Recent advances in thoracic aortic surgery

Surgical treatment for thoracic aortic diseases has been challenging for cardiovascular surgeons. Advances in diagnostic modalities such as multidetector row computed tomography, magnetic resonance imaging, and transesophageal and epiaortic echocardiography provide precise information to determine the surgical strategy. The pathologic entity of acute aortic dissection has been clearly defined, although the terminology for penetrating aortic ulcer, intramural hematoma, and thrombosed aortic dissection remains controversial. The term "acute aortic syndrome" has been advocated for emergent treatment. Therapeutic advances in total aortic arch replacement have been remarkable, particularly in the field of brain protection. Selective antegrade cerebral perfusion and retrograde cerebral perfusion have been developed since the 1990s and refined mainly by Japanese surgeons. Endovascular aortic repair with stent grafting is the most recent emerging technology that encourages a more aggressive strategy for the treatment of high-risk patients with thoracic aortic pathology.