Surgical treatment of ascending aorta and aortic root aneurysms

Aneurysms of the aortic root and ascending aorta are often due to degenerative disease of media. Aneurysm of the aortic root often affects patients in their second to fourth decades of life, whereas aneurysm of the ascending aorta occurs mostly in the fifth to seventh decades of life. These aneurysms can cause aortic insufficiency, dissection, and/or rupture. Current guidelines recommend surgical treatment when the diameter of the aneurysm exceeds 50 mm. In patients with family history of aortic dissection or with Loyes-Dietz syndrome (a more severe form of Marfan syndrome), surgery should be considered when they are even smaller. Composite replacement of the aortic valve and ascending aorta used to be the standard treatment for patients with aortic root aneurysms. During the past 2 decades, a conservative procedure whereby the aneurysm is replaced with Dacron graft and the aortic valve is preserved has gained widespread use, and the results have been excellent in experienced hands.