Surgery of the Ascending Aorta

R. Verhelst, G. Khoury

UCL St. Luc, Bruxelles

Nowadays, the versatility  of the different techniques of reconstruction of the ascending aorta enables the surgeon to choose the most appropriate operation for every patient regarding various factors like age, diameter of the aorta, structure and function of the aortic valve, type of pathology of the aortic wall, extension of the dilatation to the aortic root, presence of a chronic dissection, etc …

Indications for surgery should be more liberal in young patients, especially in the presence of marfan disease or other types of myxoïd degeneration, mainly because in these cases the aortic root and sinuses are frequently  fragilized or dilated, representing a high risk of evolution and complications if not treated appropriately. The surgical treatment of this group of patients frequently  consists in a total excision of all diseased tissues followed by a valve sparing reconstruction or Bentall operation depending on the quality of the valve.

On the other hand, old patients presenting atherosclerotic aorta frequently dilate only the tubular part of the ascending aorta with few or no dilatation of the aortic root and should therefore be treated more conservatively because the risk of complication is less. 
If they have to be operated on the procedure is generally more simple, consisting only in a replacement of the ascending aorta with or without aortic valve replacement. 
The different options are summarized in this table