Indications and Contraindications for Aortic Valve Repair

  • Tatsuhiko KomiyaEmail author


Various guidelines address the surgical indications for aortic regurgitation (AR) (Table 7.1). When the regurgitation has progressed and symptoms are present, surgical indications need to be considered. Even if symptoms are absent, in Europe, surgical treatment is recommended when either of the following exist: the left ventricular ejection fraction (LVEF) is <50% or left ventricular dilatation (left ventricular end-systolic diameter [LVDs] >50 mm, or LVDs/body surface area ratio >25 mm/m2 [Class IIa], or left ventricular end-diastolic diameter [LVDd] >65 mm [Class IIb]) exists. Left ventricular dilatation in Japanese patients is precisely classified and defined by guidelines, but considering the difference in physique between European and Japanese patients, it is appropriate to apply values corrected by body surface area. For a patient with body surface area of 1.5 m2, a LVDs >37.5 mm is indicated for surgical intervention. It is important to note that surgical treatment is recommended in the early stage of left ventricular dilatation compared to the previous guidelines and that the LVDs has become the important indicator.


  1. 1.
    Nishimura RA, Otto CM, et al. 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. 2014;129:e521–643.PubMedGoogle Scholar
  2. 2.
    Vahanian A, Alfieri O, et al. European guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42:S1–44.CrossRefGoogle Scholar
  3. 3.
    Okita Y, Okada Y, Otsuji Y, Komeda M, Nakatani S, Matsuzaki M, et al. Guidelines for surgical and interventional treatment of valvular heart disease (JCS 2012).
  4. 4.
    Aicher D, Fries R, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg. 2010;37:127–32.CrossRefGoogle Scholar
  5. 5.
    Price J, De Kerchove L, et al. Risk of valve-related events after aortic valve repair. Ann Thorac Surg. 2013;95:606–12.CrossRefGoogle Scholar
  6. 6.
    Sharma V, Suri RM, et al. Expanding relevance of aortic valve repair—is earlier operation indicated? J Thorac Cardiovasc Surg. 2014;147:100–8.CrossRefGoogle Scholar
  7. 7.
    Ashikhmina E, Sundt TM 3rd, et al. Repair of the bicuspid aortic valve: a viable alternative to replacement with a bioprosthesis. J Thorac Cardiovasc Surg. 2010;139:1395–401.CrossRefGoogle Scholar
  8. 8.
    de Kerchove L, Boodhwani M, et al. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg. 2011;142:1430–8.CrossRefGoogle Scholar
  9. 9.
    Aicher D, Schneider U, et al. Early results with annular support in reconstruction of the bicuspid aortic valve. J Thorac Cardiovasc Surg. 2013;145:S30–4.CrossRefGoogle Scholar
  10. 10.
    Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504–10.CrossRefGoogle Scholar
  11. 11.
    Svensson LG, Adams DH, et al. Aortic valve and ascending aorta guidelines for management and quality measures: executive summary. Ann Thorac Surg. 2013;95:1491–505.CrossRefGoogle Scholar
  12. 12.
    David TE, Feindel CM, et al. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 2014;148:872–9.CrossRefGoogle Scholar
  13. 13.
    Stephens EH, Liang DH, et al. Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement. J Thorac Cardiovasc Surg. 2014;147:169–78.CrossRefGoogle Scholar
  14. 14.
    Leshnower BG, Guyton RA, et al. Expanding the indications for the David V aortic root replacement: early results. J Thorac Cardiovasc Surg. 2012;143:879–84.CrossRefGoogle Scholar
  15. 15.
    Leshnower BG, Myung RJ, et al. Midterm results of David V valve-sparing aortic root replacement in acute type a aortic dissection. Ann Thorac Surg. 2015;99:795–801.CrossRefGoogle Scholar
  16. 16.
    Malas T, Saczkowski R, Sohmer B, Ruel M, Mesana T, de Kerchove L, El Khoury G, Boodhwani M. Is aortic valve repair reproducible? Analysis of the learning curve for aortic valve repair. Can J Cardiol. 2015;31:1497.e15–22.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Institute of Cardiovascular SurgeryKurashiki Central HospitalOkayamaJapan

Personalised recommendations