Debating the Aortic Arch: Open Surgical Domain or Not? | Dr. Joseph Coselli at TED 2025

Join Dr. Joseph S. Coselli as he presents **“Debating the Aortic Arch: Open Surgical Domain or Not?”**, a high-level surgical and endovascular debate on one of the most complex frontiers in cardiovascular surgery. Presented at TED 2025 and hosted by Dr. Venkatesh Ramaiah, this session examines whether the aortic arch should still be considered primarily the domain of open surgical repair or whether endovascular and hybrid approaches are redefining the standard of care. In this presentation, Dr. Coselli draws from decades of experience in *complex aortic arch and thoracoabdominal aortic surgery* to discuss the anatomical, physiological, and technical reasons why open repair remains a critical and often irreplaceable strategy in selected patients. He emphasizes the unique challenges of arch pathology, including cerebral protection, branch vessel management, and long-term durability of repair. A central focus of the debate is the **evolution of aortic arch treatment**, including the rise of hybrid procedures such as frozen elephant trunk (FET) and branched/fenestrated endovascular techniques. While these technologies have expanded treatment options, Dr. Coselli highlights that open surgical repair continues to provide unmatched versatility in complex or extensive disease. ([Wikipedia][1]) The session also explores key considerations such as patient selection, anatomical limitations of endovascular arch repair, stroke risk mitigation, and spinal cord and organ protection strategies during extensive aortic reconstruction. Dr. Coselli explains how surgical judgment remains essential even as technology continues to advance. Through clinical insight and historical perspective, this talk frames the aortic arch not as a solved problem, but as a continuously evolving battleground between open, hybrid, and endovascular innovation. This presentation is essential for cardiothoracic surgeons, vascular surgeons, and aortic specialists navigating the future of complex arch repair strategies. Learn more about TED Congress Chairman Dr. Venkatesh Ramaiah: [https://en.wikipedia.org/wiki/Venkate...](https://en.wikipedia.org/wiki/Venkate...) Learn more about Dr. Joseph S. Coselli: [https://en.wikipedia.org/wiki/Joseph_...](https://en.wikipedia.org/wiki/Joseph_...) --- *Timestamps:* 00:00 – Introduction 00:45 – Disclosures 01:05 – Why the Aortic Arch Is So Complex 01:45 – Open Surgical Principles 02:30 – Cerebral Protection Strategies 03:20 – Limitations of Endovascular Arch Repair 04:10 – Hybrid & FET Approaches 05:00 – Stroke Risk & Organ Protection 06:00 – Patient Selection Considerations 07:00 – Debate: Open vs Endovascular Future 08:00 – Key Takeaways --- *Keywords/Tags:* Aortic Arch Surgery, Open Aortic Repair, TEVAR, Hybrid Aortic Repair, Frozen Elephant Trunk, Dr. Joseph Coselli, TED Congress, Dr. Venkatesh Ramaiah, Cardiothoracic Surgery, Vascular Surgery, Aortic Arch Debate, Endovascular Aortic Repair, Stroke Prevention, Complex Aortic Disease, Aortic Innovation, Thoracic Aorta, Surgical Strategy, TED 2025