Due to its lethal and life-altering nature, aortic disease has been recognized as a challenge by physicians and surgeons and has even made its way into the world of fiction, as evident from the quote above. World-famous physician William Osler also once stated that “there is no disease more conducive to clinical humility than aneurysm of the aorta”. This chapter will focus on the surgical aspect of the tubular ascending aortic aneurysm. Though root, arch, and ascending aortic aneurysm have been considered as one entity in the past, it is important to make an anatomical distinction with these important landmarks. Due to ascending aortic aneurysms often being silent until they cause valve insufficiency or catastrophic sequelae, effort is mainly focused on identifying aortic disease before complications occur. Until recently, the natural history of ascending aortic aneurysm has not been well characterized. The threat of aortic rupture can be mitigated with surgical intervention and low operative mortality (Detter et al, Eur J Cardiothorac Surg 13(4):416–423, 1998; Lepore et al, J Heart Valve Dis 5:240–246, 1996). Prior to our surgical discussion, we will recognize some key components in the evolution of thoracic aortic aneurysm management, which has been fondly called as the Battle of the Bulge (Barr, Ann Intern Med 166:291–296, 2017).