Table 13.

Surgical Thresholds for Prophylactic Aortic Root and Ascending Aortic Replacement in Nonsyndromic Heritable Thoracic Aortic Disease Based on the Genetic Variant and Additional Risk Factors for Aortic Dissection

COR*	LOE*	Genetic Variant	Risk Factors	Aortic Diameter (cm)
2a	C-LD	ACTA2	No	≥4.5
2b	C-EO	ACTA2	Yes†	≥4.2
2b	C-LD	PRKG1	No	≥4.2
2b	C-EO	PRKG1	Yes†	≥4.0†

^*Patient has risk factors for aortic dissection (family history of type A aortic dissection with minimal aortic enlargement, aortic growth rate ≥0.3 cm/y) or significant valve disease requiring surgery.

^†Earlier surgery may be considered in patients with a family history of type A aortic dissection in the setting of no or minimal aortic dilation, aortic growth rate ≥0.3 cm/y, or at the patient’s request.

Colors correspond to COR and LOE in Table 2.

COR indicates class of recommendation; and LOE, level of evidence.