Aortic Regurgitation with Aortic Root Dilatation: Surgical Management in Young Patients
When aortic regurgitation occurs alongside significant aortic root or ascending aorta enlargement, the surgical decision is shaped by both the valve and aortic dimensions — and in young patients, a specific set of priorities governs the approach.
Clinical scenario
Aortic regurgitation coexisting with aortic root dilatation. Surgery is indicated when the aortic root or ascending aorta diameter reaches ≥45 mm at the time of valve surgery, or when the maximal root or ascending aortic aneurysm diameter is ≥55 mm. The presence of associated aortic dilatation dictates surgery irrespective of AR severity. This protocol is specifically directed at younger patients, for whom the long-term implications of the surgical technique carry particular weight.
Approach (partial)
Management requires concurrent surgical treatment of both the valve and the aortic root or ascending aorta. In young patients at experienced centres, a valve-sparing strategy is the preferred direction when conditions allow — but the complete decision framework, including the criteria that determine which surgical reconstruction is most appropriate, is detailed in the structured protocol.
References
- The presence of associated aortic dilatation dictates surgery, irrespective of AR severity.
- Valve-sparing aortic root replacement is recommended in young patients with aortic root dilatation at experienced centres, when durable results are expected.
- When AV surgery is indicated and the predicted surgical risk is low, replacement of the aortic root or ascending aorta should be considered if the maximal diameter is ≥45 mm.
- In patients with root enlargement and good tissue quality (i.e. pliable AV cusps with normal motion), a valve-sparing procedure has been demonstrated to be superior to the use of a composite valve graft (Bentall procedure) in terms of long-term mortality and overall morbidity (thromboembolism and endocarditis, with similar need for reoperation), and should be therefore favoured by experienced centres, in particular in patients with an estimated long life expectancy.
DOI: 10.1093/eurheartj/ehaf194
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