Data are limited, but the risk benefit ratio con- tinues to favor managing asymptomatic patients with severe AS who are undergoing noncardiac surgery with hemodynamic monitoring and optimization of load- ing conditions, rather than considering prophylactic AVR. The patient with rheumatic MS who is undergo- ing noncardiac surgery is treated in a manner similar to the patient with AS. Regurgitant lesions also convey an increased risk of cardiac complications in patients undergoing noncardiac surgery and thus require careful evaluation and hemodynamic monitoring. Recommendation-Specific Supportive Text 1. Asymptomatic patients with severe AS and a normal LVEF can undergo noncardiac sur- gery with acceptable risk, particularly in the absence of severe CAD.1 3 Thus, pre-operative evaluation to exclude severe CAD with CT or angiographic imaging may be useful. In these patients with severe asymptomatic AS, cardiac complications can be reduced by periprocedural continuous optimization of loading conditions, thereby avoiding hypotension and tachycardia. Sinus rhythm with normal heart rate should be maintained. Tachycardia and systemic hypoten- sion may result in decreased coronary perfusion pressure, development of arrhythmias or isch- emia, myocardial injury, cardiac failure, or death. Periprocedural hemodynamic monitoring with a right-heart catheter or intraoperative TEE may be particularly useful to allow continuous opti- mization of loading conditions. Intraoperative and postoperative monitoring of blood pressure and intracardiac volume are implemented start- ing in the preoperative period and continuing until hemodynamics are stable, up to 24 to 48 hours after the procedure. General anesthetics are well tolerated, and the anesthetic agents should be chosen to maintain sinus rhythm and normotension. Phenylephrine or norepineph- rine can be used to increase blood pressure in patients with no significant CAD.9,10 In case of systemic hypertension, arterial dilators, such as short-acting calcium channel blockers, are pre- ferred. 