Editorial comment: Setting the bar for complex aortic arch disease: implications for therapeutic options.

early stage? What is your therapeutic concept in the event of progressing descending or thoracoabdominal aortic disease? Are you going for stent-grafting or for a second operation, thoracoabdominal replacement? Dr Urbanski: We see it as a problem in Germany and we should try to be very aggressive with the follow-up, especially in patients after surgery for acute dissection. Unfortunately, we see that a very small number of patients receive postoperative examinations after surgery, even after explicit recommendation. For this reason we strive to contact the patients at least once a year and to persuade the patients and the family doctors to perform control examinations, because we know that the disease can progress. Unfortunately, we don't have the possibility to follow up all patients from our centre, but we do it for special groups, for example, for acute dissection or for patients with extensive aortic surgery, such as complete aortic arch repair, or for study purposes. But it is a very important aspect and I would like to emphasize that it is really necessary to undertake a very close follow-up of this patient group. Dr Jakob: We also ask all patients to come back to our centre and we have a 100% follow-up with imaging on all our patients, which I think is the way we have to deal with this kind of disease. Nevertheless, your results are outstanding and this is the benchmark for any upcoming endo-vascular therapies. Dr Y. Okita (Kobe, Japan): I have to raise a question about the temperature. You perfuse the patients at 28 degrees. I noted that one patient had massive gastrointestinal tract necrosis. We had a similar patient, a 75-year-old woman with a massive gastrointestinal tract necrosis. Her rectal temperature was 31, but the brain temperature was, if I remember, 27 or 26. So, especially in patients with a very, very atherosclerotic gastrointestinal tract artery, very cal-cified, I think moderate hypothermia is very dangerous for protecting the gastrointestinal tract. Dr Urbanski: Yes, it can be dangerous if the diagnostics are not properly done. In the case you referred to, I showed the slide with the CT angiography of the case as a note of caution. We did not find the problem with the upper mesenteric artery until autopsy, but we should take these changes into consideration before surgery. Currently, if we were to see atherosclerotic calcifi-cations at abdominal level on CT angiography, we would …