Preoperative Evaluation of Aortic Insufficiency: Optimal Timing

Summary

In aortic regurgitation, the timing of surgery is relatively straightforward: all symptomatic patients with severe aortic regurgitation benefit from surgery in terms of better functional class, survival and ventricular function postoperatively and should thus be referred for surgery as soon as this valve lesion is diagnosed, regardless of the left ventricular function at that moment. Asymptomatic patients with left ventricular dysfunction develop symptoms in the near future and should be referred for elective aortic relacement. Asymptomatic patients with preserved left ventricular dimensions and function and a normal exercise tolerance should be followed closely with non-invasive measurements of dimensions and ejection fraction. When deterioration of these parameters occur, the robustness of these findings should be confirmed by serial repeated measurements and once dilation and/or dysfunction of the left ventricle are assessed, referral for surgery should take place. The thresholds for unacceptable dilation (LVESD > 45–50 mm) and ejection fraction ( < 50–60 %) are somewhat broader than in mitral regurgitation, because improvement postoperatively of left ventricular function and dimensions occurs almost in all patients when duration of these abnormalities was not long which can be obviated when close follow-up is guaranteed.