Management and prognosis of surgical aortic and mitral prosthetic valve regurgitation
- Alvaro Marco del Castillo, MD
Alvaro Marco del Castillo, MD
- Professor of Medicine
- University Hospital Ramon and Cajal
- Pepe Zamorano, MD
Pepe Zamorano, MD
- Head of Cardiology
- University Hospital Ramon y Cajal
- Section Editors
- Patrizio Lancellotti, MD, PhD, FESC, FACC
Patrizio Lancellotti, MD, PhD, FESC, FACC
- Professor of Cardiology
- University of Liège Hospital
- Stephen JD Brecker, MD, FRCP, FESC, FACC
Stephen JD Brecker, MD, FRCP, FESC, FACC
- Section Editor — Valvular and Aortic Disease
- Chief of Cardiology
- Clinical Academic Group
- St. George's Hospital & University of London
Prosthetic valve dysfunction encompasses prosthetic valve obstruction (stenosis) and prosthetic valve regurgitation. Regurgitation associated with prosthetic heart valves includes regurgitation through the valve (transvalvular) as well as paravalvular regurgitation (also known as paravalvular leak[PVL]). Symptomatic severe prosthetic valve regurgitation is an uncommon complication of surgical valve replacement. However, it is associated with poor outcomes with both conservative management and surgical treatment.
This topic will discuss the prognosis and management of prosthetic valve regurgitation. Clinical manifestations and diagnosis of surgical prosthetic valve regurgitation as well as diagnosis and management of transcatheter heart valve regurgitation are discussed separately. (See "Clinical manifestations and diagnosis of surgical aortic and mitral prosthetic valve regurgitation" and "Transcatheter aortic valve implantation: Complications".)
Approach to management — The approach to management of prosthetic valve regurgitation includes monitoring asymptomatic patients, medical therapy for the cause of regurgitation (when treatable) and medical management of the sequelae of regurgitation, and evaluation of patients with severe prosthetic regurgitation for valve intervention (surgical or transcatheter), starting with determination of surgical risk.
Diagnosis and evaluation of prosthetic valve regurgitation is discussed separately. (See "Clinical manifestations and diagnosis of surgical aortic and mitral prosthetic valve regurgitation".)
●Asymptomatic patients with prosthetic valve regurgitation should be monitored, with frequency of monitoring based upon the severity of regurgitation and associated clinical findings. (See 'Monitoring' below.)
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- Approach to management
- Medical therapy
- - Treatment of cause of regurgitation
- - Treatment of consequences of regurgitation
- - Indications
- - Evidence
- On surgical treatment
- - For symptomatic patients
- - For asymptomatic patients
- On transcatheter valve-in-valve implantation
- - Aortic valve-in-valve procedure
- - Mitral valve-in-valve procedure
- On transcatheter closure of paravalvular leaks
- Transvalvular prosthetic regurgitation
- Paravalvular prosthetic regurgitation
- SUMMARY AND RECOMMENDATIONS