Conclusion
Single centre reporting with limited, non-focused indications and appropriate decision-making process for replacing the root instead of a conservative approach is an elusive target. Retrospective study design, lack of randomisation, and relatively small sample sizes, especially in patients undergoing root replacement and extent of root intervention in ATAAD repair remains controversial. Risks of re-operation contains less conflict, there being much evidence suggesting freedom from re-operation is improved with a more extensive approach. However, patients undergoing root replacement were much younger with less severe co-morbidities, potentially allowing more favourable outcomes.