Surgical repair for ascending aorta regarding an aneurysm or an acute type A aortic dissection (ATAAD) share similar principals in techniques. ATAAD is highly lethal, and the appropriate extent of surgery at acute setting is an ongoing debate. Study I researched the evolution and outcome of ascending aortic surgeries from a single centre with 47 years’ experience. Studies II and III utilized one of the world’s largest ATAAD databases to investigate the outcome in surgically treated ATAAD patients, with a special interest in reoperations and patients that had preoperative cardiac arrest requiring cardiopulmonary resuscitation. 

These studies showed that the numbers of ascending aortic surgeries were steadily increasing. Patients were older at the time of surgery, but the mortality rate has decreased over time. Freedom from reoperations was 95.0% after ATAAD surgery at 5 years. In ATAAD patients, isolated ascending aortic replacement without aortic arch involvement did not increase the incidence for a late reoperation, and the midterm survival did not differ between the two groups of ascending aortic replacement and aortic arch repair. Survival of patients with ATAAD and preoperative cardiac arrest was 50% at 3 years. 

The results after ascending aortic surgeries have significantly improved over time. The reoperation rate in Nordic countries was found to be low, and a less extensive repair at the initial presentation of ATAAD is sufficient to ensure freedom from reinterventions with comparable mortality rates. In patients with preoperative cardiac arrest, the mid-term outcome was acceptable, suggesting this group of patients should not be contraindicated for surgery.