Significant dilemma exists regarding management of the aortic root
pathology in acute aortic dissections. Several strategies for both
repair and replacement exist and there is a lack of clarity on the
superiority of one over the other. Important factors that influence
management strategies include involvement of the sinuses, competence of
the aortic valve, presence of Marfan's syndrome and connective tissue
disorders, as well as availability of surgical expertise. The wide
variability in these factors makes it unlikely for any one technique to
be suitable for management of all aortic roots and the root pathology
has to be tailored to an individual patient.