Operative results of the anterolateral thoracotomy with partial sternotomy approach for chronic-type B aortic dissection involving the aortic arch

Abstract

The anterolateral thoracotomy with partial sternotomy approach is a useful surgical procedure with acceptable outcomes for chronic-type B aortic dissection cases involving the aortic arch, when aortic remodelling using thoracic endovascular aortic repair cannot be performed.

Resternotomy Plus Left Thoracotomy Surgery after Previous Acute Type A Aortic Dissection Repair

“…Other surgical procedures for an extended thoracic replacement, which can decrease the risk of a future aortic reintervention, were also reported, though these were rarely applied for reoperation after a previous AAAD repair. [6][7][8][9][10][11][12][13] Ishikawa et al and Uchino et al reported ALPS, though their cohort included only 5.5 and 0% of reoperations, respectively. 6,7 Iwasaki et al reported a clamshell approach for an extended thoracic replacement, though there were only 8% of reoperations.…”

“…[6][7][8][9][10][11][12][13] Ishikawa et al and Uchino et al reported ALPS, though their cohort included only 5.5 and 0% of reoperations, respectively. 6,7 Iwasaki et al reported a clamshell approach for an extended thoracic replacement, though there were only 8% of reoperations. 9 Oishi et al and Tokuda et al reported an L-incision for an extended thoracic replacement, though their cohort included only 2.6 and 10% of reoperations.…”

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

“…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.…”

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

“…The anterolateral thoracotomy with partial sternotomy (ALPS), [16][17][18][19] first described by Yunoki and Oba in the 32nd annual meeting of the Japanese Society for Vascular Surgery in 2004, provides sufficient exposure from the aortic valve to the distal descending aorta. In its original form, the lower partial median sternotomy is continued to the anterolateral thoracotomy through the fourth intercostal space.…”

“…In its original form, the lower partial median sternotomy is continued to the anterolateral thoracotomy through the fourth intercostal space. 18) This approach provides full access to the aortic root. 17 , 19) To better expose the innominate artery, several authors prefer to enter the third intercostal space.…”