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Abstract Objectives: Evaluate aortic root preserving/sparing procedures for various pathologies associated with ascending aortic aneurysms, including aortic valve regurgitation. Methods: From the end of 1990 through end of 2004, 388 patients had aortic root preserving procedures (reimplantation 72, remodeling 77, tailoring 239) ± leaflet repair. Preoperatively, in-house grade aortic regurgitation was 1+ in 58, 2+ in 110, 3+ in 101, and 4+ in 66. Concurrent leaflet repairs were done in 197 (50.8%, Cabrol/Trusler commissure stitch 158, leaflet plication 36, supracommissure stitch 42, leaflet resection and repair 16, perforation repair 18, and debridement 11). Additional procedures included arch repair in 227 (58%), coronary bypass in 83 (21.4%), elephant trunk in 33 (8.5%), and minimally invasive approach in 30 (7.7%). Pathologies included dissection in 140 (36%; 86 acute), Marfan syndrome in 39 (10%), bicuspid valve in 78 (20%), and degenerative aneurysm in 142 (36.6%). The CLASS (Commissure, Leaflet, Annulus, Sinuses, Sinotubular) evaluation schema is described that is used for selecting either reimplantation, remodeling, or tailoring of the aortic root according to underlying pathology. Results: Hospital survival was 97.4% (378/388) and stroke occurred in 4.6% (18/388, four permanent, [1%]). On postoperative echocardiography, patients had either no (0) or 1+ regurgitation (1+= 98);13 (3.4%) had 2+. Three patients (1%) required reoperation for aortic valve failure before discharge (two tailoring, one remodeling). Conclusions: Excellent early results can be achieved by aortic root preserving procedures and concurrent aortic valve leaflet repairs when appropriately selected for a diverse class of pathologies.