Aneurysm and Dissection of the Thoracic and Thoracoabdominal Aorta

The surgical options for treating diseases of the aorta have been extended in the past 15 years. In this chapter, established surgical techniques as well as more recent developments in aortic surgery are described in detail. Aortic valve preserving techniques for aortic root replacement and the use of tube grafts with neosinuses, root replacement with complete porcine aortic root grafts, and composite grafts carrying either mechanical or biological valve prostheses are valuable options now for the treatment of aneurysms or dissections of the proximal ascending aorta. The variety of treatment options allow for individualized decision making with regard to patients characteristics, resulting in reduced mortality and morbidity. Aortic arch surgery became safer by introducing new techniques for brain protection, such as antegrade cerebral perfusion techniques either by cannulation of the axillary artery or direct intubation of the supra-aortal branches and combined use of moderate hypothermic circulatory arrest. For distal aortic arch aneurysms, the classic elephant trunk technique is expanded by development of frozen elephant trunk prostheses, assembled from a Dacron prosthesis for arch replacement and a covered stent graft for extension into the descending aorta, a well-suited landing zone for further endoluminal stent graft treatment of the downstream aorta. For open surgical repair of thoracic and thoracoabdominal aneurysms, the currently applied surgical techniques as well as intraoperative perfusion and spinal cord protection strategies are explained.