[Aneurysm, dissection and trauma of the thoracic aorta]

In the last two decades 600 operations for acquired diseases of the thoracic aorta were performed at our institution. On the basis of this experience the current operative tactics and techniques are outlined. After a initial learning phase the early mortality following replacement of the ascending aorta in aneurysms and chronic dissection decreased to 4%. Arch replacement now carries a risk of 15% as does surgery for acute type A dissection. Descending aortic replacement is performed under distal circulatory support and is now associated with an early mortality of only 1.6%. In case of severe polytrauma treatment of aortic rupture is delayed. Direct suture of the tear often is possible. We consider it mandatory for the surgeon to follow these patients in order to recognize and treat recurrent aneurysmal disease in due time.