Surgical treatment of thoracic aortic aneurysms has to account for anatomical location, patient risk profile, and the surgeon’s experience. Whereas endovascular treatment of the descending aorta has become a valid option for most patients and pathologies, open surgery remains the first choice to treat aneurysms of the aortic root, ascending aorta, and aortic arch and to treat patients with connective tissue disease in elective settings. Minimal invasive access is more frequently used to treat the aortic root, ascending aorta, and proximal aortic arch with excellent results. Long-term results of valve-sparing aortic root replacement undermine the recommendation to preserve the aortic valve, especially in young patients with tricuspid aortic valves. Aortic annulus stabilization either via valve reimplantation or external stabilization techniques in addition to aortic root remodelling ensures stable long-term results. Aortic root replacement using valved conduits remains a durable treatment option. Aortic arch surgery has been revolutionized by multiple technical solutions that facilitate surgical techniques (e.g. branched prefabricated grafts), extend treatment into the proximal descending aorta (e.g. frozen elephant trunk procedure), and minimize organ damage (e.g. cardiac and lower body perfusion during aortic arch repair). If endovascular treatment of the descending and thoracoabdominal aorta is not feasible, open surgical methods remain the standard of care and should routinely include protection methods to preserve organ function (e.g. left heart bypass, partial bypass). Treatment strategies in all patients should be discussed within a dedicated interdisciplinary team. Strict follow-up is mandatory.
Long-term results after aortic root replacement using self-assembled valve composite grafts in patients with small aortic annulus
