Left-sided regurgitant lesions are better tolerated but still convey increased risk, particularly if the anesthesi- ologist and surgeon are unaware of the diagnosis or severity of valve disease. 15.2.Management of the Symptomatic Patient Recommendation for Management of the Symptomatic Patient With VHD Undergoing Noncardiac Surgery COR LOE Recommendation In patients who meet standard indications for intervention for VHD (replacement and repair) on the basis of symptoms and disease severity, intervention should be performed before elective noncardiac surgery to reduce perioperative risk if possible, depending on the urgency and risk of the noncardiac Synopsis Symptomatic patients with severe VHD benefit from valve intervention before noncardiac surgery, if possible. Recommendation-Specific Supportive Text 1. Noncardiac surgery patients with symptom- atic severe AS have the highest risk of cardiac complications; the estimated rate of cardiac complications in patients with undiagnosed severe AS undergoing noncardiac surgery is 10% to 30%. AVR (SAVR, TAVI) performed before elective elevated-risk noncardiac sur- gery in symptomatic patients with severe AS will prevent hemodynamic instability during, as well as after, noncardiac surgery.1 7 In AS patients who are undergoing noncardiac sur- gery, there is lack of data on the efficacy or safety of TAVI,8 but TAVI is a reasonable option to avoid delay of semi-urgent noncardiac sur- gery. 