title: [Preferable surgical approaches to the aortic root-arch in patients with functioning tracheostomy].
abstract: Preferable surgical approaches to aortic diseases occurring between the aortic root and the arch in patients with functioning tracheotomy or permanent tracheostomy are described for securing adequate exposure and avoiding postoperative mediastinitis. Case 1: A 41-year-old man with Marfan syndrome presented with chronic type A thrombosed aortic dissection and severe aortic valve regurgitation. He had had a functional tracheostomy for managing respiratory function due to traumatic spinal cord damage. The heart and the ascending aorta were shifted to the right side of the chest and showed a significant counterclockwise rotation. Therefore, the reverse L-figure approach of a right-sided 3rd intercostal anterior thoracostomy and lower midline sternotomy was performed for Bentall operation. Case 2: A 76-year-old woman presented with thoracic aortic aneurysm of 11 cm in diameter. She had had a permanent tracheostomy with total laryngectomy. Therefore, cram shell approach was performed for total arch replacement. The 2 cases had no postoperative mediastinitis. These approaches are recommended for aortic diseases occurring in the ascending aorta or the aortic arch in patients with functioning tracheotomy.
authors.affiliation: Division of Cardiovascular Surgery, Ehime Prefetural Central Hospital, Matsuyama, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Nakayama
authors.forename: Masashi
authors.initials: M
authors.lastname: Kanou
authors.forename: Shingo
authors.initials: S
authors.lastname: Isshiki
authors.forename: Hideki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Tominaga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishitoya
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kurobe
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kitagawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Hiratani
authors.forename: Takaki
authors.initials: T
authors.lastname: Hori
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D014139:Tracheostomy