Patriarch was the ruling crime lord of the Omega space station, having come to power by killing the turian who controlled the station before him. When Aria arrived at Omega, the Patriarch hired her to work for him as an exotic dancer, oblivious of her ambition. Aria quickly climbed through the ranks, becoming one of the Patriarch's most trusted lieutenants.
After a hundred years, the Patriarch grew suspicious of Aria and attempted to eliminate her. However, his men had become accustomed to certain fringe benefits from working with Aria's asari. With his men abandoning him left and right, Aria then challenged him to single combat in the Afterlife Club, ultimately emerging victorious by crushing one of his hearts and seizing his place as Omega's de facto ruler. She kept the mighty krogan warlord around as a "trophy" and a warning to all who would dare challenge her power, renaming the once-mighty warlord "Patriarch", a word which has no meaning in her language, with the intention of mockery, but eventually came to respect it.
Patriarch spends most of his time telling old war stories to any who would listen, but he is not the krogan he once was. He has completely submitted to Aria's authority.
Aria asks Commander Shepard to protect the Patriarch through her bodyguard Grizz; Blood Pack assassins are planning to kill the Patriarch in the hopes of undermining Aria's authority, and Aria wants to keep her "trophy" safe. Shepard can persuade him to go into hiding exactly as Aria requested or eliminate the assassins on his behalf as his krantt, thus partially restoring his status as a political powerhouse in Omega. Alternatively, Shepard can chastise Patriarch about his defeatist attitude which is unbecoming of a krogan warlord. Patriarch is reminded of his long lost glory and charges off to meet the assassins for a last stand, but dies in the attempt.
- The Patriarch can be heard giving advice to one of his fans about how to recognize a traitor during a funeral. This may be a reference to the movie The Godfather.
- In addition to Patriarch, Jim Cummings also provides the voice of Urdnot Wreav. Cummings has also worked on BioWare's Dragon Age: Origins, providing the voices of Aldous and Barlin.
- If Shepard became the Patriarch's krantt or encouraged him to fight in Mass Effect 2, then during the Mass Effect 3: Citadel missions, a krogan can be seen in the Silver Coast Casino talking to an asari and a batarian about the Patriarch's greatness.