Aortic Replacement via Median Sternotomy with Left Anterolateral Thoracotomy

Abstract

Prevention of cerebral injury is an important consideration during repair of aortic arch aneurysm, and the major goal of cerebral protection techniques. We describe our surgical strategy for treatment of extended thoracic aortic aneurysms. Between January 2001 and June 2008, 17 men and 6 women, with a mean age of 67.9 +/- 8.3 years, underwent total replacement of the arch and descending aorta. Six (26.1%) patients required emergency surgery. A median sternotomy with a left anterolateral thoracotomy provided a good visual field, and bilateral axillary arteries were preferentially used for systemic as well as selective cerebral perfusion. Two (8.7%) patients died in hospital. Prolonged mechanical ventilation was required for 7.3 +/- 8.4 days after surgery in 17 patients who all recovered uneventfully. Permanent neurological dysfunction developed in 1 (4.3%) patient who died of sepsis 2 years after the operation. Our results suggest that total arch replacement through a median sternotomy plus a left anterolateral thoracotomy is helpful for extended replacement of the thoracic aorta as well as distal reoperation for dissecting type A aortic aneurysm. Perfusion via bilateral axillary arteries may improve cerebral protection.

Surgical Treatment for Aortic Coarctation with Chronic Type B Dissection: Report of a Case

“…The aortic arch and aneurysm was easily exposed using this approach, which has also been applied by Milano et al 7) Although this approach offers a good view from the aortic arch to the descending aorta, it is invasive and can cause respiratory failure. 13) On the other hand, Ohata described that a median sternotomy with a left anterolateral thoracotomy does not increase postoperative respiratory complications. 14) Our patient was smoothly extubated, and respiratory failure did not arise.…”

Root Reconstruction with Total Replacement of Ascending Aorta Using Hypothermic Circulatory Arrest and Selective Cerebral Perfusion for Moderately Dilated Distal Ascending Aorta

“…Cerebral oximetry is a functional and possibly superior method of monitoring cerebral perfusion and oxygenation [12,13]. Although cerebral protection techniques are continually undergoing refinement with improved results, we added left brain perfusion to minimize the likelihood of associated brain damage arising [14]. Moreover, vertebral perfusion via the left axillary artery is important for spinal, as well as cerebral protection.…”

Longer stent graft in frozen elephant trunk procedure: A fear or truth?

“…The overall results depends on several other factors which includes (i) Lower body protection during circulatory arrest: Adequate cooling of the patient and maintain a short circulatory arrest period. If need intermittent perfusion of lower body with a Foley's catheter (ii) Continuous perfusion of left subclavian artery: Continuous perfusion through the left subclavian artery would encourage collateral circulation to the spinal cord during the circulatory arrest period (7,8) (iii) Minimal Handling of the atherosclerotic plaques on the aorta (iv) Through deairing of the descending thoracic aorta, prior to restarting lower body circulation.…”