Assessment of aortic valve disease - a clinician oriented review

Table 5 Indications for aortic valve replacement in chronic aortic regurgitation[33,34]

Criteria	Class of indication		Differences between guidelines
	ESC/EACTS	AHA/ACC
Symptomatic severe AR (any LVEF)	I	I
Asymptomatic severe AR with depressed LV function (LVEF < 50%)	I	I
Severe AR in patients with another indication for cardiac surgery (e.g., CABG, thoracic aorta, another valve)	I	I
Asymptomatic severe AR with normal LVEF (> 50%) but with severe LV dilatation	IIa	IIa	Definition of severe LV dilatation: ESC/EACTS guideline: End-diastolic LV diameter > 70 mm, or end-systolic LV diameter > 50 mm (or > 25 mm/m2); AHA/ACC guidelines: End-systolic LV diameter > 50 mm
Moderate AR in patients with another indication for cardiac surgery (e.g., coronary bypass, thoracic aorta, another valve)	-	IIa	This indication is not covered in the ESC/EACTS guidelines
Severe AR with normal LVEF (> 50%) but with progressive LV dilatation (end-diastolic LV diameter > 65 mm) if the surgical risk is low	-	IIb	This indication is not covered in the ESC/EACTS guidelines

Class I: It is indicated, it is recommended; Class IIa: Should be considered, it is reasonable; Class IIb: May be considered; it is contraindicated; ESC/EACTS: European Society of Cardiology/European Association for Cardio-Thoracic Surgery; AHA/ACC: American Heart Association/American College of Cardiology; AR: Aortic regurgitation; LVEF: Left ventricular ejection fraction; CABG: Coronary artery bypass graft.