Recommendations for Surgical Considerations for Nonsyndromic Heritable TAA and No Identified Genetic Cause

COR	LOE	Recommendations
1	C-LD	1. In asymptomatic patients with aneurysms of the aortic root or ascending aorta with nonsyndromic heritable thoracic aortic disease (nsHTAD) and no identified genetic cause, determining the timing of surgical repair requires shared decision-making and is informed by known aortic diameters at the time of aortic dissection, TAA repair, or both in affected family members.1–4
1	C-LD	2. In asymptomatic patients with aneurysms of the aortic root or ascending aorta with nsHTAD and no identified genetic cause but no information on aortic diameters at the time of dissection or aneurysm repair in affected family members and who have no high-risk features for adverse aortic events (Table 9) it is recommended to repair the aorta when the maximal diameter reaches ≥5.0 cm.1
2a	C-LD	3. In patients with aneurysms of the aortic root or ascending aorta with nsHTAD and no identified genetic cause and a maximal aortic diameter of ≥4.5 cm, who have high-risk features for adverse aortic events (Table 9), or who are undergoing cardiac surgery for other indications, aortic repair is reasonable when performed by experienced surgeons in a Multidisciplinary Aortic Team.5