Operative Techniques in Surgery of the Proximal Thoracic Aorta and Aortic Arch

  • Enrique Gongora
  • Thomas G. Gleason


There is a strikingly uniform histopathology (cystic medial degeneration) inherent to most all diseases affecting the proximal thoracic aorta, and this pathology imparts a disruption of the structural integrity of the aortic wall giving rise to aneurysm formation, dissection, or rupture – the final common pathway of untreated proximal thoracic aortic disease. It is important to fully understand the clinical modes of presentation of proximal thoracic aortic disease as the surgical management and timing of intervention vary accordingly. Patient comorbidity, extent of thoracic aortic reconstruction required, and timing of surgery, all impact morbidity and mortality following proximal thoracic aortic surgery. The extent of reconstruction is predicated on the condition of the aortic root and the aortic valve, the presence of an underlying connective tissue disorder, the life expectancy of the patient, the desired anticoagulation status, the need for associated cardiac procedures, as well as surgeon experience. The ultimate outcome of patients undergoing these procedures depends on thorough preoperative surgical ­planning; meticulous myocardial, cerebral, and spinal cord protection; precise operative technique; and dutiful postoperative care. Thoracic aortic surgery is complex and mandates a seamless interaction between surgeons and cardiac anesthesiologists to ensure optimal patient outcomes.


Aortic Root Bicuspid Aortic Valve Aortic Annulus Thoracic Aortic Aneurysm Hypothermic Circulatory Arrest 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Cardiac Surgery, Department of SurgeryThoracic Transplantation and Mechanical Circulatory Support, Heart Transplantation Program, Scott & White Clinic, Texas A&M Helath Science Center College of Medicine, Scott & White Hospital and ClinicsTempleUSA

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