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6.5.1.1. Surgical Approach for Patients With Sporadic
Aneurysms of the Aortic Root and Ascending Aorta Meeting
Criteria for Surgery
COR LOE
Recommendations
1 B-NR 1. In patients with an aneurysm isolated to the ascending
aorta who meet criteria for surgery, aneurysm resection and
replacement with an interposition graft should be performed.
1 B-NR 2. In patients undergoing aortic valve repair or replacement with
a concomitant ascending aortic aneurysm, a separate aortic
valve intervention and ascending aortic graft is recommended.
1 B-NR 3. In patients undergoing aortic root replacement with an aortic
valve that is unsuitable for sparing or repair, a mechanical or
biological valved conduit aortic root replacement is indicated.
2a B-NR 4. In patients undergoing aortic root replacement, valve-
sparing aortic root replacement is reasonable if the aortic
valve is suitable for sparing or repair and when performed by
experienced surgeons in a Multidisciplinary Aortic Team.
6.5.2. Aortic Arch Aneurysms
COR LOE
Recommendations
1 C-EO 1. In patients with an aortic arch aneurysm who have symptoms
attributable to the aneurysm and are at low or intermediate
operative risk, open surgical replacement is recommended.
2a B-NR 2. In patients with an isolated aortic arch aneurysm who are
asymptomatic and have a low operative risk, open surgical
replacement at an arch diameter of ≥5.5 cm is reasonable.
2a C-LD 3. In patients undergoing open surgical repair of an ascending
aortic aneurysm, if the aneurysmal disease extends into the
proximal aortic arch, it is reasonable to extend the repair with
a hemiarch replacement.
2b C-LD 4. In patients undergoing open surgical repair of an aortic arch
aneurysm, if the aneurysmal disease extends into the proximal
descending thoracic aorta, an elephant trunk procedure may
be considered
2b C-EO 5. In patients with an aortic arch aneurysm who are
asymptomatic but meet criteria for intervention, but have a
high risk from open surgical repair, a hybrid or endovascular
approach may be reasonable.
