According to the Japanese Association for Thoracic Surgery annual surgery survey, the number of aortic surgery has been increasing constantly in the last two decades, with the rates approximately doubling in each decade (5,167, 11,956, and 22,708 cases in 1999, 2009, and 2019, respectively). In 2019, aortic surgery was performed for 11,036 (49%) nondissecting unruptured aneurysm, 730 (3%) ruptured aneurysm, 6,351 (28%) acute type A aortic dissection, 1,412 (6%) chronic type A aortic dissection, 2,385 (11%) acute type B aortic dissection, and 703 (3%) chronic type B aortic dissection cases. The outcomes have been improving annually. From 1999 to 2019, the hospital mortality rates decreased significantly in each case: nondissecting unruptured aneurysm, 9.8% to 4.2%; ruptured aneurysm, 38.5% to 19.7%; acute type A aortic dissection, 18.7% to 10.4%; chronic type A aortic dissection, 7.2% to 4.5%; acute type B aortic dissection, 25.2% to 9.8%; and chronic type B aortic dissection, 7.5% to 3.4%. Furthermore, stent graft, a new technology developed in 1990, was performed in 35%, 53%, 1%, 21%, 62%, and 75% of cases mentioned above, respectively, in 2019. The widespread use of stent graft greatly contributed to the increased number of aortic surgeries and improvement of surgical outcomes.