am Coll Cardiol. 1987;10:510–8.

    Article  PubMed  CAS  Google Scholar 

  26. Chaliki HP, Mohty D, Avierinos JF, Scott CG, Schaff HV, Tajik AJ, et al. Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function. Circulation. 2002;106:2687–93.

    Article  PubMed  Google Scholar 

  27. Taniguchi K, Nakano S, Kawashima Y, Sakai K, Kawamoto T, Sakaki S, et al. Left ventricular ejection performance, wall stress, and contractile state in aortic regurgitation before and after aortic valve replacement. Circulation. 1990;82:798–807.

    Article  PubMed  CAS  Google Scholar 

  28. Bonow RO, Dodd JT, Maron BJ, O’Gara PT, White GG, McIntosh CL, et al. Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation. Circulation. 1988;78:1108–20.

    Article  PubMed  CAS  Google Scholar 

  29. Klodas E, Enriquez-Sarano M, Tajik AJ, Mullany CJ, Bailey KR, Seward JB. Aortic regurgitation complicated by extreme left ventricular dilation: long-term outcome after surgical correction. J Am Coll Cardiol. 1996;27:670–7.

    Article  PubMed  CAS  Google Scholar 

  30. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231–43.

    Article  PubMed  Google Scholar 

  31. Kamath AR, Varadarajan P, Turk R, Sampat U, Patel R, Khandhar S, et al. Survival in patients with severe regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement. Results from a cohort of 166 patients with an ejection fraction ≤35%. Circulation. 2009;120:S134–8.

    Article  PubMed  Google Scholar 

  32. Taniguchi K, Takahashi T, Toda K, Matsue H, Shudo Y, Shintani H, et al. Left ventricular mass: impact on left ventricular contractile function and its reversibility in patients undergoing aortic valve replacement. Eur J Cardiothorac Surg. 2007;32:588–95.

    Article  PubMed  Google Scholar 

  33. Sokmen G, Sokmen A, Duzenli A, Soylu A, Ozdemir K. Assessment of myocardial velocities and global function of the left ventricle in asymptomatic patients with moderate-to-severe chronic aortic regurgitation: a tissue Doppler echocardiographic study. Echocardiography. 2007;24:609–14.

    Article  PubMed  Google Scholar 

  34. Marciniak A, Sutherland GR, Marciniak M, Claus P, Bijnens B, Jahangiri M. Myocardial deformation abnormalities in patients with aortic regurgitation: a strain rate imaging study. Eur J Echocardiogr. 2009;10:112–9.

    Article  PubMed  Google Scholar 

  35. Stefani L, De Luca A, Maffulli N, Mercuri R, Innocenti G, Suliman I, et al. Speckle tracking for left ventricle performance in young athletes with bicuspid aortic valve and mild aortic regurgitation. Eur J Echocardiogr. 2009;10:527–31.

    Article  PubMed  Google Scholar 

  36. Gabriel RS, Kerr AJ, Sharma V, Zeng IS, Stewart RA. B-type natriuretic peptide and left ventricular dysfunction on exercise echocardiography in patients with chronic aortic regurgitation. Heart. 2008;94:897–902.

    Article  PubMed  CAS  Google Scholar 

  37. Onishi T, Kawai H, Tatsumi K, Kataoka T, Sugiyama D, Tanaka H, et al. Preoperative systolic strain rate predicts postoperative left ventricular dysfunction in patients with chronic aortic regurgitation. Circ Cardiovasc Imaging. 2010;3:134–41.

    Article  PubMed  Google Scholar 

  38. Olsen NT, Sogaard P, Larsson HB, Goetze JP, Jons C, Mogelvang R, et al. Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery. JACC Cardiovasc Imaging. 2011;4:223–30.

    Article  PubMed  Google Scholar 

  39. Tayyareci Y, Yildirimturk O, Aytekin V, Demiroglu IC, Aytekin S. Subclinical left ventricular dysfunction in asymptomatic severe aortic regurgitation patients with normal ejection fraction: a combined tissue Doppler and velocity vector imaging study. Echocardiography. 2010;27:260–8.

    Article  PubMed  Google Scholar 

  40. Bonow RO, Lakatos E, Maron BJ, Epstein SE. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation. 1991;84:1625–35.

    Article  PubMed  CAS  Google Scholar 

  41. Tornos MP, Olona M, Permanyer-Miralda G, Herrejon MP, Camprecios M, Evangelista A, et al. Clinical outcome of severe asymptomatic chronic aortic regurgitation: a long-term prospective follow-up study. Am Heart J. 1995;130:333–9.

    Article  PubMed  CAS  Google Scholar 

  42. Bonow RO. Aortic regurgitation: time to reassess timing of valve replacement? JACC Cardiovasc Imaging. 2011;4:231–3.

    Article  PubMed  Google Scholar 

  43. Taniguchi K, Nakano S, Matsuda H, Shimazaki Y, Sakai K, Kawamoto T, et al. Depressed myocardial contractility and normal ejection performance after aortic valve replacement in patients with aortic regurgitation. J Thorac Cardiovasc Surg. 1989;98:258–65.

    PubMed  CAS  Google Scholar 

  44. Carabello BA. Cardiologists: do we have the right to call ourselves physiologists? JACC Cardiovasc Imaging. 2008;1:12–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kazuhiro Taniguchi.

Additional information

This review was submitted at the invitation of the editorial committee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taniguchi, K., Sawa, Y. Contemporary reviews by surgeon: timing of operation for chronic aortic regurgitation. Gen Thorac Cardiovasc Surg 60, 735–743 (2012). https://doi.org/10.1007/s11748-012-0093-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-012-0093-4

Keywords

Navigation