Evolution of endovascular treatment for complex thoracic aortic disease.

In a relatively short period of time, transcatheter and endovascular approaches to treat thoracic aortic and structural heart disease have exploded onto the scene. New device frontiers already being forged in the experimental stages include expanded indications and variations of fenestrated and branch stentgrafting to treat thoracoabdominal and arch disease, endovascular ascending and aortic root repair, and all of the cardiac valves. A fundamental concept to optimize durability of endovascular repair is the need for fixation and seal in healthy tissue. Before long, the entire vascular and cardiovascular system will be within the reach of endovascular interventions. Ultimately, achieving success in this endeavor will require a combination of skill sets including familiarity with high definition imaging, surgical access, and the mastery of interventional techniques, as well as the development of better anatomy-specific and disease-specific devices.