Acute aortic regurgitation surgical treatment: Difference between revisions
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Revision as of 14:48, 6 January 2015
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Aortic Regurgitation Microchapters |
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Diagnosis |
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Treatment |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Special Scenarios |
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Case Studies |
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Acute aortic regurgitation surgical treatment On the Web |
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American Roentgen Ray Society Images of Acute aortic regurgitation surgical treatment |
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Risk calculators and risk factors for Acute aortic regurgitation surgical treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Severe acute aortic insufficiency requires emergency surgery if there are no absolute contraindications to surgery.
Surgery
Timing of Emergency Surgery
Acute severe aortic insufficiency may cause death due to pulmonary edema, ventricular arrhythmias, electromechanical dissociation, or circulatory collapse. Individuals with bacteremia with aortic valve endocarditis should not wait for treatment with antibiotics to take effect, especially if there is hypotension, pulmonary edema, or low cardiac output given the high mortality associated with the acute aortic insufficiency.
Shown below is an algorithm for the treatment of acute aortic regurgitation.[1]
Abbreviations: AVR: Aortic valve replacement; ACE: Angiotensin converting enzyme; ARB: Angiotensin receptor blocker; CCB: Calcium channel blocker; LVEF: Left ventricle ejection fraction; TTE: Transthoracic echocardiography
| What is the cause of acute AR? | |||||||||||||||||||||||||||||
| Infective endocarditis | Aortic dissection | ||||||||||||||||||||||||||||
Does the patient have AR related heart failure symptoms? | ❑ Schedule for an emergent surgery[2] ❑ Administer beta blockers with caution (beta blockers inhibit compensatory tachycardia) | ||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||
❑ Schedule for early aortic valve replacement (Class I, level of evidence B)[3] | |||||||||||||||||||||||||||||
Type of Surgery
Replacement with an aortic valve homograft should be performed if feasible. The surgical approach depends upon the cause of aortic insufficiency. Aortic valve replacement or repair may be needed in cases of valvular structural abnormalities and aortic root repair/replacement may be needed in cases of aortic dissection.
Preoperative Medical Therapy
Patients may be temporarily managed before surgery with vasodilators such as nitroprusside and possibly inotropic agents such as dopamine or dobutamine to improve stroke volume and reduce left ventricular end-diastolic pressure.[4] Intra-aortic balloon pump is contraindicated as this would worsen aortic regurgitation by increasing afterload.
Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection
In mild aortic insufficiency secondary to aortic dissection, the aortic valve can be repaired/replaced at the time of surgery for aortic dissection.
Aortic Insufficiency Surgical Therapy
References
- ↑ Nishimura, R. A.; Otto, C. M.; Bonow, R. O.; Carabello, B. A.; Erwin, J. P.; Guyton, R. A.; O'Gara, P. T.; Ruiz, C. E.; Skubas, N. J.; Sorajja, P.; Sundt, T. M.; Thomas, J. D. (2014). "2014 AHA/ACC Guideline 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". Circulation. doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.
- ↑ "http://circ.ahajournals.org/content/121/13/e266.full". External link in
|title=(help) - ↑ 3.0 3.1 Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=ignored (help) - ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 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. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-04-07. Unknown parameter
|month=ignored (help)