[Surgical tactics in dissecting aneurysms of the ascending aorta]

The aspects of surgical tactics in management of dissecting aneurysms of the ascending aorta are analysed in relation to the disease etiology, the anatomical pattern of the aortic root, presence of attending aortic insufficiency, and dissection extension. Based on the experience of 32 operations (March 1979--February 1988), it is concluded that the abnormal type must be the best criterion for choosing the surgical technique. In dissecting aneurysms due to aortic wall degeneration, Bentall-De Bono and Cabrol's modifications are preferable. In dissecting aneurysms of atherosclerotic origin, the boundary of the proximal extension of dissection should be taken into account. When the dissection extends into the aortic root, the operation using a valve-containing conduit with reimplantation of the ostia of the coronary arteries is feasible. If the aortic root is not involved, isolated prosthesis of the ascending aorta or separate prosthesis of the aortic valve and ascending aorta may be performed depending on the presence of aortic failure.