BAV indicates bicuspid aortic valve; CTA, computed tomographic angiography; CMR, cardiac magnetic resonance; TTE, transthoracic echocardiography. CLINICAL STATEMENTS AND GUIDELINES In patients with a BAV with indications for SAVR and a diameter of the aortic sinuses or ascending aorta 4.5 cm, replacement of the aortic sinuses and/or ascending aorta is reasonable if the surgery is performed at a Comprehensive Valve Center.4 7 In patients with a BAV who meet criteria for replacement of the aortic sinuses, valve-sparing surgery may be considered if the surgery is performed at a Comprehensive Valve Center.8,9 In asymptomatic patients with a BAV who are at low surgical risk, have a diameter of the aortic sinuses or ascending aorta of 5.0 to 5.5 cm, and have no additional risk factors for dissection, operative intervention to replace the aortic sinuses and/or the ascending aorta may be considered if the surgery is performed at a Comprehensive Valve Center.4 7,10 14 Synopsis The timing and type of surgery for replacement of the aorta are dependent on the anatomy of the aorta (as demonstrated on imaging), patient characteristics, and institutional expertise (Figure 6). Recommendation-Specific Supportive Text 1. Retrospective studies of patients with a BAV have shown that the incidence of aortic dissection is very low and is estimated to be approximately 0.4% with routine surveillance of the aorta.1 However, data are limited with regard to the degree of aortic dilation at which the risk of dissection is high enough to war- rant operative intervention in patients who do not fulfill criteria for AVR on the basis of severe AS or AR. Thus, an individualized approach to the timing of surgical intervention for a dilated aorta is suggested. 