Endografting for the treatment of thoracic aortic pathology continues to gain popularity; in some countries, numbers of endovascular aortic repairs now exceed those of open surgical cases. The skills and understanding of open surgical teams are not always translated into endovascular intervention teams, which may be led by cardiologists or vascular surgeons with little knowledge of thoracic pathology. Our experience with more than 400 thoracic interventional cases leads us to believe that that the cardiovascular surgeon is crucial to the success of any thoracic endovascular aortic repair program. Experienced surgeons should be involved in preoperative planning of cases, assessment of access vessels, creation of landing zones with revascularization procedures, passage of stents through the thoracic aorta, and protection of the spinal cord. In addition, surgeons should be familiar with the most common complications of thoracic endovascular aortic repair and be able to use both open surgical and endovascular strategies for complication management.