Severe AR Surgical Indication — RACP Adult Medicine MCQ

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ModerateCardiologySevere AR Surgical IndicationRACP Adult Medicine

A 65-year-old man with severe aortic regurgitation and LVEF 42% is asymptomatic. His LVESD is 55 mm and LVEDD is 75 mm. According to current guidelines, what is the recommended management?

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Correct answer: A — Watchful waiting until symptoms develop

Severe aortic regurgitation with LV dilation (LVESD >50 mm or LVESD index >25 mm/m²) and/or LVEF ≤50% in an asymptomatic patient is an indication for aortic valve replacement (Class I recommendation). This patient has LVESD 55 mm and LVEF 42%, both meeting surgical criteria. The rationale is that delaying surgery until symptoms develop risks irreversible LV dysfunction. Surgical AVR is preferred over TAVI for pure AR (TAVI outcomes for AR are less well-established). Medical therapy with vasodilators (nifedipine, ACEi) may be used as a bridge but does not replace timely surgery.

Reference: CSANZ – 2022 – Valvular Heart Disease Guidelines; ESC – 2021 – VHD Guidelines