Treatment

• Acute aortic regurgitation

  • Severe acute AR requires surgical treatment as soon as possible.

  • Medical management of complications (e.g., pulmonary edema) should not delay definitive treatment.

• Chronic aortic regurgitation

  • Surgery is the mainstay of treatment for symptomatic AR and severe asymptomatic AR.

  • Optimize medical management of comorbidities (e.g., heart failure treatment).

All patients with acute severe aortic regurgitation should undergo urgent surgical treatment.

IABP increases regurgitated volume and is contraindicated in acute severe AR

• Indications

  • Acute severe AR

  • Symptomatic chronic severe AR

  • Asymptomatic chronic severe AR with one of the following:

    • Reduced LVEF ≤ 55%

    • Consider if LVESD > 50 mm

    • Cardiac surgery for other indications

• Surgical aortic valve replacement: Standard procedure for acute and chronic AR

Medical management

All patients should be screened and treated for other cardiac risk factors. No medical treatments are known to influence the progression of the disease.

• Hypertension

  • Initiate treatment if systolic blood pressure is > 140 mm Hg.

• Heart failure: Manage according to guideline recommendations (see “Treatment of heart failure”).

Monitoring

• Serial echocardiography: Regular follow-up imaging is indicated for asymptomatic patients to identify possible progression and indications for intervention.

• Asymptomatic patients with normal LVEF: progression to symptoms or LV dysfunction at a rate of < 6% per year

• Asymptomatic patients with decreased EF: progression to symptoms at a rate of > 25% per year

• Symptomatic patients: mortality rate is > 10% per year