第82回 日本循環器学会 学術集会
Session: Meet the ESC in Japan :Aortic Valve disease[Aortic Regurgitaion - Threshold & Surgical Intervention-]
In the era of aortic valvuloplasty (AVP), threshold for surgical intervention for aortic regurgitation (AR) can be classified into the following three stages:
1) Indication for aortic valve surgeryLeft ventricular end-diastolic/systolic diameter of 65/50mm and left ventricular ejection fraction of 50% is currently defined as threshold for intervention. However, in contrast to aortic valve replacement for cases with aortic stenosis, early surgical outcomes for AR are excellent. With improving long-term results of AVP, we hope earlier intervention will be recommended for low risk patients in the future when AVP is aimed. Early indication will also facilitate AVP.
2) Indication for AVP Currently, most etiologies of AR can be repaired, however, type III lesion is the most challenging case. Cusp height less than 16mm in tricuspid valve and less than 19mm in bicuspid valve is considered as contraindication for AVP. Of course they can be repaired by cusp-extension with a pericardial patch, although the long-term outcomes are still encouraging. Decision-making should be based on negotiation with each case.
3) Indication for root replacementCurrent guidelines recommend aortic root replacement in cases with root diameter more than 45mm when AVP is performed. However, root replacement has another role to facilitate AVP with respect to arrangement of commissural orientation in addition to the prevention of rupture or dissection. Especially in cases with bicuspid aortic valve, this threshold should be lowered. Considering the valve-related adverse events, AVP has an important role in surgical repair of AR.
We believe earlier indication may improve the quality of life of patients with AR necessitating surgical intervention.