Aortic regurgitation (AR) is a condition where the aortic valve in the heart does not close properly, causing blood to flow backward from the aorta into the left ventricle. Treating this condition depends on its severity, symptoms, and the underlying cause. The main goal of treatment is to reduce symptoms, prevent heart damage, and improve quality of life.
**Medications** can help manage symptoms but do not cure or stop the progression of aortic regurgitation. They may include drugs to lower blood pressure, reduce the heart’s workload, or control irregular heart rhythms. However, medication alone is usually not sufficient for severe cases.
When the valve dysfunction becomes significant or symptoms develop, **surgical intervention** is often necessary. The traditional and most definitive treatment is **surgical aortic valve replacement (SAVR)**. This involves open-heart surgery where the damaged valve is removed and replaced with either a mechanical or biological prosthetic valve. Mechanical valves last longer but require lifelong blood thinners, while biological valves may wear out over time but usually do not require long-term anticoagulation.
In recent years, **aortic valve repair** has become an important alternative to replacement in selected patients. Repair aims to preserve the patient’s own valve by restoring its normal function and leaflet coaptation. Techniques vary depending on the cause of regurgitation and may include reshaping or reinforcing the valve leaflets, stabilizing the valve annulus, or addressing dilation of the aortic root or ascending aorta. Valve-sparing root replacement (David procedure) and remodeling (Yacoub procedure) are examples of surgical methods that preserve the native valve while correcting associated aortic root problems.
For patients who are at high surgical risk or unsuitable for open-heart surgery, **transcatheter aortic valve implantation (TAVI or TAVR)** has emerged as a less invasive option. Originally developed for aortic stenosis, TAVI is increasingly being used for aortic regurgitation, especially with newer devices designed specifically for this condition. TAVI involves threading a catheter through a blood vessel to implant a new valve inside the old one without removing it. However, TAVI for AR is technically more challenging due to the lack of valve calcification and larger annulus sizes, which can increase risks such as valve leakage or displacement. Despite these challenges, TAVI offers a valuable alternative for patients who cannot undergo surgery.
Other minimally invasive procedures, such as **balloon valvuloplasty**, are generally more applicable to valve stenosis rather than regurgitation but may be considered in specific cases to improve valve function temporarily.
In summary, treatment options for aortic regurgitation range from medical management to complex surgical repair or replacement, and minimally invasive transcatheter procedures. The choice depends on the severity of the regurgitation, symptoms, patient’s overall health, and the expertise available. Early detection and regular monitoring are crucial to determine the optimal timing for intervention to prevent irreversible heart damage.
