**9. Conclusions**

The treatment of patients with aortic root and ascending aortic aneurysms has been evolving over the past three decades. The majority of patients are still currently receiving Bentall procedure with a mechanical or bioprosthetic valved conduit. However, the number of surgeons performing AVS operations is increasing, and the indications are expanding. More surgeons are beginning to perform these procedures on patients with bicuspid valves, severe aortic insufficiency, and in the setting of acute Type A dissection. Again, patient selection and cusp examination are paramount to achieving success, but the addition of cusp repair techniques to the AVS operation has enabled an increasing number of patients to retain their native valves. The long-term data has proven that these operations can be performed with low morbidity and mortality, and provide durable aortic valve function. When feasible, AVS operations are the optimal treatment for patients with aortic disease and normal leaflets, as they avoid the burden of lifelong anticoagulation and significantly reduce their risk of endocarditis or requiring a subsequent operation for structural valve deterioration.
