Aortic insufficiency surgical treatment


 * Associate Editor-In-Chief:, 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.

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.

Type of Surgery
Replacement with an aortic valve homograft should be performed if feasible. The surgical approach depends on the cause for aortic insufficiency with valve repair/replacement in cases of valvular structural abnormalities and instead aortic root repair/replacement in cases of aortic dissection.

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 stoke volume and reduce left ventricular end-diastolic pressure. Intra-aortic balloon pump is contraindicated as this would worsen aortic regurgitation by increasing after load.

Mild Acute Aortic Insufficiency in the Setting of Aortic Dissection
In mild aortic insufficiency secondary to aortic dissection, the valve can be repaired/replaced at the time of surgery for aortic dissection.