This protocol covers patients with chronic aortic regurgitation that is both severe in degree and symptomatic. In this population, the presence of symptoms signals a critical threshold — one that demands a clear, structured management decision.
When aortic regurgitation is severe and the patient is symptomatic, surgery is recommended regardless of left ventricular function, unless the anticipated surgical risk is prohibitive. For patients in whom surgery is not feasible or is contraindicated, the clinical focus shifts to medical management aimed at symptomatic relief.
The primary clinical goal in this setting is symptomatic improvement. When surgical intervention is not an option, medical therapy with a specific class of vasodilating agents may be used to address symptoms — the full structured algorithm, including agent selection and applicable criteria, is in the complete protocol.
DOI: 10.1093/eurheartj/ehaf194
AV surgery is recommended in symptomatic patients with severe AR regardless of LV function.
When the patient is symptomatic and AR severe, surgery is recommended unless the anticipated surgical risk is prohibitive.
Medical therapy, especially angiotensin-converting enzyme-inhibitors (ACE-Is) or dihydropyridine calcium channel blockers, may provide symptomatic improvement in individuals with chronic severe AR for whom surgery is not feasible or contraindicated.
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