{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:55:41Z","timestamp":1791406541129,"version":"4.3.3"},"reference-count":92,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>The aorta, once viewed as a passive conduit, is now recognized as an active organ crucial for hemodynamic regulation and vascular homeostasis. Thoracic aortic aneurysms (TAAs), particularly those involving the ascending aorta, often remain silent until life-threatening complications such as dissection or rupture occur. Current management primarily relies on aortic diameter criteria, yet up to 60% of type A dissections occur at sizes below the 5.5 cm surgical threshold, revealing the limitations of this approach. This narrative review summarizes recent advances in understanding ascending aortic aneurysms, including insights into their genetic and degenerative mechanisms, the role of novel morphological and hemodynamic markers, and the potential of advanced imaging techniques. It also explores evolving surgical strategies, from conventional open repair, still the gold standard, to minimally invasive and investigational endovascular approaches. By integrating biological, morphological, and clinical factors, emerging strategies aim to move beyond diameter alone toward more personalized risk assessment. This paradigm shift may improve early detection, optimize surgical timing, and ultimately enhance outcomes for patients with ascending aortic aneurysms.<\/jats:p>","DOI":"10.3390\/jcm14196993","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:07:48Z","timestamp":1759417668000},"page":"6993","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair"],"prefix":"10.3390","volume":"14","author":[{"given":"Wa\u00ebl","family":"Oweini","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5325-677X","authenticated-orcid":false,"given":"Jalal","family":"Jolou","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7933-5767","authenticated-orcid":false,"given":"Tornike","family":"Sologashvili","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Murith","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Huber","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1143-347X","authenticated-orcid":false,"given":"Mustafa","family":"Cikirikcioglu","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ezad426","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ","volume":"65","author":"Czerny","year":"2024","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"di Gioia, C.R.T., Ascione, A., Carletti, R., and Giordano, C. (2023). Thoracic Aorta: Anatomy and Pathology. Diagnostics, 13.","DOI":"10.3390\/diagnostics13132166"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e13697","DOI":"10.1111\/eci.13697","article-title":"The Role of Vascular Smooth Muscle Cells in the Development of Aortic Aneurysms and Dissections","volume":"52","author":"Rombouts","year":"2022","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1001\/jama.2023.23668","article-title":"Diagnosis and Management of Aortic Diseases","volume":"331","author":"Altenburg","year":"2024","journal-title":"JAMA"},{"key":"ref_5","first-page":"505","article-title":"Thoracic Aortic Aneurysm","volume":"39","author":"Senser","year":"2021","journal-title":"Cardiol. Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.mayocp.2021.02.027","article-title":"A Population-Based Study of the Incidence and Natural History of Degenerative Thoracic Aortic Aneurysms","volume":"96","author":"Huang","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1080\/07853890.2022.2034932","article-title":"Projection of Global Burden and Risk Factors for Aortic Aneurysm\u2013Timely Warning for Greater Emphasis on Managing Blood Pressure","volume":"54","author":"Huang","year":"2022","journal-title":"Ann. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dieter, R.S., Dieter, R.A., and Dieter, R.A. (2019). Diseases of the Aorta, Springer Nature.","DOI":"10.1007\/978-3-030-11322-3"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1053\/j.semtcvs.2021.02.029","article-title":"Incidence and Prevalence of Thoracic Aortic Aneurysms: A Systematic Review and Meta-Analysis of Population-Based Studies","volume":"34","author":"Lopes","year":"2022","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1016\/j.jtcvs.2017.11.105","article-title":"Epidemiology and Management of Thoracic Aortic Dissections and Thoracic Aortic Aneurysms in Ontario, Canada: A Population-Based Study","volume":"155","author":"McClure","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.15420\/usc.2022.39","article-title":"Sex and Gender Differences in Aortic Disease","volume":"17","author":"Huckaby","year":"2023","journal-title":"US Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.cjco.2023.09.006","article-title":"Female-Specific Considerations in Aortic Health and Disease","volume":"6","author":"Crosier","year":"2023","journal-title":"CJC Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.hlc.2021.10.023","article-title":"Inter-Ethnic Differences in Valvular Dysfunction, Aortopathy, and Progression of Disease of an Asian Bicuspid Aortic Valve Population","volume":"31","author":"Chew","year":"2022","journal-title":"Heart Lung Circ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/j.amjcard.2019.03.013","article-title":"Differences in Echocardiographic Measures of Aortic Dimensions by Race","volume":"123","author":"LaBounty","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1002\/jmri.24183","article-title":"Determinants and Normal Values of Ascending Aortic Diameter by Age, Gender, and Race\/Ethnicity in the Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"39","author":"Turkbey","year":"2014","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_16","unstructured":"Faiza, Z., and Sharman, T. (2025). Thoracic Aorta Aneurysm. StatPearls, StatPearls Publishing."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e027045","DOI":"10.1161\/JAHA.122.027045","article-title":"Risk Factors for Mortality From Aortic Aneurysm and Dissection: Results From a 26-Year Follow-Up of a Community-Based Population","volume":"12","author":"Koba","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1093\/cvr\/cvy006","article-title":"From Genetics to Response to Injury: Vascular Smooth Muscle Cells in Aneurysms and Dissections of the Ascending Aorta","volume":"114","author":"Michel","year":"2018","journal-title":"Cardiovasc. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/s13098-023-01101-1","article-title":"Type 2 Diabetes Has a Protective Causal Association with Thoracic Aortic Aneurysm: A Mendelian Randomization Study","volume":"15","author":"Zhang","year":"2023","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1126\/science.1253026","article-title":"Dysfunctional Mechanosensing in Aneurysms","volume":"344","author":"Humphrey","year":"2014","journal-title":"Science"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s12055-020-01092-y","article-title":"Ascending Aorta Mechanics and Dimensions in Aortopathy \u2013 from Science to Application","volume":"38","author":"Cikach","year":"2022","journal-title":"Indian. J. Thorac. Cardiovasc. Surg."},{"key":"ref_22","first-page":"e37","article-title":"Part I: Dynamics of Aortic Cells and Extracellular Matrix in Aortic Aneurysms and Dissections","volume":"40","author":"Shen","year":"2020","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1161\/ATVBAHA.120.315146","article-title":"Activation of M3AChR (Type 3 Muscarinic Acetylcholine Receptor) and Nrf2 (Nuclear Factor Erythroid 2-Related Factor 2) Signaling by Choline Alleviates Vascular Smooth Muscle Cell Phenotypic Switching and Vascular Remodeling","volume":"40","author":"He","year":"2020","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tang, H.-Y., Chen, A.-Q., Zhang, H., Gao, X.-F., Kong, X.-Q., and Zhang, J.-J. (2022). Vascular Smooth Muscle Cells Phenotypic Switching in Cardiovascular Diseases. Cells, 11.","DOI":"10.3390\/cells11244060"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e73-85","DOI":"10.1161\/CIRCRESAHA.108.174367","article-title":"Long-Term Doxycycline Is More Effective than Atenolol to Prevent Thoracic Aortic Aneurysm in Marfan Syndrome through the Inhibition of Matrix Metalloproteinase-2 and -9","volume":"102","author":"Chung","year":"2008","journal-title":"Circ. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1274034","DOI":"10.1155\/2017\/1274034","article-title":"Cardiovascular Disease in Ageing: An Overview on Thoracic Aortic Aneurysm as an Emerging Inflammatory Disease","volume":"2017","author":"Pisano","year":"2017","journal-title":"Mediat. Inflamm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jtcvs.2021.06.014","article-title":"Geometry and Flow in Ascending Aortic Aneurysms Are Influenced by Left Ventricular Outflow Tract Orientation: Detecting Increased Wall Shear Stress on the Outer Curve of Proximal Aortic Aneurysms","volume":"166","author":"Salmasi","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s00395-024-01053-1","article-title":"Unveiling Cellular and Molecular Aspects of Ascending Thoracic Aortic Aneurysms and Dissections","volume":"119","author":"Ganizada","year":"2024","journal-title":"Basic. Res. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e010885","DOI":"10.1161\/JAHA.118.010885","article-title":"Thoracic Aortic Aneurysm Growth in Bicuspid Aortic Valve Patients: Role of Aortic Stiffness and Pulsatile Hemodynamics","volume":"8","author":"Rooprai","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1161\/CIRCULATIONAHA.113.003026","article-title":"Bicuspid Aortic Cusp Fusion Morphology Alters Aortic 3D Outflow Patterns, Wall Shear Stress and Expression of Aortopathy","volume":"129","author":"Mahadevia","year":"2014","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wang, J., Deng, W., Lv, Q., Li, Y., Liu, T., and Xie, M. (2021). Aortic Dilatation in Patients With Bicuspid Aortic Valve. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.615175"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.athoracsur.2020.03.017","article-title":"Shear Stress and Aortic Strain Associations With Biomarkers of Ascending Thoracic Aortic Aneurysm","volume":"110","author":"Pasta","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_33","first-page":"26","article-title":"Structure of the Elastin-Contractile Units in the Thoracic Aorta and How Genes That Cause Thoracic Aortic Aneurysms and Dissections Disrupt This Structure","volume":"32","author":"Karimi","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_34","unstructured":"Cekmecelioglu, D., and Preventza, O. (2025). Aortic Aneurysmectomy: The ACC\/AHA Guidelines. Semin. Thorac. Cardiovasc. Surg., in press."},{"key":"ref_35","unstructured":"(2025, April 10). 2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Available online: https:\/\/www.ahajournals.org\/doi\/epdf\/10.1161\/CIR.0000000000001106."},{"key":"ref_36","unstructured":"(2025, September 15). ESC Guidelines for the Management of Peripheral Arterial and Aortic Diseases. Available online: https:\/\/www.escardio.org\/Guidelines\/Clinical-Practice-Guidelines\/Peripheral-Arterial-and-Aortic-Diseases."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0022-5223(97)70360-X","article-title":"What Is the Appropriate Size Criterion for Resection of Thoracic Aortic Aneurysms?","volume":"113","author":"Coady","year":"1997","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1016\/j.jtcvs.2018.09.124","article-title":"Decision-Making Algorithm for Ascending Aortic Aneurysm: Effectiveness in Clinical Application?","volume":"157","author":"Saeyeldin","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.athoracsur.2023.03.037","article-title":"Aortic Size at the Time of Type A and Type B Dissections","volume":"116","author":"Perez","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.hlc.2022.10.020","article-title":"Ascending Aorta Dissection Before 5.5 cm Diameter; \u201cIt Wasn\u2019t Raining When Noah Built the Ark\u201d","volume":"32","author":"Papakonstantinou","year":"2023","journal-title":"Heart Lung Circ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.jtcvs.2017.10.140","article-title":"Height Alone, Rather than Body Surface Area, Suffices for Risk Estimation in Ascending Aortic Aneurysm","volume":"155","author":"Zafar","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.jtcvs.2023.06.021","article-title":"Twenty-Five Years of Observations from the International Registry of Acute Aortic Dissection (IRAD) and Its Impact on the Cardiovascular Scientific Community","volume":"168","author":"Trimarchi","year":"2024","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s12350-017-0883-2","article-title":"Multi-Modality Molecular Imaging of Aortic Aneurysms","volume":"24","author":"Malm","year":"2017","journal-title":"J. Nucl. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1136\/heartjnl-2019-316251","article-title":"Evaluating the Diagnostic Accuracy of Maximal Aortic Diameter, Length and Volume for Prediction of Aortic Dissection","volume":"106","author":"Heuts","year":"2020","journal-title":"Heart"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1016\/j.jacc.2019.07.078","article-title":"Ascending Aortic Length and Risk of Aortic Adverse Events: The Neglected Dimension","volume":"74","author":"Wu","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.jacc.2013.12.028","article-title":"How Does the Ascending Aorta Geometry Change When It Dissects?","volume":"63","author":"Rylski","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.21037\/jtd-21-119","article-title":"3D Morphometric Analysis of Ascending Aorta as an Adjunctive Tool to Predict Type A Acute Aortic Dissection","volume":"13","author":"Saade","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1136\/heartjnl-2017-312867","article-title":"Aortic Elongation Part II: The Risk of Acute Type A Aortic Dissection","volume":"104","author":"Heuts","year":"2018","journal-title":"Heart"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1093\/ejcts\/ezaa131","article-title":"Development of a Multivariable Prediction Model for Patient-Adjusted Aortic Risk Morphology","volume":"58","author":"Boburg","year":"2020","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.jcmg.2018.03.009","article-title":"Multimodality Imaging of Thoracic Aortic Diseases in Adults","volume":"11","author":"Bhave","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.jvs.2008.03.059","article-title":"Increased 18F-Fluorodeoxyglucose Uptake in Abdominal Aortic Aneurysms in Positron Emission\/Computed Tomography Is Associated with Inflammation, Aortic Wall Instability, and Acute Symptoms","volume":"48","author":"Reeps","year":"2008","journal-title":"J. Vasc. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1093\/ehjci\/jeu283","article-title":"(Tissue PET) Vascular Metabolic Imaging and Peripheral Plasma Biomarkers in the Evolution of Chronic Aortic Dissections","volume":"16","author":"Sakalihasan","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.jtcvs.2020.12.110","article-title":"The Long-Term Fate of Ascending Aorta Aneurysm after Wrapping versus Replacement","volume":"164","author":"Kim","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1093\/eurheartj\/ehw075","article-title":"FDG-PET\/CT Images during 5 Years before Acute Aortic Dissection","volume":"37","author":"Tahara","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4103\/ijnm.ijnm_1_21","article-title":"Can 18Fluoro-Deoxy-Glukose-Positron Emission Tomography\/Computed Tomography Be a Useful for Decision of Elective Surgery in Thoracic Aortic Aneurysm","volume":"36","author":"Simsek","year":"2021","journal-title":"Indian J. Nucl. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"986","DOI":"10.2967\/jnumed.121.263507","article-title":"Radiotracers to Address Unmet Clinical Needs in Cardiovascular Imaging, Part 2: Inflammation, Fibrosis, Thrombosis, Calcification, and Amyloidosis Imaging","volume":"63","author":"Stendahl","year":"2022","journal-title":"J. Nucl. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"6396","DOI":"10.1007\/s00330-019-06320-7","article-title":"Predictive Imaging for Thoracic Aortic Dissection and Rupture: Moving beyond Diameters","volume":"29","author":"Adriaans","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Al-Rawi, M., Belkacemi, D., Lim, E.T.A., and Khashram, M. (2024). Investigation of Type A Aortic Dissection Using Computational Modelling. Biomedicines, 12.","DOI":"10.3390\/biomedicines12091973"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"20160759","DOI":"10.1098\/rsif.2016.0759","article-title":"Predicting False Lumen Thrombosis in Patient-Specific Models of Aortic Dissection","volume":"13","author":"Menichini","year":"2016","journal-title":"J. R. Soc. Interface"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/j.jtcvs.2022.09.003","article-title":"The Predictive Capability of Aortic Stiffness Index for Aortic Dissection among Dilated Ascending Aortas","volume":"167","author":"Fortunato","year":"2024","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Ekedi, A.V.N.B., Rozhkov, A.N., Shchekochikhin, D.Y., Novikova, N.A., Kopylov, P.Y., Bestavashvili, A.A., Ivanova, T.V., Zhelankin, A.V., Generozov, E.V., and Konanov, D.N. (2023). Evaluation of microRNA Expression Features in Patients with Various Types of Arterial Damage: Thoracic Aortic Aneurysm and Coronary Atherosclerosis. J. Pers. Med., 13.","DOI":"10.3390\/jpm13071161"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ijcard.2023.02.006","article-title":"Novel Biomarkers Associated with Thoracic Aortic Disease","volume":"378","author":"Thijssen","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.yjmcc.2022.05.001","article-title":"Matricellular Proteins: Potential Biomarkers and Mechanistic Factors in Aortic Aneurysms","volume":"169","author":"Li","year":"2022","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/HCO.0000000000000903","article-title":"Artificial Intelligence and Machine Learning in Aortic Disease","volume":"36","author":"Hahn","year":"2021","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41588-021-00962-4","article-title":"Deep Learning Enables Genetic Analysis of the Human Thoracic Aorta","volume":"54","author":"Pirruccello","year":"2022","journal-title":"Nat. Genet."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.bja.2025.01.015","article-title":"2024 EACTS\/EACTAIC\/EBCP Guidelines on Cardiopulmonary Bypass in Adult Cardiac Surgery","volume":"134","author":"Wahba","year":"2025","journal-title":"Br. J. Anaesth."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Rukosujew, A., Motekallemi, A., Wisniewski, K., Weber, R., De Torres-Alba, F., Ibrahim, A., Weiss, R., Martens, S., and Dell\u2019Aquila, A.M. (2022). Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102698"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.athoracsur.2018.05.081","article-title":"Perioperative Risk Profiles and Volume-Outcome Relationships in Proximal Thoracic Aortic Surgery","volume":"106","author":"Mori","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s13019-020-01204-0","article-title":"Association between Institutional Case Volume and Mortality Following Thoracic Aorta Replacement: A Nationwide Korean Cohort Study","volume":"15","author":"Nam","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Hamiko, M., Jahnel, K., Rogaczewski, J., Schafigh, M., Silaschi, M., Spaeth, A., Velten, M., Roell, W., Ahmad, A.E.-S., and Bakhtiary, F. (2023). The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta. JCM, 12.","DOI":"10.1055\/s-0043-1761662"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Reil, J.-C., Marquetand, C., Busch-Tilge, C., Ivannikova, M., Rudolph, V., Aboud, A., Ensminger, S., Sch\u00e4fers, H.-J., Stierle, U., and Reil, G.-H. (2023). Functional Interaction of Aortic Valve and Ascending Aorta in Patients after Valve-Sparing Procedures. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-42068-3"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1007\/s12265-016-9699-8","article-title":"Old Myths, New Concerns: The Long-Term Effects of Ascending Aorta Replacement with Dacron Grafts. Not All That Glitters Is Gold","volume":"9","author":"Spadaccio","year":"2016","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1148\/rg.2021210026","article-title":"CT of Postoperative Repair of the Ascending Aorta and Aortic Arch","volume":"41","author":"Marquis","year":"2021","journal-title":"RadioGraphics"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.xjtc.2023.06.018","article-title":"Aortic Root Remodeling after Surgical Repair of Acute Type A Aortic Dissection Using Different Anastomosis Techniques","volume":"21","author":"Lin","year":"2023","journal-title":"JTCVS Tech."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e269","DOI":"10.1016\/j.athoracsur.2018.04.070","article-title":"Pericardial Sandwich Technique for End-to-End Anastomosis of Artificial Graft","volume":"106","author":"Araki","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"4596","DOI":"10.21037\/jtd-23-550","article-title":"A Modified Prosthesis Eversion Technique for Proximal Anastomosis in Ascending Aorta Replacement","volume":"15","author":"Zheng","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1093\/icvts\/ivab342","article-title":"The Effect of Aortic Arch Replacement on Pulse Wave Velocity after Surgery","volume":"34","author":"Hori","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Thomas, R., Dhanekula, A.S., Byers, P., Flodin, R., DeRoo, S., Shalhub, S., and Burke, C.R. (2024). Elective Root Replacement Increases the Risk of Type B Dissection in Patients with Marfan Syndrome. J. Thorac. Cardiovasc. Surg.","DOI":"10.1016\/j.jtcvs.2024.09.027"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"70","DOI":"10.14503\/THIJ-17-6364","article-title":"Varying Evidence on Deep Hypothermic Circulatory Arrest in Thoracic Aortic Aneurysm Surgery","volume":"45","author":"Gupta","year":"2018","journal-title":"Tex. Heart Inst. J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s12055-018-0734-z","article-title":"Replacing the Ascending Aorta in the Elderly: Do or Do Not","volume":"35","author":"Harky","year":"2019","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"S488","DOI":"10.21037\/jtd.2017.04.57","article-title":"Wrapping of the Ascending Aorta Revisited\u2014Is There Any Role Left for Conservative Treatment of Ascending Aortic Aneurysm?","volume":"9","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.athoracsur.2006.10.022","article-title":"Unsupported Reduction Ascending Aortoplasty: Fate of Diameter and of Windkessel Function","volume":"83","author":"Walker","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/jocs.12139","article-title":"Ascending Aortic Aneurysm Treatment with Linear Plication and External Wrapping Technique: Mid-Term Results","volume":"28","author":"Ozcan","year":"2013","journal-title":"J. Card. Surg."},{"key":"ref_84","first-page":"584","article-title":"Reduction Aortoplasty: Safe and Durable Treatment for Borderline Dilatation in Selected Patients","volume":"21","author":"Niclauss","year":"2012","journal-title":"J. Heart Valve Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.ejcts.2007.01.028","article-title":"Is Size-Reducing Ascending Aortoplasty with External Reinforcement an Option in Modern Aortic Surgery?","volume":"31","author":"Feindt","year":"2007","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Rovas, G., Reymond, P., Van Steenberghe, M., Diaper, J., Bikia, V., Cikirikcioglu, M., Habre, W., Huber, C., and Stergiopulos, N. (2025). Evaluation of a Novel Compliance-Matching Aortic Graft in a Swine Model. J. Biomech., 183.","DOI":"10.1016\/j.jbiomech.2025.112629"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"94","DOI":"10.21037\/jovs.2018.04.12","article-title":"Biological Solutions to Aortic Root Replacement: Valve-Sparing versus Bioprosthetic Conduit","volume":"4","author":"Scaffa","year":"2018","journal-title":"J. Vis. Surg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0044-1782186","article-title":"Isolated or Combined Ascending Aortic Replacement through a Partial Sternotomy: Early and Midterm Outcomes","volume":"73","author":"Angerer","year":"2025","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Hamiko, M., Salamate, S., Nassari, M.A., Spaeth, A., Sirat, S., Doss, M., Amer, M., Silaschi, M., Ahmad, A.E.-S., and Bakhtiary, F. (2024). Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root Including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study. J. Clin. Med., 13.","DOI":"10.20944\/preprints202404.0899.v1"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"5592622","DOI":"10.1155\/2023\/5592622","article-title":"Minimally Invasive Endovascular Repair for Nondissected Ascending Aortic Disease: A Systematic Review","volume":"2023","author":"Huo","year":"2023","journal-title":"Emerg. Med. Int."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.21037\/jtd.2016.07.35","article-title":"Endovascular Treatment of the Ascending Aorta: New Frontiers for Thoracic Endovascular Aneurysm Repair?","volume":"8","author":"Klonaris","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1016\/j.athoracsur.2013.11.066","article-title":"Endovascular Repair of the Ascending Aorta: When and How to Implement the Current Technology","volume":"97","author":"Preventza","year":"2014","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6993\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T04:22:41Z","timestamp":1760070161000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,2]]},"references-count":92,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196993"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196993","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,2]]}}}