A full revision of the original 1998 VHD guide- line was made in 2006, and an update was made in Another full revision was made in 2014,2 with an update in 2017.3 There was an additional statement of clarification specifically for surgery for aortic dilation in patients with bicuspid aortic valves (BAV) in 2016.4 The present guideline will replace the 2014 guideline and 2017 focused update. Some recommendations from the earlier VHD guidelines have been updated as war- ranted by new evidence or a better understanding of CLINICAL STATEMENTS AND GUIDELINES earlier evidence, whereas others that were inaccurate, irrelevant, or overlapping were deleted or modified. Throughout, our goal was to provide the clinician with concise, evidence-based, contemporary recommenda- tions and the supporting documentation to encourage their use. Where applicable, sections were divided into subsections of 1) diagnosis and follow-up, 2) medical therapy, and 3) intervention. The purpose of these sub- sections is to categorize the Class of Recommendation according to the clinical decision-making pathways that caregivers use in the management of patients with VHD. The document recommends a combination of life- style modifications and medications that constitute components of GDMT. For both GDMT and other rec- ommended drug treatment regimens, the reader is advised to confirm dosages with product insert mate- rial and to carefully evaluate for contraindications and drug drug interactions. Table 1 is a list of associated guidelines that may be of interest to the reader. 1.5. Class of Recommendation and Level of Evidence The Class of Recommendation (COR) indicates the strength of recommendation, encompassing the esti- mated magnitude and certainty of benefit in proportion to risk. 