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

Matsueda, Takashi; Ikeno, Yuki; Yokawa, Koki; Koda, Yojiro; Henmi, Soichiro; Inoue, Takeshi; Tanaka, Hiroshi; Okita, Yutaka

doi:10.1016/j.jtcvs.2017.09.048

Cited by 10 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8) Although this approach provided sufficient exposure for myocardial and brain protection and for reattaching the intercostal arteries, postoperative prolonged mechanical ventilation was also a major issue. We no longer use this approach, since the aorta can be exposed through a thoracoabdominal incision without a sternotomy [9][10][11] or through the straight incision with rib-cross (SIRC) approach. 12)…”

Section: Combined Median Sternotomy and Thoracoabdominal Incisionmentioning

confidence: 99%

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

Shiiya

Washiyama

Takahashi

et al. 2023

ATCS

View full text Add to dashboard Cite

Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.

show abstract

Section: Combined Median Sternotomy and Thoracoabdominal Incisionmentioning

confidence: 99%

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

Shiiya

Washiyama

Takahashi

et al. 2023

ATCS

View full text Add to dashboard Cite

show abstract

“…In patients with few risk factors, we considered more extensive replacement, ranging from the aortic arch to the descending or infrarenal abdominal aorta. Replacement was approached via thoracotomy through the fourth or fifth intercostal spaces with rib-cross thoracotomy (Video 2), 11,12 so as to avoid the need for aortic operations requiring repeated sternotomy or thoracotomy.…”

Section: Extensive Aneurysmmentioning

confidence: 99%

Results of staged repair of aortic disease in patients with Marfan syndrome

Ikeno¹,

Yokawa²,

Nakai³

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

Objective:We present our open surgical strategies for staged replacement of the thoracic and thoracoabdominal aorta in patients with Marfan syndrome.Methods: Between October 1999 and December 2017, 82 patients with Marfan syndrome underwent 118 aortic repairs. We divided the aorta into 4 segments for categorization: (1) the aortic root, (2) aortic arch, (3) descending thoracic, and (4) abdominal aorta. Procedures were categorized according to the types of surgery. Staged repair was defined as a subsequent operation on a different segment of the aorta after initial repair (n ¼ 111, 94.1%), and reoperation was defined as an operation on the same segment (n ¼ 7, 5.9%). Results:The mean age at initial operation was 41.7 AE 14.9 years. Staged repairs included aortic root replacement (n ¼ 42, 36%), total arch replacement (n ¼ 11, 9.3%), combined aortic root and total arch replacement (n ¼ 13, 11%), descending aorta replacement (n ¼ 4, 3.4%), thoracoabdominal aortic repair (n ¼ 36, 31%), and extensive arch-descending or thoracoabdominal repair (n ¼ 5, 4.2%). Four patients received 3 staged repairs. Operative mortality was 0.8% (1/118). Stroke occurred in 1.7% (2/118), and spinal cord injury occurred in 1.7% (2/117). Overall survival was 95.8 AE 2.4% at 10-years. Twenty-four patients underwent replacement of the whole aorta after 2.5 AE 3.8 years following initial repair.Conclusions: Our strategies for staged replacement of the thoracic and thoracoabdominal aorta in patients with Marfan syndrome resulted in excellent early-and long-term outcomes.

show abstract

“…Enthusiasm for improving techniques of open aortic repair and perioperative management is fading, partly because of high mortality and morbidity in reported series of open surgery for descending thoracic aorta; in addition, 30-day mortality was 0 to 33% in previous reports. [1][2][3][4][5][6][7][8][9] Although TEVAR is less invasive and has lower mortality compared with conventional open surgery, especially in the early phase, there are still unresolved issues in the treatment of descending thoracic aorta, such as inadequate landing zone, angulation of the aortic arch, tortuosity of the descending aorta, and chronic dissection. These factors lead to various types of endoleak and repeated reintervention.…”

Section: Perspectivementioning

confidence: 99%

Open surgery for descending thoracic aorta in an endovascular era

Fujikawa

Yamamoto

Oshima

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Background: Thoracic endovascular aortic repair has become the preferred treatment for a variety of descending thoracic aortic pathologies. However, there are unresolved issues such as morphologic appearance of chronic dissection, persistent false lumen perfusion, and adequacy of landing zone. Enthusiasm for improving the technique of open aortic repair and perioperative management is fading. In this study, we would like to demonstrate how we improve our surgical outcomes by establishing a dedicated aortic multidisciplinary team at the Kawasaki Aortic Center.Method: We performed a single-center retrospective study from January 2015 to December 2016. All patients with open descending thoracic aortic replacement were recruited. Preoperative patient demographic data, bypass strategies, operative details, and postoperative outcomes were reviewed.Result: From January 2015 to December 2016, we treated 168 cases of descending thoracic aortic repair using a left thoracotomy. Median age was 69.0 AE 21.8 years old, and 63.1% were aortic dissection (acute, 4.8%; chronic, 58.3%); 81.3% patients underwent elective operations. Left heart bypass, deep hypothermic circulatory arrest, and partial cardiopulmonary bypass were performed in 88.6%, 9.0%, and 2.4% of patients, respectively. Mean operative time was 312 AE 94 minutes. In-hospital mortality in total was 0.6%. The rate of transient spinal cord injury was 4.7%.Conclusions: Under a dedicated aortic multidisciplinary team, we demonstrated that open descending thoracic aorta replacement can be performed with excellent early outcomes with low reintervention rates, regardless of the nature of the aortic pathologies.

show abstract

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

Abstract: Our treatment method for extensive thoracic aneurysm, from the ascending aorta to the thoracoabdominal aorta, achieved satisfactory results via the use of specific strategies and appropriate organ protection according to the aneurysm extension in the selected patients.

Cited by 10 publications

References 25 publications

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

Results of staged repair of aortic disease in patients with Marfan syndrome

Open surgery for descending thoracic aorta in an endovascular era

Contact Info

Product

Resources

About