Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair

Article Article scientifique Revue de la littérature Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair eng 2025-10-02 2025-10-02 author Oweini Waël Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland. 943576 author Jolou Jalal 0000-0001-5325-677X Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland. 649382 author Sologashvili Tornike 0000-0001-7933-5767 Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland. 807807 Département de chirurgie (CHIRU) author Murith Nicolas Paul Henri Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland. 28339 Département de chirurgie (CHIRU) author Huber Christoph 0000-0001-9048-849X Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland. 853395 Département de chirurgie (CHIRU) author Cikirikcioglu Mustafa 0000-0003-1143-347X Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland. 135609 Département de chirurgie (CHIRU) 6993 10.3390/jcm14196993 41096073 2077-0383 PMC12524484 https://www.mdpi.com/2077-0383/14/19/6993 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. Ascending aorta aneurysm Genetic aortopathy Surgical thresholds Thoracic aortic disease Vascular imaging Dewey 617 57 Département de chirurgie 222 false 1290 Recherche cardiovasculaire et de propulsion hémodynamique 1009 Journal of clinical medicine 14 19 239c13b9-dd47-44d8-a07d-454fae547127 Article (Published version) Public Article_scientifique_from_europePmc.pdf 348421 application/pdf CC BY-4.0 1c04f1aa85e989a134a6d53f2f2200b89e8a017730b4b39c64c04f26ca960ad1 openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair	Journal of clinical medicine			2025	16	471

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Oweini, Waël