Thus, an individualized approach to the timing of surgical intervention for a dilated aorta is suggested. Surgery is recommended in patients with a BAV with or without symptoms and with a diameter of the aortic sinuses or the ascending aorta of 5.5 cm.2 2. Specific risk factors, including family history of aortic dissection, aortic growth rate >0.5 cm per year, and aortic coarctation, are associated with a greater risk of aortic dissection. In patients with these risk factors, operative intervention to replace the aortic sinuses and/or the ascending aorta is reasonable when the aortic dimension is 5.0 to 5.5 cm, if the surgery is performed at a Comprehensive Valve Center.4,10 12,15 3. In patients with a BAV, data are limited with regard to the degree of aortic dilation at which the risk of dissection is high enough to warrant replacement of the ascending aorta at the time of AVR. The risk of progressive aortic dilation and dissection after AVR in patients with BAV has been the subject of several studies, but definitive data are lacking. In patients undergoing AVR because of severe AS or AR, replacement of the ascending aorta is reason- able when the aortic diameter is >4.5 cm.4 7,10 14 4. There are a limited number of patients with BAV who meet criteria for operative intervention on the aortic sinuses and/or ascending aorta but have a well-functioning aortic valve. Because of the growing experience with valve-sparing surgery on highly selected patients,8,9 surgical replacement of the aorta with aortic valve repair or reimplantation may be considered. However, given the complexity of this procedure, surgery should be performed at a Comprehensive Valve Center. 5. 