Surgical and Endovascular Management of Pseudoaneurysms of the Ascending Aorta and Aortic Root: Operative Strategies and Long-Term Outcomes

Ascending aortic and aortic root pseudoaneurysms are rare but potentially life-threatening complications, most commonly occurring after prior cardiac or aortic interventions. Management remains challenging and may require complex surgery or, in selected cases, endovascular therapy. We reported the experience of a single cardiovascular center in the management of aortic pseudoaneurysms. We retrospectively reviewed 12 consecutive patients treated for thoracic aortic pseudoaneurysms between August 2008 and November 2025. Demographic, perioperative, and follow-up data were obtained from the institutional Society of Thoracic Surgeons (STS) database. Descriptive statistics were used for baseline characteristics and outcomes. Overall survival was estimated using Kaplan–Meier analysis. Mean patient age was 56 ± 14 years, and 83.3% were male. All patients had prior cardiac interventions. Five patients (41.6%) had infected pseudoaneurysms. Median pseudoaneurysm size was 6.55 cm. Ten patients underwent open surgical repair, and two underwent percutaneous treatment. Hospital mortality was 8.3%. Postoperative stroke occurred in 16.7%, acute kidney injury in 16.7%, and atrial fibrillation in 25%. Median follow-up was 28 months with overall mortality of 16.7%. Estimated survival at the end of follow-up was 85%. One late death occurred in a patient with candidemia and recurrent infection. Surgical repair of ascending aortic pseudoaneurysms can be performed with acceptable morbidity and mortality and is effective in most patients. Infected pseudoaneurysms remain particularly challenging. In carefully selected high-risk patients, endovascular approaches provide a feasible less-invasive alternative with reasonable mid-term outcomes.