Indications for aortic valve replacement according to the American Heart Association Guidelines are as follows:

1. Severe aortic regurgitation with symptomatic heart failure (class I).

2. Severe aortic regurgitation with equivocal symptoms who performed poorly on a treadmill exercise test (class I).

3. Severe aortic regurgitation with no symptoms left ventricular ejection fraction < 50% (class I).

4. Severe aortic regurgitation with no symptoms, a normal left ventricular ejection fraction, but left ventricular end systolic dimension of > 55 mm or end diastolic dimension of 75 mm (class IIa).

5. Severe aortic regurgitation with no symptoms, a normal left ventricular ejection fraction, but left ventricular end systolic dimension between 50-55 mm or end diastolic dimension between 70-75 mm (class IIb).