Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch

Tokuda, Yoshiyuki; Oshima, Hideki; Abe, Tomonobu; Mutsuga, Masato; Fujimoto, Kazuro; Terazawa, Sachie; Ito, Hideki; Hibino, Makoto; Uchida, Wataru; Komori, Kimihiro; Usui, Akihiko

doi:10.1093/icvts/ivw034

Cited by 16 publications

(18 citation statements)

References 24 publications

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“…Surgery of the ascending aorta with or without combined procedures, such as total arch replacement and aortic root reconstruction, has been traditionally performed through a median full sternotomy because this procedure can provide good exposure for deep surgical operations, especially when descending aorta management or aortic root procedures are required. Surgeons have often considered that the performance of a distal anastomosis in a deep position is technically challenging and that approaching the aorta beyond the reflection point of the arch via a median sternotomy is generally difficult [6]. Nowadays, however, the development of minimally invasive techniques has allowed increasingly improved results of aortic surgery, not only for isolated heart valve disease but also for ascending aorta repair, the Bentall procedure, and hemi-arch replacement.…”

Section: Discussionmentioning

confidence: 99%

“…A full median sternotomy remains the standard approach for complex aortic surgery to ensure adequate exposure and safety [5]. However, some experts attempt to perform minimally invasive procedures in aortic arch surgery [6,7]. The present study was performed to demonstrate that complex aortic surgery including total arch surgery and aortic root repair via a partial upper sternotomy is viable, safe, and equivalent to the standard procedure in terms of both safety and the risk of major adverse cardiac and cerebrovascular events.…”

Section: Introductionmentioning

confidence: 93%

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Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy

Jiang

Liu

et al. 2020

J Cardiothorac Surg

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Background: Use of minimally invasive approaches for isolated aortic valve or ascending aorta surgery is increasing. However, total arch replacement or aortic root repair through a minimally invasive incision is rare. This study was performed to report our initial experience with surgery of the ascending aorta with complex procedures through an upper mini-sternotomy approach. Methods: We retrospectively analyzed 80 patients who underwent ascending aorta replacement combined with complex procedures including hemi-arch, total arch, and aortic root surgeries from September 2010 to May 2018. Using standard propensity score-matching analysis, 36 patients were matched and divided into 2 groups: the upper mini-sternotomy group (n = 18) and the median sternotomy group (n = 18). The preoperative assessment revealed no statistically significant differences between the two groups. Results: Hospital mortality occurred in one patient (2.8%). The mini-sternotomy group showed a longer crossclamping time (160 ± 38 vs. 135 ± 36 min, p = 0.048) due to higher rate of valve-sparing aortic root replacement and total arch repair. The cardiopulmonary bypass time in mini-sternotomy group was shorter than that of full sternotomy group (209 ± 47 min vs 218 ± 62 min, p = 0.595) but fell short of significance. There was no significant difference in lower body hypothermia circulatory arrest time between the two groups (40 ± 10 min vs 48 ± 20 min, p = 0.139). The upper mini-sternotomy group displayed a shorter ventilation time (22 vs. 45 h, p = 0.014), intensive care unit stay (4.6 ± 2.7 vs. 7.9 ± 3.7 days, p = 0.005), and hospital stay (8.2 ± 3.8 vs. 21.4 ± 11.9 days, p = 0.001). The upper mini-sternotomy group showed a lower postoperative red blood cell transfusion volume (4.6 ± 3.3 vs. 6.7 ± 5.7 units, p = 0.042) and postoperative drainage volume (764 ± 549 vs. 1255 ± 745 ml, p = 0.034). The rates of dialysis for newly occurring renal failure, neurological complications, and re-exploration were similar between the two groups (p = 1.000). Conclusion: The upper mini-sternotomy approach is safe and beneficial in ascending aorta surgery with complex procedures for aortic dissection, including total arch replacement and aortic root repair.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy

Jiang

Liu

et al. 2020

J Cardiothorac Surg

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“…However, surgical exposure is sometimes limited and additional left thoracotomy might be required in cases aortic aneurysm or dissection entry exists beyond the left subclavian artery. In a recent report, extended TAR with the combination of left anterior thoracotomy and upper median sternotomy displayed a higher rate of respiratory complications compared to standard TAR with the median sternotomy [5]. Thoracic endovascular aortic repair is becoming applied for aortic arch pathologies.…”

Section: Discussionmentioning

confidence: 99%

Mini open stent grafting with half sternotomy for aortic arch aneurysm

Tamaki

Sakaguchi

Terasaki

et al. 2019

J Cardiothorac Surg

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Background Open stent grafting is an alternative of graft replacement and thoracic endovascular aortic repair for aortic arch aneurysm. We have performed open stent grafting with half sternotomy (mini-OSG) to reduce in-hospital stay and recovery time of patients and herein report seven cases of mini-OSG for aortic aneurysm and dissection. Case presentation The patients’ mean age was 66 years. Cardiopulmonary bypass was performed conventionally, and an open stent graft was inserted via an aortotomy on the aortic arch during circulatory arrest. No mortality occurred. The mean operation time was 387 min, and the mean blood loss was 587 ml. The patients were weaned from the ventilator 7.1 h postoperatively. No pseudoaneurysm or endoleakage was observed during the 2- to 20-month follow-up. Conclusions Mini-OSG might be less invasive, although further studies and intensive follow-up are needed.

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“…Very few reports have been published regarding 1-stage replacement from the aortic arch to thoracoabdominal aorta. 11,18,19 Svensson and colleagues 20 reported a successful case in a 68-year-old patient who underwent replacement of the entire aorta from the aortic valve to the aortic bifurcation via deep hypothermia with circulatory arrest and retrograde perfusion of the brain. Massimo and colleagues 6 reported that 7 patients underwent replacement of the aorta from aortic valve to bifurcation.…”

Section: Discussionmentioning

confidence: 99%

One-stage replacement of the aorta from arch to thoracoabdominal region

Matsueda

Ikeno

Yokawa

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch

Abstract: A combination of left anterior thoracotomy and upper median sternotomy can be applied to the single-stage repair of extended aneurysms with acceptable results in appropriately selected patients.

Cited by 16 publications

References 24 publications

Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy

Surgery of ascending aorta with complex procedures for aortic dissection through upper mini-sternotomy versus conventional sternotomy

Mini open stent grafting with half sternotomy for aortic arch aneurysm

One-stage replacement of the aorta from arch to thoracoabdominal region

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