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Overview of open surgical repair of the thoracic aorta

Y Joseph Woo, MD
Christina L Greene, MD
Section Editors
Gabriel S Aldea, MD
Edward Verrier, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Open surgical repair of the thoracic aorta has been the standard for managing a variety of thoracic aortic pathologies, but is associated with significant morbidity and mortality. Although minimally invasive approaches have lessened the need, particularly for descending aortic disease, open repair of the thoracic aorta remains necessary to manage a variety of thoracic diseases as well as for complications of thoracic aortic stent-graft placement.

Open repair of the thoracic aorta will be reviewed predominantly as it pertains to the repair of thoracic aortic aneurysm and aortic dissection (TAAD), but variations on surgical techniques required to manage other thoracic aortic pathologies are also briefly reviewed, where applicable. Endovascular techniques for repairing the thoracic aorta are discussed elsewhere. (See "Clinical manifestations and diagnosis of thoracic aortic aneurysm".)


Open repair of the thoracic aorta is the standard of care for the management of a variety of ascending thoracic aortic pathologies including ascending thoracic aortic aneurysm and acute ascending thoracic aortic dissection. For descending thoracic aortic pathologies (aneurysm dissection, aortic injury), endovascular repair is emerging as a preferred initial approach, given the lower rates of perioperative morbidity and mortality. For patients with indications for thoracic aortic repair who are not suitable candidates for an endovascular approach, open repair of thoracic aortic aneurysm is still reasonable.

Thoracic aortic pathologies repaired using an open surgical approach include [1]:

Type A (ascending) acute aortic dissection or intramural hematoma in the ascending aortic arch [2,3]. (See "Management of acute aortic dissection" and "Overview of acute aortic syndromes".)


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