Surgical techniques. Ascending aorta.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Aneurysm and dissection are common ascending aorta diseases.
• Graft replacement of the ascending aorta is a standard procedure with good outcomes.
• Complex cases involving the aortic sinuses or arch present management challenges.

Purpose of the Study:

• To review management strategies for ascending aorta diseases.
• To discuss prosthesis selection for aortic root replacement.
• To evaluate valve-sparing procedures and the Ross procedure in specific contexts.

Main Methods:

• Review of current literature and surgical techniques for ascending aorta pathologies.
• Discussion of patient and procedure variables influencing prosthesis choice.
• Analysis of outcomes for different surgical approaches, including valve-sparing and Ross procedures.

Main Results:

• Ascending aorta graft replacement yields excellent early and late results.
• Complex aortic pathologies may necessitate aortic root/arch replacement using hypothermic circulatory arrest.
• Valve-sparing procedures offer long-term benefits when aortic valve leaflets are normal.

Conclusions:

• Optimal aortic root prosthesis selection is patient- and procedure-dependent.
• Valve-sparing procedures are advantageous for suitable patients.
• The Ross procedure may be considered for select patients with combined aortic valve and ascending aorta disease, excluding those with connective tissue disorders.