Recent chapters in the relatively brief history of surgical treatment of patients with ascending aortic aneurysms and aortic arch aneurysms continue to be punctuated by substantial clinical improvements. More precise diagnostic methods, increased awareness of the dismal natural history of patients with these aneurysms, improved methods of myocardial and cerebral protection, refined vascular grafts and prosthetic valves, widespread availability of specific coagulation components, more sophisticated anesthetic and postoperative management, and more timely referral of patients (prior to rupture or irreversible deterioration of left ventricular function, or both) have all been instrumental in promoting these improving results. The thrust of future efforts should be directed to the appropriate identification, diagnosis, and treatment of remote aneurysms and atherosclerotic disease in the cerebral and coronary circulation, detection of patients predisposed to aortic dissection, and ultimately to the development of pharmacologic methods to prevent aortic dissection and atherosclerotic aneurysm development. Eventually, it is hoped, more complete understanding of the genetics, molecular biology, and biochemistry of both acquired and congenital degenerative thoracic aortic aneurysms will also lead to preventive measures for these patients.
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