Coselli 1 Evolution of Thoracic Aortic Operations

Tremendous innovations have been introduced in the last half-century to improve care for patients with aortic disease. Lesions that were essentially untreatable in the early 1950s can now be repaired with a greater likelihood of survival than ever imagined. Aortic repair has grown to encompass adjuncts designed to ameliorate specific surgical morbidities, such as cerebral, spinal cord, and renal ischemia, while embracing endovascular technologies to enable less invasive approaches, including hybrid procedures. Other recent technical advances include the use of prefabricated branched aortic grafts to minimize residual native aortic tissue and, thus, to reduce the late formation of patch aneurysms; surgical adhesives to improve the strength of fragile anastomoses; and valve-sparing aortic root replacement surgery to preserve the native aortic valve, improve hemodynamics, and reduce the need for anticoagulation. The evolution of surgical repair of the two most challenging aortic segments—the aortic arch and thoracoabdominal aorta—warrant detailed consideration.