OBJECTIVE The objective of our study was to report on the total experience in thoracic aortic surgery over a 40-year time period for a single institution. METHODS All 1075 patients who underwent surgery for thoracic aortic pathology from 1972 to 2011 (n = 1159) were included. Patient, procedural, and follow-up information was obtained from hospital records and the civil registry. Patients were grouped into 4 categories: acute type A dissection (n = 261), other ascending aortic/arch surgery (n = 626), descending aortic surgery (n = 175), and thoracoabdominal surgery (n = 97). Risk factors for early and late mortality and the incidence of reoperations were analyzed. RESULTS The annual number of operations increased significantly over time. In all 4 patient groups, early mortality (in hospital or within 30 days of operation) decreased significantly over time to 15.3% in group 1, 1.9% in group 2, 0% in group 3, and 10.5% in group 4 during the contemporary time period 2007 to 2011. Overall actuarial survival was 54.3% (95% confidence interval, 50.7-57.9) after 10 years and 27.8% (95% confidence interval, 26.4-38.3) after 20 years. Late survival improved over time, but was reduced compared with the general population and was related predominantly to preexisting risk factors. In 80 patients, 111 reoperations were necessary, most frequently in group 1 patients and in patients with connective tissue disease. CONCLUSIONS Thoracic aortic operations were performed increasingly during a 40-year time period. Early mortality decreased and late survival increased significantly in all patient groups. A significant proportion of patients required multiple operations.