Aortic root aneurysms are a condition linked to heritable disorders, leading to major adverse aortic events such as dissection and rupture. Aortic root anatomy and structure is critical for aortic valve function. Aneurysmal dilatation predisposes the aortic valve to regurgitation. Several causes contribute to aneurysm development, making accurate diagnosis through imaging vital. Surgical management has evolved, with valve-sparing techniques such as remodeling, reimplantation, and the Florida Sleeve employed to preserve native aortic valve function. Conversely, composite aortic root replacement techniques, like the Bentall procedure, remain the gold standard for cases where valve preservation is unfeasible. Outcomes for both surgical approaches remain promising, yet patient selection and individualized management are critical, particularly for those with connective tissue disorders and bicuspid aortic valve morphologies. Emerging techniques, including personalized external aortic root support (PEARS), offer novel alternatives but require further investigation for broader application. Continued research is essential to refine surgical techniques and improve patient outcomes in managing aortic root aneurysms.