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Related Concept Videos

Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...

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Related Experiment Video

Updated: Jun 19, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Published on: May 21, 2017

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Aortic Valve Replacement in the Failing Left Ventricle: Worthwhile?

Asanish Kalyanasundaram1, Thais Faggion Vinholo1, Mohammad A Zafar1

  • 1Aortic Institute at Yale-New Haven Hospital, New Haven, CT 06510, USA.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed
Summary

Surgical aortic valve replacement (SAVR) is safe for patients with severe aortic stenosis or regurgitation and a low ejection fraction (EF) of 35% or less. SAVR significantly improves EF over time, with survival comparable to the general population.

Keywords:
aortic regurgitationaortic stenosisaortic valve replacementejection fractionheart failureintra-aortic balloon pump

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair and Replacement
  • Echocardiography

Background:

  • Current guidelines recommend aortic valve replacement (AVR) for severe aortic stenosis or regurgitation, irrespective of left ventricular ejection fraction (LVEF).
  • However, surgeons may hesitate to perform SAVR in patients with very low LVEF (<55%) due to perceived high operative risks.
  • This study investigates the outcomes of SAVR in patients with severely impaired LVEF (≤35%).

Purpose of the Study:

  • To evaluate the safety and efficacy of surgical aortic valve replacement (SAVR) in patients with severely reduced left ventricular ejection fraction (LVEF ≤ 35%).
  • To assess changes in LVEF and mid-term survival following SAVR in this high-risk patient group.

Main Methods:

  • A retrospective analysis of 895 patients undergoing SAVR between 2004 and 2019 identified 40 patients with LVEF ≤ 35%.
  • Preoperative and postoperative echocardiograms were used to assess changes in LVEF.
  • Intra-aortic balloon pump (IABP) was used prophylactically in 18 patients; mid-term survival was analyzed.

Main Results:

  • Hospital survival was high at 97.5%.
  • The average LVEF improved significantly from 26% preoperatively to 46% at mid-term follow-up (mean 43 months).
  • Five-year survival was comparable to age- and gender-matched general population, with significant reductions in left ventricular dimensions observed.

Conclusions:

  • SAVR can be performed safely in patients with a compromised left ventricle (LVEF ≤ 35%) and severe aortic valve disease.
  • Patients experience significant improvements in LVEF post-SAVR, leading to normalized long-term survival.
  • Prophylactic use of IABP may be beneficial in this cohort, and surgeons should not avoid SAVR in these patients.