Surgical Treatment of Acute Aortic Syndrome

Abstract Acute aortic syndrome comprises a variety of pathologies of the aorta characterized by a breakdown of the intimal integrity leading to bleeding into the media layer. With the potential of life-threatening complications, it is an emergency condition requiring prompt and proper management. Nonetheless, it is still affected with high morbidity and mortality. The Stanford classification based upon the localization of affected aorta is guiding decision making for surgical treatment. Several treatment options, such as open surgical, endovascular, or hybrid techniques, were developed over the last years, and indications are discussed for different conditions and dependent on individual findings. Strategies are presented for intraoperative monitoring, cannulation for extracorporal circulation, perfusion, myocardial, and organ protection as well as management of complications. Emphasis is put on surgical techniques for aortic root repair, ascending aortic replacement, aortic arch, and descending aorta treatment.