Con: “Debate: does every ascending aorta repair require at least an open distal anastomosis at the innominate? Or not?”
Ascending aortic replacement is usually performed with a cross-clamp at the distal ascending aorta. This cross-clamping is one of the routine procedures in cardiac surgery, and the risk of the cross-clamping has been lowered to minimum in regular practice. Theoretically, the cross-clamp itself is a risk to apply and might lead to aortic dissection (1) or create a source of embolization in the aortic wall. However, when there is no atheroma, calcification, or other abnormal situations including aortic dissection in the aorta, the cross-clamp is applied very safely in modern cardiac surgery.