Dr Kaushalendra Rathore MCh FRACS
Cardiothoracic Surgeon
JJ group of Cardiothoracic Surgery
Aorta Surgery:

Ascending aorta is the extension beyond the aortic valve, and it gives branches to various organs including brain and distal body. Normally ascending aorta is smaller than 3 cm in diameter, but sometimes it is bigger in dimensions and need regular follow-up and surgical consultation. Research suggests that ascending aorta>6 cm is an independent risk factor for the aortic rupture and related complications1. This cut off is not reliable as many patients present with aortic dissection and rupture even when aortic dimensions are small (figure 1).

• Dilatation can be because of congenital (bicuspid valve, genetic disorder) or because of acquired causes (infection, trauma, post stenosis dilatation), connective tissue disorder (Marfan, Elher Danlos etc) or idiopathic conditions. Bicupid valve pathology can present in different manners and require close follow-up and if aortic valve or aorta dimensions deteriorate then surgery is indicated (figure 2)

• Aortic root and distal pathologies can be treated with multiple surgical techniques (ascending aorta replacement, aortic root replacement, hemi-arch replacement, aortic debranching and distal stenting). Surgery choice depends upon the patient pathology, clinical stage, and surgeons experience (figure 3).

• Aortic root can be replaced using tissue or mechanical valve conduit, but other option in younger patient are Davids technique (aortic root reimplantation) or Yacoubs (root remodeling) procedures where native aortic valve can be preserved, and patient can avoid blood thinning tablets. Long-term results of Bentall or valve root replacement is well established and gives good results as well2.

• Risk and benefits: Aortic surgery is an extensive surgery with known risk factors like bleeding, stroke, infection, graft related issues line pseudoaneurysm’s or recurrence of dilatation from the remaining native tissue.


1. Harky A, Bashir M et al. Size and dissection: what is the relation? Indian Journal Thorac and Cardiovasc Surg. 2019;35(2):572-578.
2. Price et al. Long-term outcomes of aortic root operations for Marfan syndrome: A comparison of Bentall versus aortic valve-sparing procedures. JTCVS. 2016 Feb;151(2):330-6.
3. Shrestha et al. Elective David I Procedure Has Excellent Long-Term Results: 20-Year Single-Center Experience. Ann Thorac Surg 2018;105:731–8).