Timing of Surgical Intervention for Aortic Regurgitation

Abstract

Aortic regurgitation is a frequently encountered condition, in which traditional measurements of severity have proven to be of limited value in identifying those who would be best served by aortic valve replacement. Novel methods of assessing severity are vital, particularly as an entirely new paradigm of aortic regurgitation has surfaced, with the advent of transcatheter aortic valve replacement (TAVR), and the adverse events that are being observed with varying degrees of aortic regurgitation. With that in mind, a comprehensive assessment of aortic regurgitation should now include indexed left ventricular systolic volumes and a comprehensive assessment of right ventricular function, in addition to the quantitative measures that are currently recommended. Cardiac MRI also provides valuable information and should be strongly considered, particularly in challenging cases. The incremental value of additional echocardiographic parameters such as strain imaging, speckle tracking imaging, and tissue Doppler imaging remains unclear, and evidence for their utility is not, as yet, compelling. However, the field of aortic regurgitation assessment has been reinvigorated by the prevalence of paravalvular regurgitation post-TAVR, and many of the abovementioned parameters may need to be re-visited so that we can more accurately determine prognosis and risk stratify patients in a more reliable and evidence-based manner.

Association of renin–angiotensin system inhibitors use with short- and long-term mortality in patients with aortic stenosis: A systematic review and meta-analysis

“…Second, increased sympathetic activity, which is associated with cardiovascular diseases ( 30 ), is more effectively inhibited by RASi in patients who underwent AVR. Third, aortic regurgitation or mitral regurgitation, which is associated with left ventricular remodeling ( 12 , 31 , 32 ), is significantly less severe in patients who underwent AVR. Furthermore, the association between RASi and better clinical outcomes might be mediated by decreasing afterload, valvulo-arterial impedance, systemic vascular resistance, vascular calcification, inflammatory cytokine levels, and endothelial dysfunction ( 33 – 36 ).…”