Background: Type A acute aortic dissection (TAAAD) is rapidly fatal without emergency surgical. Surgical outcomes have improved over the years with improvements in technique and postoperative care. Classically, supracomissural aortic replacement has been the standard of care. However, reintervention rates, particularly on the aortic root, in certain groups of patients shifted the focus towards improving long terms results of surgical repair. With regard to the aortic root, root replacement has been the gold standard. However, the surgical community realised that valve replacement in itself is a disease, and valve sparing aortic root replacement (VSRR) took centre stage in the care of these patients. Methods: We search the Pubmed and EMBASE for articles related to VSRR, composite valve conduit root (CVC) replacement, and the long terms results of both in TAAAD. Results: Supracomissural repair is limited by reintervention and CVC results are affected by complications related to the prosthetic valve. Conversely, VSRR is associated with good short-term outcomes, improvement in quality of life, and it is durable. Conclusion: VSRR is a sound technique in TAAAD in experienced hands.