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