However, given the complexity of this procedure, surgery should be performed at a Comprehensive Valve Center. 5. Data are limited with regard to the degree of aortic dilation at which the risk of dissection is high enough to warrant operative intervention in patients who do not fulfill criteria for AVR on the basis of severe AS or AR. In asymptomatic patients with a BAV and a diameter of the aortic sinuses and/or ascending aorta of 5.0 to 5.5 cm who are at low surgical risk and have no additional risk factors for aortic dissection, surgery to replace the aortic sinuses and/or ascending aorta may be considered as long as surgery is performed at a Comprehensive Valve Center. Additionally, shared decision-making between the patient and the healthcare team is needed to clearly outline the risks of surgery and weigh them against the potential reduction in future risk of aortic dissection.4 7,10 14 5.1.2.2. Intervention: Repair or Replacement of the Aortic Valve Recommendations for Intervention: Repair or Replacement of the Aortic Valve Referenced studies that support the recommendations are summarized in Online Data Supplement 18. COR LOE Recommendations In patients with BAV and severe AR who meet criteria for AVR, aortic valve repair may be considered in selected patients if the surgery is performed at a Comprehensive Valve Center.1 3 In patients with BAV and symptomatic, severe AS, TAVI may be considered as an alternative to SAVR after consideration of patient- specific procedural risks, values, trade-offs, and preferences, and when the surgery is performed at a Comprehensive Valve Center.4 6 Synopsis The indications for the timing of aortic valve interven- tion in patients with a BAV and AS or AR is similar to those for trileaflet aortic valves. See the respective sec- tions on AS (Section 3.2) and AR (Section 4). 