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Current Management of Patients with Severe Aortic Regurgitation

Current Treatment Options in Cardiovascular Medicine volume 19, Article number: 9 (2017) Cite this article

Opinion statement

Chronic aortic regurgitation can result from various congenital and acquired anomalies and can be associated with proximal aortic disease. As the number of aortic valve procedures is growing, the incidence of post-procedural regurgitation also increases with associated morbidity. Typical evolution is characterized by a clinically silent phase of variable duration followed by a rather rapid decline with high incidence of adverse events. A challenge remains to find the optimal timing for an intervention: Patients are exposed to unnecessary surgical risks if treated prematurely, but peri- and post-operative prognosis is worse when the intervention is performed too late. Clinical evaluation and serial imaging tests can optimize the timing for intervention. Clinical follow-up should try to elucidate associated symptoms, with quantitative measurement of functional capacity as needed. Serial imaging examinations are required to identify sub-clinical left ventricular dysfunction or severe dilatation that should prompt a surgery. At least in selected cases, newer imaging modalities (MRI, 3D echocardiography) and/or biomarkers can help for the management of these patients, and more research is needed to determine if their systematic use can be beneficial. Medical treatment with vasodilators and anti-remodeling drugs can be helpful in some patients but should not replace or delay aortic valve surgery when indicated. Most patients will eventually be treated with surgical aortic valve replacement. Although possible in selected cases, transcatheter aortic valve replacement is not commonly used for patients with pure aortic regurgitation. For patients with prior aortic valve replacement and aortic regurgitation (paravalvular or intravalvular), emerging percutaneous approaches can be considered when available, especially for those at high surgical risk.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Acknowledgments

Jonathan Beaudoin is funded by the Fonds de Recherche du Québec-Santé (Montreal, Quebec, Canada) and his research program by the Heart and Stroke Foundation of Canada.

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  1. Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Department of Medicine, Laval University, Québec, QC, Canada

    Charles Nadeau-Routhier MD, Ons Marsit MSc & Jonathan Beaudoin MD FRCPC

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Correspondence to Jonathan Beaudoin MD FRCPC.

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Charles Nadeau-Routhier, Ons Marsit, and Jonathan Beaudoin each declare no potential conflicts of interest.

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This article is part of the Topical Collection on Valvular Heart Disease

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Nadeau-Routhier, C., Marsit, O. & Beaudoin, J. Current Management of Patients with Severe Aortic Regurgitation. Curr Treat Options Cardio Med 19, 9 (2017). https://doi.org/10.1007/s11936-017-0508-8

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Keywords

  • Aortic regurgitation
  • Aortic valve replacement
  • Transcatheter valve replacement
  • Valvular heart disease