**5. Conclusion**

The anatomic complexity and serious pathology that affect the aortic root challenge the cardiac surgeon. In the 61 years since De Bakey and Cooley first replaced an ascending aneurysm with the aid of cardiopulmonary bypass, a number of surgeons' devised innovative steps to improve patient outcomes. Leaders in the field of cardiac surgery such as Bono, Bentall, Yacoub, and David have contributed greatly to our surgical armamentarium for treatment of aortic root pathology.

The design of the De Paulis Valsalva graft is another great addition to the surgeon's arsenal and reinforces the need to continue analyzing and improving surgical techniques based on the dynamic physiologic environment of the aortic root during aortic valve sparing procedures. While it is common to hear surgeons refer to aortic root replacements as a "Bentall," the procedures currently employed have undergone an evolution, enough so that what is done now does not resemble the aortic inclusion and side-to-side coronary anastomosis technique.
