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AR Surgery Thresholds 2025 — EECC MCQ

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ModerateValvular Heart DiseaseAR Surgery Thresholds 2025EECC

A 65-year-old man with severe chronic aortic regurgitation has LVEF 48% and LVESD 52 mm. He has mild exertional dyspnoea (NYHA II). According to the 2025 ESC VHD Guidelines, what are the intervention thresholds for chronic severe AR?

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Correct answer: B — Surgery is indicated for symptomatic severe AR (Class I), or asymptomatic patients when LVEF ≤55% or LVESDi >22 mm/m² (new 2025 threshold, replacing >25 mm/m²); this patient meets criteria on both symptoms and LVEF

In chronic severe aortic regurgitation, the key determinant is timely aortic valve surgery before irreversible LV dysfunction. Under the 2025 ESC/EACTS VHD guidance, aortic valve surgery is recommended for symptomatic severe AR regardless of LV function. This man is symptomatic with NYHA II exertional dyspnoea, so he already has a Class I indication. He also has LV systolic impairment: LVEF 48%, which is below the intervention threshold. The 2025 update also recognises earlier intervention in low-risk asymptomatic severe AR when LVEF is ≤55% or LVESDi is >22 mm/m², rather than waiting for very advanced LV dilatation or severe LV failure. TAVI is not the preferred routine treatment for native chronic AR; it may be considered only when surgery is unsuitable and anatomy is appropriate. Therefore option B is correct.

Reference: 2025 ESC/EACTS Guidelines for the management of valvular heart disease, European Heart Journal 2025; recommendations on indications for intervention in severe aortic regurgitation: https://academic.oup.com/eurheartj/article/46/44/4635/8234488