To respect or replace?
Following the timely diagnosis of ATAAD, the guidelines for when to perform the more extensive approach of a root replacement are reported by Lars Svensson et al.9 When the primary or secondary tear extends into or originates at the site of the coronary sinuses of the aortic root, a radical root replacement is indicated. Furthermore, the dilation of the aortic root beyond 45mm below the level of sinotubular junction is indicative of the need to replace the root.9
As further reported in the guidelines it is imperative to assess the root independently and be able to verify its prospects for the preservation of the native valve structures, the integrity of the coronary ostia, and the requirement to perform the root replacement.9 Svensson et al. further state that factors that affect the decision making and management of the valves in the cases of isolated aortic stenosis or aortic regurgitation, are relevantly applicable in setting of ATAAD repair. Another key indicator for pursuing a root replacement is the presence of a connective tissue disorder, such as Marfan syndrome.9,10