title: 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.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Bioregulatory Medicine, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan. y3104@med.u-ryukyu.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashiro
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kuniyoshi
authors.forename: Katsuya
authors.initials: K
authors.lastname: Arakaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Inafuku
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morishima
authors.forename: Yuya
authors.initials: Y
authors.lastname: Kise
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001366:Axillary Artery / Q000503:physiopathology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010477:Perfusion; D012039:Regional Blood Flow; D012121:Respiration, Artificial; D018805:Sepsis / Q000209:etiology; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome