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Patient with AR

Significant aortic root enlargementa

Severe AR Significant AR

VSARR

Bentall VSARR and AV repair

Symptoms

AV surgery (Class IIb)

Follow-up AV surgery

(Class I)

TAVI (Class IIb) SAVR AV repair (Class IIa)

Eligible for surgeryb

LVEF ≤50% or LVESD >50 mm or LVESDi >25 mm/m2

LVEF ≤55% or LVESDi >22 mm/m2 or LVESVi >45 mL/m2 Good tissue quality

Team expertise Young patient

Good tissue quality

Team expertise Young patient

Figure 5 Management of patients with aortic regurgitation. AR, aortic regurgitation; AV, aortic valve; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVESDi, left ventricular end-systolic diameter indexed to body surface area; LVESVi, left ventricular end-systolic volume indexed to body surface area; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve replacement; VSARR, valve-sparing aortic root replacement. aIndications for surgery on the root/ascending aorta are described in the 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases.8 bConcomitant replacement of the aortic root or ascending aorta should be considered if the maximal diameter is ≥45 mm and the predicted surgical risk is low.

ESC Guidelines                                                                                                                                                                                          4661

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