Limitations
Despite the strength of its findings, this study also has some limitations to consider. It reflects the experience of only two centres treating ATAAD and therefore only a limited number of surgeons. Despite the moderate sample size, the key conclusions relating to death and recurrence are based on outcomes with a small event rate, thus limiting the certainty of conclusions on performance of the native aortic valve after resuspension. Additionally, as with all studies reporting long-term outcomes, some patients were lost to follow-up (20%), most frequently due to patient care being continued away from the tertiary centres, which reflects the reality of patient management for such a complex disease. Furthermore, follow up of aortic root dimensions in the AAG cohort was based entirely on echocardiographic analysis rather than the gold standard cross sectional imaging. Future studies in larger groups using CT follow-up for aortic root dimensions would provide clearer conclusions on this topic.