Timing of Intervention Recommendations for Timing of Intervention for Chronic AR Referenced studies that support the recommendations are summarized in Online Data Supplement 15 to 17. COR LOE Recommendations In symptomatic patients with severe AR (Stage D), aortic valve surgery is indicated regardless of LV systolic function.1 7 In asymptomatic patients with chronic severe AR and LV systolic dysfunction (LVEF 55%) (Stage C2), aortic valve surgery is indicated if no other cause for systolic dysfunction is In patients with severe AR (Stage C or D) who are undergoing cardiac surgery for other indications, aortic valve surgery is indicated. In asymptomatic patients with severe AR and normal LV systolic function (LVEF >55%), aortic valve surgery is reasonable when the LV is severely enlarged (LVESD >50 mm or indexed ) (Stage C2).10,11,13 24 In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable. In asymptomatic patients with severe AR and normal LV systolic function at rest (LVEF >55%; Stage C1) and low surgical risk, aortic valve surgery may be considered when there is a progressive decline in LVEF on at least 3 serial studies to the low normal range (LVEF 55% to 60%) or a progressive increase in LV dilation into the severe range (LV end- diastolic dimension [LVEDD] 3: Harm B-NR In patients with isolated severe AR who have indications for SAVR and are candidates for surgery, TAVI should not be performed.29 32 Synopsis Most patients with indications for surgery for chronic severe AR require valve replacement with a mechani- cal or bioprosthetic valve (Figure 4). 