Materiały źródłowe

• #1 Aortic Valve Regurgitation | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/aortic-valve-regurgitation.html

  Treatment varies according to how bad your condition is. If you have a mild form of the condition, you may need only regular check-ups with your healthcare provider. You may not have symptoms for many years. Symptoms may get worse slowly over time and not affect daily life. […] In severe aortic regurgitation, surgery is commonly advised. The timing of surgery is important to discuss with your healthcare provider and surgeon. In some cases, severe aortic regurgitation may be treated with medicine. Medicine may also be used in the short-term before valve replacement surgery. Or it may be used ongoing if you are not able to have valve replacement surgery. […] It’s also important to manage your blood pressure. […] Treatment options may include: […] For people with severe aortic regurgitation, symptoms, enlargement of the left ventricle or abnormal pump function, the treatment is often somewhat different:

• #2 Aortic Valve Regurgitation: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/heart-valves/aortic-valve-regurgitation/treatment

  Treatment of aortic valve regurgitation will vary depending on the severity of the condition. If symptoms are mild or absent, your doctor may encourage healthy lifestyle changes and frequent check-ups. Certain medications may also be prescribed as a treatment. However, surgery may be necessary if the condition worsens or if symptoms are severe. […] To treat aortic valve regurgitation your doctor may prescribe antiarrhythmic medicines, diuretics, or medications to lower blood pressure. These may be prescribed prior to a surgical procedure or as long-term medication, especially if you’re unable to undergo surgery. […] Depending on the severity of the case, an aortic valve repair procedure may be necessary to mend damage or repair holes in the aortic valve. The surgery can also separate fused valve flaps, or remove and reshape any excess tissue, allowing the valve flaps to close correctly.

• #3 Aortic valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-treatment/drc-20353135

  Treatment of aortic valve regurgitation depends on: […] The goals of aortic valve regurgitation treatment are to ease symptoms and prevent complications. […] If your symptoms are mild or you don’t have symptoms, you may only need regular health checkups. You may need regular echocardiograms to check the health of the aortic valve. Heart-healthy lifestyle changes also are usually recommended. […] If you have aortic valve regurgitation, you may be given medicines to: […] Surgery may be needed to repair or replace the diseased valve, especially if the condition and symptoms are severe. Heart valve surgery may be needed even if aortic regurgitation isn’t severe or when there are no symptoms. […] The decision to repair or replace a damaged aortic valve depends on: […] Surgery to repair or replace an aortic valve may be done as open-heart surgery. This involves a cut, also called an incision, in the chest. Sometimes surgeons can do minimally invasive heart surgery to replace the aortic valve.

• #4 Aortic Valve Regurgitation: Treatment & Diagnosis | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-valve-regurgitation/treatment

  Whether you require aortic valve leakage treatment depends on factors like your symptoms, the underlying cause, the severity of the regurgitation, and your overall health. Mild aortic regurgitation is often managed with medication and regular monitoring through periodic echocardiograms. However, more severe cases may require aortic valve regurgitation surgery. […] Medication can alleviate symptoms and slow the progression of aortic regurgitation. Blood pressure meds like ACE inhibitors and beta-blockers can reduce pressure on the aortic valve. […] Based on the anatomy of the aortic valve, it can either be replaced or repaired. […] Aortic valve repair surgery: In cases where the aortic valve leaflets have normal tissue quality, the aortic valve can often be repaired. This procedure may involve reshaping or reconstructing the valve leaflets, removing excess tissue so the leaflets close correctly, or patching the part of the valve that is leaking.

• #5 Treatment for Aortic Valve Regurgitation

  https://healthlibrary.umcno.org/RelatedItems/3,90484

  Treatment for Aortic Valve Regurgitation […] Aortic valve regurgitation is when the aortic valve leaks. The aortic valve is one of the four heart valves. It’s on the left side of the heart. It sits between the left lower chamber (ventricle) and the large blood vessel that sends blood to the body (aorta). […] Types of treatment […] Treatment depends on the cause of your condition and how severe it is. […] With mild to moderate aortic valve regurgitation, you may have no symptoms. And you may have normal heart function and size. If your condition is mild to moderate, you may be treated with: […] Regular monitoring. This includes regular checkups to check the degree of leaking and how well the chambers of your heart are working. […] Risk factor management. Your health care provider will help you manage conditions that can cause aortic valve disease, such as high blood pressure. Your provider may prescribe certain blood pressure medicines, such as ACE (angiotensin-converting enzyme) inhibitors, ARBs (angiotensin II receptor blockers), or calcium channel blockers.

• #6 Aortic Valve Insufficiency: Causes, Symptoms & Diagnosis

  https://www.healthline.com/health/aortic-insufficiency

  Aortic valve regurgitation happens when your aortic valve doesnt fully close, causing some blood to remain in your left ventricle. It can cause symptoms like chest pain and fatigue, among others. […] Treatment can depend on the severity of your aortic valve insufficiency. […] If your condition is mild, you may not require treatment. A doctor may recommend regular heart monitoring and improving your heart health. This may include general recommendations to support cardiovascular health, including: maintaining a moderate weight, getting regular physical activity with exercises that are safe for you, following a heart-healthy eating pattern rich in plant-based foods and whole grains, quitting smoking, if you smoke. […] If you have advanced aortic disease, you may need surgery to repair or replace the aortic valve. This can include: transcatheter aortic valve replacement (TAVR) surgery, which is a minimally invasive surgery that replaces the aortic valve with an aortic valve made from animal tissue; surgical AV replacement, which replaces the valve with a mechanical one, or one from an animal or deceased donor through open-heart surgery; valve repair (valvuloplasty), which repairs the existing valve through open-heart surgery.

• #7 Aortic Valve Regurgitation

  https://www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/aortic-valve-regurgitation/

  Treatment of aortic regurgitation depends on the severity of your disease which is determined by signs, symptoms and testing. Based on the findings, your doctor may recommend treatment options including lifestyle changes, medications or medical or surgical procedures. […] Lifestyle Changes […] Avoid smoking. […] Eat a heart-healthy diet. […] Exercise under directions of your doctor. […] Manage stress. […] Address risk factors for coronary artery disease such as obesity, high blood pressure, and high cholesterol. […] Make and keep appointments to see your doctor for routine checkups and follow-up tests. […] Medications […] Beta blockers will help reduce your blood pressure. […] Diuretics water pills will help reduce the amount of fluid retention in your body. […] Medical and Surgical Procedures […] Angioplasty […] Aortic valve repair or replacement […] Transcatheter aortic valve replacement (TAVR)

• #8 Treatment for Aortic Valve Regurgitation

  https://healthlibrary.umcno.org/RelatedItems/3,90484

  Irregular heartbeat (arrhythmias). […] Sudden death. […] To reduce the risk for other problems, you may be given medicines such as: […] Blood thinners to prevent blood clots if you’ve had valve surgery. […] Antibiotics before some medical and dental procedures to prevent infections. […] Medicines to help the heart pump. […] Living with aortic valve regurgitation […] See your health care provider for regular checkups. Call right away if your symptoms change. Make sure to: […] Watch for symptoms when you exercise. Early symptoms may be noticed during exercise or activity. […] Talk with your provider about exercise and physical activity. […] Tell all of your health care providers, including your dentist, about your condition. […] Eat a low-salt, heart-healthy diet. This helps lower your blood pressure and reduce the stress on your heart.

• #9 Pharmacological interventions for the treatment of aortic root and heart valve disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8668151/

  Aortic valve surgery, predominantly aortic valve replacement (AVR), is the mainstay of treatment of symptomatic severe AR or asymptomatic severe AR with LV dilatation or systolic dysfunction (poor pumping function of the heart) (Armstrong 2000). Prompt aortic valve replacement in such patients improves in-hospital and long-term survival, as long as there are no complications (such as severe embolic cerebral damage, i.e. stroke caused by the passage of a blood clot to the brain) or comorbidity that makes the prospect of recovery remote (Gaasch 2015; Nishimura 2017). […] Medical (drug) treatment has been reported to improve symptoms, but not to affect the prognosis or natural history of severe AS. Thus, pharmacologic treatment is limited to symptomatic patients, or asymptomatic patients with LV systolic dysfunction, who may not be candidates for aortic valve surgery, or may not be in preparation for aortic valve surgery. Treatment of underlying cardiovascular risk factors and conditions is recommended (Vahanian 2021).

• #10 Pharmacological interventions for the treatment of aortic root and heart valve disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8668151/

  According to guidelines, medical treatment might be beneficial for symptomatic AR when surgery is not possible. After surgical therapy for AR, ARBs, beta-blockers and ACEIs are considered useful in the management of heart failure, hypertension, or both. Beta-blockers, ARBs, or both, should be considered in Marfan syndrome, pre and post-surgery, for their potential to slow aortic root dilatation. They should also be considered in cases of bicuspid aortic valve in cases of aortic root and/or ascending aorta dilation (Vahanian 2021; Otto 2021).

• #11 Aortic Valve Regurgitation: Treatment & Diagnosis | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-valve-regurgitation/treatment

  Whether you require aortic valve leakage treatment depends on factors like your symptoms, the underlying cause, the severity of the regurgitation, and your overall health. Mild aortic regurgitation is often managed with medication and regular monitoring through periodic echocardiograms. However, more severe cases may require aortic valve regurgitation surgery. […] Medication can alleviate symptoms and slow the progression of aortic regurgitation. Blood pressure meds like ACE inhibitors and beta-blockers can reduce pressure on the aortic valve. […] Based on the anatomy of the aortic valve, it can either be replaced or repaired. […] Aortic valve repair surgery: In cases where the aortic valve leaflets have normal tissue quality, the aortic valve can often be repaired. This procedure may involve reshaping or reconstructing the valve leaflets, removing excess tissue so the leaflets close correctly, or patching the part of the valve that is leaking.

• #12 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation/treatment

  The ideal time for AVR is late enough in the course of the disease to justify the risk-benefit ratio of surgery, yet early enough to prevent potential irreversible myocardial damage from occurring. The LVEF has been shown to correlate best with surgical outcome. […] There is no evidence that medical therapy can reduce aortic regurgitation severity or delay disease progression. In patients with severe chronic aortic regurgitation, systolic blood pressure is typically higher than in patients without aortic regurgitation. The ACC/AHA Guidelines recommend that patients with asymptomatic (Stage B and Stage C) chronic aortic regurgitation receive vasodilators to treat hypertension. In patients with severe AR who are symptomatic and/or show left ventricular systolic dysfunction (Stages C2 and D) but are not candidates for surgery, the ACC/AHA Guidelines recommend treatment for LV dysfunction with ACE inhibitors, ARBs, and/or sacubitril/valsartan.

• #13 Pharmacological interventions for the treatment of aortic root and heart valve disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8668151/

  According to guidelines, medical treatment might be beneficial for symptomatic AR when surgery is not possible. After surgical therapy for AR, ARBs, beta-blockers and ACEIs are considered useful in the management of heart failure, hypertension, or both. Beta-blockers, ARBs, or both, should be considered in Marfan syndrome, pre and post-surgery, for their potential to slow aortic root dilatation. They should also be considered in cases of bicuspid aortic valve in cases of aortic root and/or ascending aorta dilation (Vahanian 2021; Otto 2021).

• #14 Aortic insufficiency: defining the role of pharmacotherapy – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15725042/

  Major advances in the diagnostic, evaluation, and particularly surgical treatment of aortic regurgitation (AR) have redefined the role of medical treatment. In acute AR, aortic valve replacement (AVR) is the only life-saving treatment. Medical treatment may improve the hemodynamic state temporarily before surgery. […] The primary goal is to optimize the time of the AVR. If there is any symptom and/or left ventricular (LV) dysfunction, early AVR is required. Vasodilators should only be considered as a short-term treatment before surgery if there is evidence of severe heart failure or as a long-term treatment if AVR is contraindicated because of cardiac or noncardiac factors. […] In asymptomatic patients with severe chronic AR and normal LV function (even if the left ventricle is moderately dilated), vasodilators may prolong the compensated phase of chronic AR, although proof of their efficacy in delaying AVR is limited. Nifedipine is the best evidence-based treatment in this indication. ACE inhibitors are particularly useful for hypertensive patients with AR. beta-Adrenoceptor antagonists (beta-blockers) may be indicated to slow the rate of aortic dilatation and delay the need for surgery in patients with AR associated with aortic root disease. Furthermore, they may improve cardiac performance by reducing cardiac volume and LV mass in patients with impaired LV function after AVR for AR.

• #15 Aortic Regurgitation: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24396-aortic-regurgitation

  Aortic regurgitation treatment may include medication or surgery. If you have an acute case, you’ll need treatment right away. […] Depending on the severity of your condition, you may need surgery to repair or replace your aortic valve. Your healthcare provider will evaluate you and decide if you need surgery. […] If valve surgery isn’t a good option for you, your provider may prescribe medications to manage heart failure and improve your quality of life. Other medicines may reduce your risk of blood clots and stroke. […] People who get an aortic valve repair or replacement may need another surgery in the future. […] After an aortic valve replacement, you might need to take anticoagulants to prevent blood clots. You’ll need to take them for a few months (for bioprosthetic valves made from pig, cow or human tissue) or for the rest of your life (for mechanical valves). […] If you get a new valve, your provider may recommend that you take antibiotics before visiting the dentist. This can prevent endocarditis (infection inside your heart).

• #16 Aortic Valve Regurgitation Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/aortic-valve-regurgitation/treatment-options

  Treatment for aortic valve regurgitation can range from changes in lifestyle to surgery. Your medical team will work with you to determine which approach is most suited for your condition. […] Sometimes medication is an effective treatment for aortic valve regurgitation. Medications can be used to reduce blood pressure or to improve heart function; occasionally, antibiotics may be prescribed to reduce infection risk before dental or medical procedures. […] If you have significant symptoms of regurgitation or reduced heart function, your doctor may suggest that the heart valve be replaced with either a mechanical or tissue valve (from a pig, cow, or human donor). Surgical therapies can frequently be performed using smaller incisions and include: […] Aortic valve replacement surgery is performed during routine open heart procedures. This can be done with a small incision in certain patients.

• #17 Aortic Regurgitation Treatment & Management: Approach Considerations, Emergency Department Care, Vasodilator Therapy

  https://emedicine.medscape.com/article/150490-treatment

  In severe acute aortic regurgitation (AR), surgical intervention is usually indicated, but the patient may be supported medically with dobutamine to augment cardiac output and shorten diastole and with sodium nitroprusside to reduce afterload in hypertensive patients. […] Vasodilator therapy may be used on an inpatient or outpatient basis under conditions described in the current ACC/AHA guidelines. […] All patients with an artificial heart valve should receive antibiotic prophylaxis prior to dental procedures. For antithrombotic therapy, all patients with an artificial heart valve should receive daily aspirin, and many should also receive oral anticoagulation therapy. […] Although diuretics, nitrates, and digoxin are sometimes used to help control symptoms in patients with AR, not enough data in the clinical literature justify routinely recommending or discouraging these therapies. Also, no data support drug therapy of any class in patients with less than severe AR.

• #18 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation

  In patients with severe AR who are symptomatic and/or show left ventricular systolic dysfunction (Stages C2 and D) but are not candidates for surgery, the ACC/AHA Guidelines recommend treatment for LV dysfunction with ACE inhibitors, ARBs, and/or sacubitril/valsartan. […] Although much more rare than chronic aortic regurgitation, acute aortic regurgitation carries a very high mortality if prompt surgical intervention in the form of AVR is not undertaken. […] Treatment of pulmonary edema and afterload reduction can help relieve symptoms, buying the patient some time before surgery is performed. Nitroprusside is the treatment of choice, as it reduces both preload and afterload with great efficacy. […] If the acute aortic regurgitation is due to infective endocarditis, current guidelines suggest at least 5 to 7 days of IV antibiotics antibiotic treatment before valve replacement, if possible.

• #19 Aortic Regurgitation Treatment & Management: Approach Considerations, Emergency Department Care, Vasodilator Therapy

  https://emedicine.medscape.com/article/150490-treatment

  In severe acute aortic regurgitation (AR), surgical intervention is usually indicated, but the patient may be supported medically with dobutamine to augment cardiac output and shorten diastole and with sodium nitroprusside to reduce afterload in hypertensive patients. […] Vasodilator therapy may be used on an inpatient or outpatient basis under conditions described in the current ACC/AHA guidelines. […] All patients with an artificial heart valve should receive antibiotic prophylaxis prior to dental procedures. For antithrombotic therapy, all patients with an artificial heart valve should receive daily aspirin, and many should also receive oral anticoagulation therapy. […] Although diuretics, nitrates, and digoxin are sometimes used to help control symptoms in patients with AR, not enough data in the clinical literature justify routinely recommending or discouraging these therapies. Also, no data support drug therapy of any class in patients with less than severe AR.

• #20 Aortic Regurgitation Treatment & Management: Approach Considerations, Emergency Department Care, Vasodilator Therapy

  https://emedicine.medscape.com/article/150490-treatment

  In severe acute aortic regurgitation (AR), surgical intervention is usually indicated, but the patient may be supported medically with dobutamine to augment cardiac output and shorten diastole and with sodium nitroprusside to reduce afterload in hypertensive patients. […] Vasodilator therapy may be used on an inpatient or outpatient basis under conditions described in the current ACC/AHA guidelines. […] All patients with an artificial heart valve should receive antibiotic prophylaxis prior to dental procedures. For antithrombotic therapy, all patients with an artificial heart valve should receive daily aspirin, and many should also receive oral anticoagulation therapy. […] Although diuretics, nitrates, and digoxin are sometimes used to help control symptoms in patients with AR, not enough data in the clinical literature justify routinely recommending or discouraging these therapies. Also, no data support drug therapy of any class in patients with less than severe AR.

• #21 Aortic Valve Regurgitation | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/aortic-valve-regurgitation.html

  Sometimes aortic valve regurgitation is acute: […] Acute, severe aortic valve regurgitation needs surgery right away. You may need medicines for a short time to stimulate your heart or to dilate or constrict your blood vessels. […] In some cases, an infection of the heart valves can cause acute valve regurgitation. This may only need to be treated with antibiotics.

• #22 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation/treatment

  The ideal time for AVR is late enough in the course of the disease to justify the risk-benefit ratio of surgery, yet early enough to prevent potential irreversible myocardial damage from occurring. The LVEF has been shown to correlate best with surgical outcome. […] There is no evidence that medical therapy can reduce aortic regurgitation severity or delay disease progression. In patients with severe chronic aortic regurgitation, systolic blood pressure is typically higher than in patients without aortic regurgitation. The ACC/AHA Guidelines recommend that patients with asymptomatic (Stage B and Stage C) chronic aortic regurgitation receive vasodilators to treat hypertension. In patients with severe AR who are symptomatic and/or show left ventricular systolic dysfunction (Stages C2 and D) but are not candidates for surgery, the ACC/AHA Guidelines recommend treatment for LV dysfunction with ACE inhibitors, ARBs, and/or sacubitril/valsartan.

• #23 Aortic Regurgitation – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/heart-valve-disorders/aortic-regurgitation

  Aortic regurgitation is leakage of blood back through the aortic valve each time the left ventricle relaxes. […] The damaged heart valve must be monitored periodically so that it can be replaced or repaired surgically once the leakage becomes significant and the heart starts to fail. […] Treatment with medication is not especially effective in slowing the progression of heart failure and does not eliminate the need for timely valve repair or replacement. […] Echocardiography is done periodically to determine how rapidly the left ventricle is enlarging, which will help doctors determine when surgery should be done. The damaged valve should be surgically repaired or replaced with an artificial valve before the left ventricle becomes irreversibly damaged. […] People who have had a valve replacement are given antibiotics before surgical, dental, or medical procedures to reduce the risk of infection of the heart valve.

• #24 Aortic valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-treatment/drc-20353135

  Treatment of aortic valve regurgitation depends on: […] The goals of aortic valve regurgitation treatment are to ease symptoms and prevent complications. […] If your symptoms are mild or you don’t have symptoms, you may only need regular health checkups. You may need regular echocardiograms to check the health of the aortic valve. Heart-healthy lifestyle changes also are usually recommended. […] If you have aortic valve regurgitation, you may be given medicines to: […] Surgery may be needed to repair or replace the diseased valve, especially if the condition and symptoms are severe. Heart valve surgery may be needed even if aortic regurgitation isn’t severe or when there are no symptoms. […] The decision to repair or replace a damaged aortic valve depends on: […] Surgery to repair or replace an aortic valve may be done as open-heart surgery. This involves a cut, also called an incision, in the chest. Sometimes surgeons can do minimally invasive heart surgery to replace the aortic valve.

• #25 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation

  Surgical aortic valve replacement (AVR), not repair, is the definitive treatment for aortic regurgitation. The 2020 ACC/AHA Guidelines provide the following recommendations for AVR in patients with aortic regurgitation: […] AVR is indicated (class 1 recommendation) for all patients with Stage D aortic regurgitation, all patients with Stage C2 aortic regurgitation (LVEF 55% of less), and for patients with Stage C aortic regurgitation who are undergoing surgery for another cardiac condition. […] AVR is reasonable (class 2a recommendation) for patients with Stage C1 aortic regurgitation (LVEF above 55% and LV end-systolic dimension above 50 mm) and for patients with Stage B aortic regurgitation that is hemodynamically moderate who are undergoing surgery for another cardiac condition. […] AVR may be considered (class 2b recommendation) for patients with Stage C aortic regurgitation who, on at least three studies showed either a progressive decrease in LVEF to the low normal range (55% to 60%) or a progressive increase of left ventricular dilation to severe range (left ventricular end-diastolic dimension greater than 65 mm).

• #26 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation

  Surgical aortic valve replacement (AVR), not repair, is the definitive treatment for aortic regurgitation. The 2020 ACC/AHA Guidelines provide the following recommendations for AVR in patients with aortic regurgitation: […] AVR is indicated (class 1 recommendation) for all patients with Stage D aortic regurgitation, all patients with Stage C2 aortic regurgitation (LVEF 55% of less), and for patients with Stage C aortic regurgitation who are undergoing surgery for another cardiac condition. […] AVR is reasonable (class 2a recommendation) for patients with Stage C1 aortic regurgitation (LVEF above 55% and LV end-systolic dimension above 50 mm) and for patients with Stage B aortic regurgitation that is hemodynamically moderate who are undergoing surgery for another cardiac condition. […] AVR may be considered (class 2b recommendation) for patients with Stage C aortic regurgitation who, on at least three studies showed either a progressive decrease in LVEF to the low normal range (55% to 60%) or a progressive increase of left ventricular dilation to severe range (left ventricular end-diastolic dimension greater than 65 mm).

• #27 Aortic Regurgitation Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/150490-guidelines

  Surgery is recommended for symptomatic patients with severe aortic regurgitation regardless of left ventricular (LV) function; for asymptomatic patients with (a) LV end-systolic diameter (LVESD) 50 mm or 25 mm/m2 body surface area (if body size is small) or (b) resting left ventricular ejection fraction (LVEF) 50%; and for both symptomatic and asymptomatic patients undergoing coronary artery bypass grafting (CABG) or surgery of the ascending aorta or of another valve. […] Valve-sparing aortic root replacement is recommended for young patients with aortic root dilation. Ascending aortic surgery is indicated for Marfan patients with aortic root disease and maximal ascending aortic diameter 50 mm. […] Vasodilator therapy is indicated for long-term treatment in patients who have severe chronic AR and symptoms of LV dysfunction but who are not candidates for surgery.

• #28 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation

  Because of the dilation of the aortic annulus and root, a transcatheter approach to AVR (TAVR) is not typically feasible in isolated chronic aortic regurgitation, and SAVR is greatly preferred. The risks of TAVR include transcatheter valve migration and paravalvular leaks. […] The ideal time for AVR is late enough in the course of the disease to justify the risk-benefit ratio of surgery, yet early enough to prevent potential irreversible myocardial damage from occurring. […] There is no evidence that medical therapy can reduce aortic regurgitation severity or delay disease progression. In patients with severe chronic aortic regurgitation, systolic blood pressure is typically higher than in patients without aortic regurgitation. The ACC/AHA Guidelines recommend that patients with asymptomatic (Stage B and Stage C) chronic aortic regurgitation receive vasodilators to treat hypertension.

• #29 Surgery for Chronic Aortic Regurgitation: When Should It Be Considered? | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1115/p1709.html

  When aortic valve surgery with low or no operative mortality and no late complications becomes possible, valve replacement may be recommended as soon as the heart starts dilating and developing hypertrophy. However, surgery still has perioperative mortality and late morbidity. The use of surgery in an asymptomatic patient with chronic aortic regurgitation must be justified by good evidence of long-term benefit.

• #30 Aortic valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-treatment/drc-20353135

  Surgery for aortic valve regurgitation includes: […] Sometimes, surgeons can do minimally invasive heart surgery to replace the aortic valve. This procedure is called transcatheter aortic valve replacement (TAVR). It uses smaller incisions than those used in open-heart surgery. […] Biological tissue valves break down over time. Eventually, they may need to be replaced. People with mechanical valves need blood thinners for life to prevent blood clots. Ask your health care team about the benefits and risks of each type of valve.

• #31 Aortic Valve Regurgitation: Treatment & Diagnosis | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-valve-regurgitation/treatment

  Whether you require aortic valve leakage treatment depends on factors like your symptoms, the underlying cause, the severity of the regurgitation, and your overall health. Mild aortic regurgitation is often managed with medication and regular monitoring through periodic echocardiograms. However, more severe cases may require aortic valve regurgitation surgery. […] Medication can alleviate symptoms and slow the progression of aortic regurgitation. Blood pressure meds like ACE inhibitors and beta-blockers can reduce pressure on the aortic valve. […] Based on the anatomy of the aortic valve, it can either be replaced or repaired. […] Aortic valve repair surgery: In cases where the aortic valve leaflets have normal tissue quality, the aortic valve can often be repaired. This procedure may involve reshaping or reconstructing the valve leaflets, removing excess tissue so the leaflets close correctly, or patching the part of the valve that is leaking.

• #32 Aortic valve regurgitation | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/aortic-valve-regurgitation?content_id=CON-20310186

  Aortic valve replacement. The surgeon removes the damaged valve and replaces it. The replacement might be a mechanical valve or one made from cow, pig or human heart tissue. A tissue valve also is called a biological tissue valve. […] Sometimes, surgeons can do minimally invasive heart surgery to replace the aortic valve. This procedure is called transcatheter aortic valve replacement (TAVR). It uses smaller incisions than those used in open-heart surgery. […] Sometimes the aortic valve is replaced with your own lung valve, also called the pulmonary valve. Your pulmonary valve is replaced with a biological lung tissue valve from a deceased donor. This more complicated surgery is called the Ross procedure. […] Biological tissue valves break down over time. Eventually, they may need to be replaced. People with mechanical valves need blood thinners for life to prevent blood clots. Ask your health care team about the benefits and risks of each type of valve.

• #33 Aortic Valve Disease | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/aortic-valve-disease

  During open surgery, the aortic valve can be replaced or repaired. […] Patients with stenosis typically require valve replacement. […] Leaky valves can often be repaired or replaced. […] Replacement valves can be mechanical (manufactured) or made of biological tissue: […] Our surgeons have developed a reputation as leaders in aortic valve open surgery. […] The surgeon replaces the diseased aortic valve with the pulmonary valve (one of the other four heart valves). […] This procedure was developed at the Frankel Cardiovascular Center and is recognized globally as game-changing for patients who need a new aortic valve but have a small aortic root.

• #34 Aortic Valve Regurgitation: Treatment & Diagnosis | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-valve-regurgitation/treatment

  Aortic valve replacement (AVR) surgery: In cases of severe aortic regurgitation, you may need your faulty aortic valve replaced with an artificial implant. AVR is a standard treatment option for aortic regurgitation and other heart disorders like aortic stenosis. In an AVR procedure, your surgeon will remove the defective aortic valve and replace it with an artificial one. They may use a mechanical valve or one made from human, cow, or pig heart tissue. […] Transcatheter aortic valve replacement (TAVR) surgery: TAVR is a minimally invasive surgery used to replace the aortic valve. A prosthetic valve is inserted through a catheter, typically placed via an artery in the groin. While TAVR is currently used primarily for patients with severe aortic stenosis, research is ongoing to explore its potential use for patients with aortic regurgitation in the future. […] Valve-sparing aortic root replacement: This surgery replaces the aortic root while keeping the valve intact. Retaining the aortic valve eliminates the need for lifelong blood-thinning medications often required with valve replacement surgeries.

• #35 Aortic Valve Conditions and Treatment

  https://www.froedtert.com/heart-valve-disease/aortic-valve

  This transcatheter procedure uses a balloon to open or widen the problem valve to restore normal blood flow in patients. […] Underlying medical conditions, multiple heart problems and other factors may mean you will do better with a traditional, open procedure for aortic valve repair or replacement. […] Valve-sparing aortic root replacement aims to repair an aortic aneurysm or dissection preserving the patient’s own aortic valve instead of implanting an artificial valve.

• #36 Aortic Regurgitation | Doctor

  https://patient.info/doctor/aortic-regurgitation-pro

  Treatment of isolated AR has traditionally been by valve replacement. […] Valve replacement remains the most widely used technique but the proportion of valve repair procedures is increasing in experienced centres. […] Surgery is recommended via median sternotomy or minimally invasive route, although transcatheter aortic valve insertion (TAVI) is not recommended for low or intermediate surgical risk. […] When there is an associated aneurysm of the aortic root, conventional surgical therapy has consisted of the combined replacement of the aorta and valve with re-implantation of the coronary arteries. […] Valve-sparing aortic replacement is increasingly employed in expert centres, especially in young patients, to treat combined aortic root dilatation and valve regurgitation. […] Aortic valve-sparing operations which preserve the aortic cusps in aortic root dilation with aortic insufficiency can also be performed. […] Aortic valve-sparing operations have been shown to have improved long-term survival and a reduced risk of aortic insufficiency and thromboembolic complications.

• #37 Aortic valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-treatment/drc-20353135

  Surgery for aortic valve regurgitation includes: […] Sometimes, surgeons can do minimally invasive heart surgery to replace the aortic valve. This procedure is called transcatheter aortic valve replacement (TAVR). It uses smaller incisions than those used in open-heart surgery. […] Biological tissue valves break down over time. Eventually, they may need to be replaced. People with mechanical valves need blood thinners for life to prevent blood clots. Ask your health care team about the benefits and risks of each type of valve.

• #38 New minimally invasive treatment option for aortic regurgitation | MUSC Health | Charleston SC

  https://muschealth.org/health-professionals/progressnotes/2022/summer/aortic-regurgitation-treatment

  Patients in South Carolina with severe aortic regurgitation previously had only one treatment option: open heart surgery. […] But with new transcatheter heart valve technology, a new aortic valve can be placed inside their diseased one by an already established, minimally invasive technique known as transcatheter aortic valve replacement (TAVR). […] The JenaValve allows for minimally invasive valve replacement for aortic regurgitation. […] This new device makes TAVR possible for a greater number of patients. […] Amoroso says the results have been promising. […] I think the procedure offers a treatment opportunity for a whole group of patients whom weve only been able to treat with open heart surgery in the past, he said. This valve offers an alternative for treating patients with aortic regurgitation with a minimally invasive technique that allows patients to recover more quickly.

• #39 Aortic Regurgitation: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/heart-disease/aortic-regurgitation

  Doctors may treat mild aortic valve regurgitation with medications and by closely tracking how you’re doing. They use a grading system, ranging from mild to severe, to find out how serious your aortic regurgitation is. […] In more serious cases, aortic valve replacement may be the best option. […] This can be done with traditional, open-heart surgery or with a relatively newer procedure known as transcatheter aortic valve replacement (TAVR). […] Your doctor will insert a replacement valve at the site of your defective valve. Once the new valve is in place, your doctor takes out the catheter and your heart will continue to work as it once did.

• #40 Aortic Valve Regurgitation: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/heart-valves/aortic-valve-regurgitation/treatment

  When aortic valve repair is not an option, the valve can be replaced. Aortic valve replacement involves the removal of the damaged valve and replacing it with a mechanical valve or a valve made from cow, pig, or human tissue. […] TAVR (transcatheter aortic valve replacement) is an option for certain patients. This is a minimally invasive procedure that involves the insertion of a replacement valve using a catheter. This thin, flexible tube is guided through a blood vessel to the heart, where the replacement valve is positioned. The catheter is then removed, leaving only a small incision.

• #41 Treatment of severe aortic valve regurgitation with the Trilogy TAVI system | EuroIntervention

  https://eurointervention.pcronline.com/article/treatment-of-severe-aortic-valve-regurgitation-with-the-trilogy-tavi-system

  Transcatheter aortic valve implantation (TAVI) for pure aortic valve regurgitation (AR) with off-label devices is challenging because of the increased risk for transcatheter heart valve (THV) embolisation or migration and paravalvular leak in the absence of aortic valve calcification. The Trilogy transfemoral TAVI system (JenaValve) recently received a CE (European Conformity) mark for the treatment of aortic regurgitation and aortic stenosis. Early data on the Trilogy valve in AR patients have shown promising results. The standard treatment for symptomatic severe AR is surgical aortic valve replacement. However, according to the guidelines, TAVI may be considered in experienced centres for selected patients. At present, the JenaValve Trilogy is the only THV with CE mark approval for patients with severe AR at high surgical risk. The data on the efficacy and safety of the JenaValve Trilogy TAVI system are still limited, so further studies are needed to show outcomes in patients with severe AR and challenging anatomy.

• #42 TAVI for Pure Aortic Regurgitation With Dedicated Devices | ICR Journal

  https://www.icrjournal.com/articles/transcatheter-aortic-valve-implantation-severe-pure-aortic-regurgitation-dedicated-devices?language_content_entity=en

  Aortic regurgitation (AR) is not the most common valvular disease; however, its prevalence increases with age, with more than 2% of those aged 70 years having at least moderate AR. […] Transcatheter aortic valve implantation for patients with pure severe AR and at prohibitive surgical risk is occasionally performed, but remains a clinical challenge due to absence of valvular calcium, large aortic root and increased stroke volume. […] To date, the only two dedicated transcatheter valves for AR are the J-Valve (JC Medical) and the JenaValve (JenaValve Technology). […] Despite surgery being a viable option in patients with AR, there is an unmet need for a percutaneous procedure, particularly in patients at high or prohibitive surgical risk, which could be as feasible and successful as transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.

• #43 TAVI for Pure Aortic Regurgitation With Dedicated Devices | ICR Journal

  https://www.icrjournal.com/articles/transcatheter-aortic-valve-implantation-severe-pure-aortic-regurgitation-dedicated-devices?language_content_entity=en

  In fact, for patients with pure severe AR without stenosis and at prohibitive surgical risk, TAVI is occasionally performed, but it remains a significant clinical challenge. […] However, the main issue is the absence of valvular calcium. […] The larger stroke volume in AR compared with aortic stenosis makes device positioning and deployment unpredictable, with a tendency to prosthesis embolisation or malposition, which can be either into the aorta or into the left ventricle up to several hours after the procedure. […] Prosthesis oversizing is routinely performed to mitigate the risk of valve migration. […] With first-generation devices, outcomes were particularly poor due to valve embolisation, residual AR and the need for a second valve. […] Although the newer-generation TAVI devices have improved these outcomes, they remain suboptimal compared with TAVI for aortic stenosis, highlighting the need for dedicated transfemoral systems for treating pure AR that provide robust annular anchoring in the absence of aortic valve calcium. […] Dedicated devices show a promising future for TAVI in severe pure AR.

• #44 Aortic Valve Regurgitation | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/aortic-valve-regurgitation.html

  Sometimes aortic valve regurgitation is acute: […] Acute, severe aortic valve regurgitation needs surgery right away. You may need medicines for a short time to stimulate your heart or to dilate or constrict your blood vessels. […] In some cases, an infection of the heart valves can cause acute valve regurgitation. This may only need to be treated with antibiotics.

• #45 Aortic Regurgitation

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation

  In patients with severe AR who are symptomatic and/or show left ventricular systolic dysfunction (Stages C2 and D) but are not candidates for surgery, the ACC/AHA Guidelines recommend treatment for LV dysfunction with ACE inhibitors, ARBs, and/or sacubitril/valsartan. […] Although much more rare than chronic aortic regurgitation, acute aortic regurgitation carries a very high mortality if prompt surgical intervention in the form of AVR is not undertaken. […] Treatment of pulmonary edema and afterload reduction can help relieve symptoms, buying the patient some time before surgery is performed. Nitroprusside is the treatment of choice, as it reduces both preload and afterload with great efficacy. […] If the acute aortic regurgitation is due to infective endocarditis, current guidelines suggest at least 5 to 7 days of IV antibiotics antibiotic treatment before valve replacement, if possible.

• #46 Aortic Regurgitation Treatment & Management: Approach Considerations, Emergency Department Care, Vasodilator Therapy

  https://emedicine.medscape.com/article/150490-treatment

  Transcatheter aortic valve replacement (TAVR) has emerged as an important therapy for aortic stenosis (with or without AR) and now is being evaluated for use in patients with predominantly AR. […] Management of AR that is the result of TAVR, typically following its use for aortic stenosis, depends on the severity and hemodynamic impact of the AR. […] Asymptomatic patients with severe chronic AR require ongoing clinical surveillance with periodic echocardiography. […] Surgery is recommended for patients with an ESD of 55 mm or greater or an EDD of 75 mm or greater.

• #47 Treatment for Aortic Valve Regurgitation

  https://healthlibrary.umcno.org/RelatedItems/3,90484

  Irregular heartbeat (arrhythmias). […] Sudden death. […] To reduce the risk for other problems, you may be given medicines such as: […] Blood thinners to prevent blood clots if you’ve had valve surgery. […] Antibiotics before some medical and dental procedures to prevent infections. […] Medicines to help the heart pump. […] Living with aortic valve regurgitation […] See your health care provider for regular checkups. Call right away if your symptoms change. Make sure to: […] Watch for symptoms when you exercise. Early symptoms may be noticed during exercise or activity. […] Talk with your provider about exercise and physical activity. […] Tell all of your health care providers, including your dentist, about your condition. […] Eat a low-salt, heart-healthy diet. This helps lower your blood pressure and reduce the stress on your heart.

• #48 Aortic Regurgitation: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24396-aortic-regurgitation

  Aortic regurgitation treatment may include medication or surgery. If you have an acute case, you’ll need treatment right away. […] Depending on the severity of your condition, you may need surgery to repair or replace your aortic valve. Your healthcare provider will evaluate you and decide if you need surgery. […] If valve surgery isn’t a good option for you, your provider may prescribe medications to manage heart failure and improve your quality of life. Other medicines may reduce your risk of blood clots and stroke. […] People who get an aortic valve repair or replacement may need another surgery in the future. […] After an aortic valve replacement, you might need to take anticoagulants to prevent blood clots. You’ll need to take them for a few months (for bioprosthetic valves made from pig, cow or human tissue) or for the rest of your life (for mechanical valves). […] If you get a new valve, your provider may recommend that you take antibiotics before visiting the dentist. This can prevent endocarditis (infection inside your heart).

• #49 Antithrombotic Therapy in Patients With Valvular Heart Disease

  https://www.uspharmacist.com/article/antithrombotic-therapy-in-patients-with-valvular-heart-disease

  The therapeutic goals for treating VHD include reducing symptoms, repairing or replacing valves, and preventing blood clots. After the procedure, it is recommended that patients be started on antithrombotic therapy, such as warfarin or aspirin, to prevent thromboembolism. […] After valve replacement(s), antithrombotic therapy with an antiplatelet and vitamin K antagonist (VKA) is recommended with the dosing, duration, and international normalized ratio (INR) goal varying among bioprosthetic and mechanical replacements and TAVR. Administering daily low-dose aspirin (75 mg to 100 mg) indefinitely and a VKA to obtain an INR goal of 2-3 for the first 3 months is reasonable for patients with a bioprosthetic valve who have a low risk of bleeding. […] It is recommended that patients with mechanical valves be on daily low-dose aspirin indefinitely and a VKA, but the INR goal depends on the type of mechanical valve and the presence of venous thromboembolism (VTE) risk factors.

• #50 Aortic Regurgitation Treatment & Management: Approach Considerations, Emergency Department Care, Vasodilator Therapy

  https://emedicine.medscape.com/article/150490-treatment

  In severe acute aortic regurgitation (AR), surgical intervention is usually indicated, but the patient may be supported medically with dobutamine to augment cardiac output and shorten diastole and with sodium nitroprusside to reduce afterload in hypertensive patients. […] Vasodilator therapy may be used on an inpatient or outpatient basis under conditions described in the current ACC/AHA guidelines. […] All patients with an artificial heart valve should receive antibiotic prophylaxis prior to dental procedures. For antithrombotic therapy, all patients with an artificial heart valve should receive daily aspirin, and many should also receive oral anticoagulation therapy. […] Although diuretics, nitrates, and digoxin are sometimes used to help control symptoms in patients with AR, not enough data in the clinical literature justify routinely recommending or discouraging these therapies. Also, no data support drug therapy of any class in patients with less than severe AR.

• #51 Aortic Regurgitation: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24396-aortic-regurgitation

  Aortic regurgitation treatment may include medication or surgery. If you have an acute case, you’ll need treatment right away. […] Depending on the severity of your condition, you may need surgery to repair or replace your aortic valve. Your healthcare provider will evaluate you and decide if you need surgery. […] If valve surgery isn’t a good option for you, your provider may prescribe medications to manage heart failure and improve your quality of life. Other medicines may reduce your risk of blood clots and stroke. […] People who get an aortic valve repair or replacement may need another surgery in the future. […] After an aortic valve replacement, you might need to take anticoagulants to prevent blood clots. You’ll need to take them for a few months (for bioprosthetic valves made from pig, cow or human tissue) or for the rest of your life (for mechanical valves). […] If you get a new valve, your provider may recommend that you take antibiotics before visiting the dentist. This can prevent endocarditis (infection inside your heart).

• #52 Aortic Valve Regurgitation: Treatment & Diagnosis | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/aortic-valve-regurgitation/treatment

  Whether you require aortic valve leakage treatment depends on factors like your symptoms, the underlying cause, the severity of the regurgitation, and your overall health. Mild aortic regurgitation is often managed with medication and regular monitoring through periodic echocardiograms. However, more severe cases may require aortic valve regurgitation surgery. […] Medication can alleviate symptoms and slow the progression of aortic regurgitation. Blood pressure meds like ACE inhibitors and beta-blockers can reduce pressure on the aortic valve. […] Based on the anatomy of the aortic valve, it can either be replaced or repaired. […] Aortic valve repair surgery: In cases where the aortic valve leaflets have normal tissue quality, the aortic valve can often be repaired. This procedure may involve reshaping or reconstructing the valve leaflets, removing excess tissue so the leaflets close correctly, or patching the part of the valve that is leaking.

• #53 Aortic Regurgitation Treatment : Discover AR

  https://discover-ar.com/ar-treatment-options/

  Learn more about how aortic regurgitation is treated. […] Treatment will depend on the stage of severity of your AR. Medication can help relieve symptoms when the AR is mild or moderate, but aortic valve surgery is the recommended treatment option for patients with severe AR and some patients with moderate AR. […] AR is a treatable condition. Depending on your overall health and the progress of your condition, you may have several treatment options available to you. […] However, if you’ve been diagnosed with severe symptomatic AR (ssAR), medical management won’t be the right treatment option for you. Once you’re experiencing symptoms, surgery is the recommended treatment. […] For ssAR, surgery is the treatment option recommended by doctors today. It is the most effective treatment option, and it will address the condition at its root giving you a better quality of life going forward.

• #54 Aortic valve regurgitation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/symptoms-causes/syc-20353129

  Aortic valve regurgitation can develop suddenly or over many years. Once the condition becomes severe, surgery often is needed to repair or replace the valve. […] Early diagnosis of heart valve disease, such as aortic valve regurgitation, is important. Doing so may make the condition easier to treat. […] Aortic valve repair and aortic valve replacement are associated procedures for treating aortic valve regurgitation.

• #55 Contemporary Evaluation and Clinical Treatment Options for Aortic Regurgitation

  https://www.mdpi.com/2308-3425/10/9/364

  Aortic regurgitation (AR) is the third most frequent form of valvular disease and has increasing prevalence with age. […] Recent studies suggest current guideline recommendations for chronic disease may result in late intervention and suboptimal outcomes. […] Emerging transcatheter therapies may allow the treatment of patients at high risk for surgery, although novel methods to assess AR severity and its impact on LV size and function may improve the timing and outcomes of surgical intervention. […] In chronic severe AR, surgery is indicated in symptomatic patients regardless of LV systolic function. […] In asymptomatic severe regurgitation, surgery is indicated with LV systolic dysfunction (LVEF ≤ 55%) without another identifiable cause. […] SAVR is recommended in moderate or severe AR in patients undergoing cardiac surgery for another indication.

• #56 Contemporary Evaluation and Clinical Treatment Options for Aortic Regurgitation

  https://www.mdpi.com/2308-3425/10/9/364

  Intervening on valvular heart disease before symptom development may prevent irreversible LV remodeling and improve clinical outcomes. […] Asymptomatic AR is associated with increased mortality and morbidity and current guidelines give a Class I level of recommendation for intervention in asymptomatic patients if the LV is markedly dilated (LV end-systolic [ES] dimension >50 mm or >25 mm/m²). […] However, growing evidence shows that poor outcomes are associated with a smaller LVES (and not end-diastolic) dimension of >20 mm/m². […] The goal of surgical repair is to restore adequate leaflet coaptation surface and described repair techniques include cusp plication, triangular resection, Trusler stitch, free edge resuspension, patch repair, and subcommissural annuloplasty. […] Historically the definitive therapy has been surgery with aortic valve replacement or repair.

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