Valve replacement options in the setting of an ascending aortic aneurysm

Aortic valve disease is frequently associated with proximal aortic aneurysmal disease. While, there are clear indications for aortic valve replacement, the ideal type of valve prosthesis, mechanical versus biologic remains controversial. This controversy becomes even more complex when the proximal aorta requires replacement as root replacement is more challenging and reoperative surgery following root replacement is even more so. In addition, not all proximal aortic aneurysms behave the same way; Marfan's aneurysms behave more aggressively than non-Marfan's aneurysms. The variance in aneurysm behavior mandates a clear understanding of the biology and consequent natural history of each patient's aortic aneurysm. In this review, we discuss valve replacement options for patients requiring aortic valve replacement and concomitant proximal aortic replacement.