Recommendations C. Recommendations on indications for surgery in (A) severe aortic regurgitation and (B) aortic root or tubular ascending aortic aneurysm (irrespective of the severity of aortic regurgitation).

Indications for surgery	Classa	Levelb
A) Severe aortic regurgitation
Surgery is recommended in symptomatic patients regardless of LV function. 105,106,107,108,109	I	B
Surgery is recommended in asymptomatic patients with LVESD >50mm or LVESD >25 mm/m2 BSA (in patients with small body size) or resting LVEF ≤50%. 107,108,112,114,115	I	B
Surgery may be considered in asymptomatic patients with LVESD >20 mm/m2 BSA (especially in patients with small body size) or resting LVEF ≤55%, if surgery is at low risk.	IIb	C
Surgery is recommended in symptomatic and asymptomatic patients with severe aortic regurgitation undergoing CABG or surgery of the ascending aorta or of another valve.	I	C
Aortic valve repair may be considered in selected patients at experienced centres when durable results are expected.	IIb	C
B) Aortic root or tubular ascending aortic aneurysmc (irrespective of the severity of aortic regurgitation)
Valve-sparing aortic root replacement is recommended in young patients with aortic root dilation, if performed in experienced centres and durable results are expected. 133,134,135,136,140	I	B
Ascending aortic surgery is recommended in patients with Marfan syndrome who have aortic root disease with a maximal ascending aortic diameter ≥50 mm.	I	C
Ascending aortic surgery should be considered in patients who have aortic root disease with maximal ascending aortic diameter: • ≥55 mm in all patients. • ≥45 mm in the presence of Marfan syndrome and additional risk factorsd or patients with a TGFBR1 or TGFBR2 mutation (including Loeys-Dietz syndrome).e • ≥50 mm in the presence of a bicuspid valve with additional risk factorsd or coarctation.	IIa	C
When surgery is primarily indicated for the aortic valve, replacement of the aortic root or tubular ascending aorta should be considered when ≥45 mm.f	IIa	C