Aortic surgery, especially for pathologies requiring urgent surgical intervention has undergone
significant changes in the past twenty years, leading to major improvement in short- and long-term
outcomes. This thesis aims to provide a comprehensive, up-to-date overview on clinical characteristics
of acute aortic syndrome, with special emphasis on current operative treatment possibilities, including
well-established and novel, innovative surgical approaches. Within this scheme, further specific goals
are to analyse different cannulation and perfusion options, the role of core temperature management
during hypothermic circulatory arrest and impact of age-related differences in surgical approach of
AAS.
Ultrasound-guided direct cannulation on the concavity of aortic arch applying Seldinger technique is a
reliable method in dissection repairs. Prompt antegrade perfusion provides not only cerebral, but also
peripheral organ and tissue protection, which is an advantage in this high-risk group of patients. This
alternative arterial inflow technique can be applied for prompt establishment of cardiopulmonary
bypass in type A dissections or other aortic emergencies, especially during haemodynamic instability.
We have proven that tympanic temperature measurements correlate with arterial blood temperature
monitoring during aortic surgery applying hypothermic circulatory arrest, therefore, should replace
bladder and rectal measurements.
Early diagnosis and aggressive surgical approach without delay is a key factor in effective treatment
for aortooesophageal fitulas. Endovascular treatment is essential to save the patient, but as a standalone
procedure often ends-up with life threatening mid-term graft infection. Eliminating the source of
bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the
gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to
justify the sequence of endovascular aortic repair and subtotal oesophageal resection, followed by a
gastro-oesophageal reconstruction, as an effective surgical approach.
More frequent proximal and distal progression of the dissection flap occurs in younger patients with
acute type A aortic dissection. Older age is associated with a lower probability of an intimal tear at the
level of sinus of Valsalva. These findings, associated with prognostic implications, account for the
choice of more radical proximal procedures for repair of aortic dissection in younger patients
