**11. Ascending aorta**

The entry site of the dissection tear is usually found the ascending aorta, which is at very high risk of rupture. After excising the dissected portion of ascending aorta, supracommissural ascending aorta replacement can be performed. Open distal anastomoses can be done under hypothermic circulatory arrest after releasing the cross clamp. This facilitates inspection of the aortic arch and if required, arch repair can be undertaken. Also, it is technically much easier to construct a very distal ascending aortic anastomoses. Around 5.6% patients underwent ascending aorta replacement in GERAADA survey [42]. But this procedure also allows for subsequent aneurysmal dilation of the remaining portion of the aorta [43].
