Aortic Regurgitation

There are on the order of 100,000 aortic valve surgeries each year, with approximately 18,000 of them performed annually in the USA.

Of aortic valves, 20% to 30% have isolated regurgitation at time of replacement.

At time of replacement, 12-30% of aortic valves have combined regurgitation and stenosis.

M:F ratio: 3:1.

Racial predominance: None known.

Left ventricular failure

Right ventricular failure

Subendocardial ischemia

Splanchnic ischemia

Underlying causes of acute aortic regurgitation including aortic dissection, a malfunctioning valve prosthesis, or endocarditis

Hypertension, which increases aortic regurgitation and decreases cardiac output

Bradycardia, which increases aortic regurgitation and decreases cardiac output

When going onto bypass, avoid LV distention from fibrillatory arrest before aortic cross-clamping (frequently occurs during cooling on pump) until LV decompression is immediately achievable

Long latency period between onset of hemodynamic changes and symptoms with the exception of acute aortic regurgitation (∼20-30 y)

Myocardial ischemia uncommon

Bicuspid valve +/− ascending aortic aneurysm frequently associated with aortic regurgitation

Abdominal pain a manifestation of splanchnic ischemia