Parent views on a two-step consent process used in emergency neonatal research in the delivery room in Eastern Uganda.

Acute type A aortic dissection (ATAAD) is a life-threating condition associated with high morbidity and mortality rate [, ]. When the aortic dissection extends proximally to involve the aortic root, surgical management becomes particularly challenging for cardiac surgeons. The selection of an appropriate treatment strategy for a dissected aortic root requires a comprehensive evaluation of the patient’s anatomical characteristics, demographic profile, comorbid conditions, and physiologic status at the time of surgical intervention []. The decision to perform aortic root intervention is primarily determined by the integrity of the aortic valve, the anatomical extent of the root involvement and the underlying tissue pathology. In recent years, aortic root replacement using a valved conduit and valve-sparing root replacement (VSRR) techniques has become widely accepted [, , –]. Although elective studies have demonstrated favourable long-term durability, evidence supporting these approaches in the setting of ATAAD remains limited, particularly with regard to patient selection and perioperative safety []. Furthermore, it remains uncertain whether such complex surgical procedures are always necessary when the aortic dissection is limited to a single coronary sinus of Valsalva, with otherwise preserved aortic cusps and annuli, or in cases requiring urgent or emergency surgical intervention [–]. Limited root repair using selective sinus repair was first described by Westaby and Urbanski et al. in 2002 [, ]. These techniques typically involve the use of patient-tailored, U-shaped grafts sutured into the resected portion of the affected sinus. The graft is secured to the aortic wall using running sutures that pass through the aortic annulus. However, these approaches do not incorporate reinforcement of the aortic wall or suture lines, as complete excision of the dissected tissue has traditionally been considered sufficient [–].