Optimal management of acute aortic dissection involving the ascending aorta and arch remains both challenging and controversial. In many series, hospital mortality has hovered around 20%, unchanged over the last three decades despite significant advances in diagnostic prowess and strategies to prevent, identify and treat complications such as malperfusion. Clearly, Osler’s dictum that aneurysm teaches clinical humility applies equally to dissection.
Though clinical results are often determined by the “hand you’re dealt”, there are significant management issues that hold promise for better early and late outcomes, and these are the subject of many of the articles within this issue, written by established aortic experts. The value of aortic teams, extent of root and arch replacement at initial surgery, management of malperfusion and the role of stent grafting and the elephant trunk are but a few of the important topics herein.
We are grateful for the contributions of these authors and feel privileged to have helped shepherd their wisdom into this collection.