Aortic pathology

Ascending aorta
The first description was published in 1960 by Ellis et al., who associated disease of the aortic valve and ascending aorta (annuloaortic ectasia). The natural history of this disease usually leads to aortic regurgitation, but also to an aneurysm of the ascending thoracic aorta, the main complication of which is dissection.

Marfan syndrome is one of the leading causes of annuloaortic ectasia. Surgery is indicated when aortic valve regurgitation is moderate to severe, with left ventricular involvement and/or dilatation of the ascending aorta to at least 45 mm in diameter.
Surgical treatment is required because the natural course is rupture, with 100% mortality.

Surgery is performed with cardiopulmonary bypass and consists of replacing the aortic valve and ascending aorta with a mechanical valve combined with a straight vascular graft, with reimplantation of the ostia of the left and right coronary arteries into the tubular prosthesis (the Bentall and Bono technique, described in 1968).

There are other surgical techniques that are variants of the Bentall and Bono procedure, such as the Cabrol technique, which is now rarely used. There are also the David and Yacoub techniques, which have the advantage of preserving the native aortic valve if it is intact.

The mortality associated with this surgery is close to that of aortic valve replacement surgery, i.e. less than 2%, except in an emergency situation without comorbidities, in which it is less than 10%.

Descending
Aneurysms
Dissection