Aortic insufficiency surgical treatment


 * Associate Editor-In-Chief:, Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.

Overview
In the case of severe acute aortic insufficiency, all individuals should undergo emergency surgery if there are no absolute contraindications for 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. Instead, replacement with an aortic valve homograft should be performed if feasible. Surgical approach depends on the cause for aortic insufficiency with valve repair/replacement in cases of valvular structural abnormalities to aortic root repair/replacement in cases of aortic dissection.

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.

In mild aortic insufficiency secondary to aortic dissection, valve can be repaired/replaced at the time of surgery for aortic dissection.