Abstract

Aortic arch disease remains among the more physiologically and technically challenging problems to safely manage surgically. Early pioneers who developed surgical solutions for numerous cardiovascular problems were limited in their ability to successfully overcome the unacceptably high operative mortality and neurologic morbidity rates. This chapter reviews the historic milestones and landmark leaders who contributed to the development of modern aortic arch surgery. The relevant anatomy, physiology, pathophysiology, and epidemiology are reviewed and put into clinical context. Perioperative planning and preparation as well as current operative techniques are described. The different strategies for brain protection are described in physiologic and practical detail. In this chapter, the reader will be guided through some of the confusing and conflicting data regarding the different surgical, hybrid, and endovascular approaches to aortic arch replacement.