Table 3

 Indication for surgery in patients with severe aortic regurgitation

Indication class*ESC guidelines†ACC/AHA guidelines
*Class I indicates that there is evidence or general agreement that the procedure is useful; class II indicates that there is conflicting evidence or opinion; IIa indicates then that weight of evidence favours surgery whereas IIb indicates that the efficacy of surgery is less well established.
†Guidelines are only for asymptomatic patients.
ACC, American College of Cardiology; AHA, American Heart Association; CCS, Canadian Cardiovascular Society; EF, ejection fraction; ESC, European Society of Cardiology; LV, left ventricle; normal LVF, normal left ventricular function defined by EF ⩾50%; LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; LVESI, left ventricular end-systolic diameter index; NYHA, New York Heart Association.
I LVEDD >70 mm orAny patient in NYHA class III or IV
LVESD >50 mm orNYHA class II with normal LVF but progressive
LVESI >25 mm/m2LV dilatation or declining EF or declining exercise tolerance on serial studies
Ascending aorta >55 mmEF 25–49%
CCS class II angina
IIa Rapid increase in LV diametersNYHA class II with normal LVF and stable LVF, LV size and exercise tolerance on serial studies
Bicuspid aortic valve or Marfan with aorta >55 mmAsymptomatic patient with normal LVF but LVESD >55 mm
or LVEDD >75 mm (consider body size)
IIb EF <25%
Asymptomatic patient with normal LVF but
LVESD 50–55 mm
or LVEDD 70–75 mm (consider body size)
Asymptomatic patient with decreased EF with exercise