Kim HH, Lee S, Lee SH, et al. - Researchers aimed at reporting the long-term outcomes of aortic diameter expansion at four cardiac regions (annulus, sinus, ascending aorta and proximal arch) after wrapping or replacement during aortic valve surgery of the moderately dilated ascending aorta. Of 964 consecutive patients who underwent aortic valve replacement, 204 (mean age 60.7±7.4 years) underwent ascending aorta wrapping (n = 96) or replacement (n = 108) for moderately dilated ascending aorta (40 to 55 mm). After propensity score matching, the wrapping and replacement groups had the baseline maximal ascending aortic diameter median value of 47.3±3.1 mm and 49.4±13.5mm, respectively. In multivariable competing risk analysis, they identified the initial ascending aorta diameter at the wrapping procedure to be an independent risk factor of proximal arch re-dilation. For the prediction of proximal arch re-dilation, an initial ascending aorta diameter of 47.2 mm was suggested as the cutoff value. Overall findings suggest that for patients with a moderately enlarged ascending aorta, aortic wrapping and replacement appear long-term durable treatment options. Following an aorta wrapping procedure, they suggest undertaking careful evaluation of re-dilation in the proximal arch.