Aortic dissection represents an exciting and difficult challenge for the cardiac surgeon. Aortic surgery as a specialty has developed rapidly since the pioneering times of Debakey, Cooley, and Crawford. Enthusiasm regarding this kind of surgery is still growing today for multiple reasons. Firstly, the progressive standardization of the surgical procedure contributes to reducing mortality and morbidity. Secondly, the improvement of imaging technology helps to plan the intervention to adapt it to the patient like a tailor. Thirdly, advances in brain protection techniques, prevention of damage to the spinal cord and arterial cannulation sites, and improved protection of visceral organs. Fourthly, the availability of improved device technology with the increasing use of hybrid prostheses to more easily perform distal anastomoses or endovascular approaches in type B dissections. Lastly, knowledge of the dynamics of aortic dilatation and the role of genetics. In patients with hereditary diseases of the thoracic aorta, such as Marfan syndrome, early diagnosis has been shown to be effective in reducing the prevalence of acute aortic dissection, allowing for tailored medical management and surgical intervention. However, the optimal strategy for identifying individuals in the general population with an increased risk of acute thoracic aortic disease remains a challenge.