Proximal repair in acute type A aortic dissection: The dark side of the root

There is no agreement regarding the best treatment for proximal repair in acute type A aortic dissection. Isolated replacement of the ascending aorta has been shown effective but can leave patients at a higher risk of further aortic procedures. The interpretation of the results coming from the literature is difficult because of the great variability of the clinical scenarios and the anatomic extension of the dissection. The analysis of the risk factors suggests that the presence of the underlying root pathology and a more extensive involvement of the aortic root should address the surgeon towards a more radical proximal resection.