[Surgery of type A acute aortic dissection. Past, present and future]

Type A Aortic Dissection is a medical-surgical emergency which requires prompt diagnosis and adequate treatment. Since its inception--more than 40 years ago--the surgical treatment has evolved up until now, when it offers an immediate solution to the high mortality rate due to complications, with acceptable morbidity and mortality rates. This improvement is due also to better diagnostic techniques, postoperative management and profound hypothermia with circulatory arrest. The basic techniques to achieve this consist of resection of the entry tear and closure of the false lumen and repair of the aortic regurgitation when present. Failure of them--proximally or distally--leads to persistence of the false lumen and the possibility of complications or late reoperations. The long-term follow-up, monitorized by non-invasive methods, is mandatory to decide the proper management.