Indications and Contraindications for Aortic Valve Repair
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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.
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