title: Advantages of the L-incision approach comprising a combination of left anterior thoracotomy and upper half-median sternotomy for aortic arch aneurysms.
abstract: Although surgical outcomes of total arch replacement have improved, the strategy for extended arch aneurysms remains controversial. We have applied the L-incision approach (combination of left anterior thoracotomy and upper half-median sternotomy) for total arch replacement for single-stage repair of extensive arch aneurysms. We retrospectively reviewed the operative outcomes of patients who underwent total arch or extended total arch replacement for degenerative aneurysms from 1999 to 2010. Operations were performed via median sternotomy in 47 patients (M group) and the L-incision approach was used in 38 patients (L group). Through the L-incision approach, we were able to complete distal anastomosis below the pulmonary hilus. The L-incision approach has advantages of reducing selective antegrade cerebral perfusion and lower body circulatory arrest times compared with the M group. Recurrent laryngeal nerve palsy and renal dysfunction were less frequent in the L group than those in the M group. Respiratory dysfunction and wound infection were similar between the groups. Hospital mortalities were 5.3% in the L group and 6.4% in the M group. The L-incision approach has similar or better postoperative outcomes compared with the median sternotomy approach. This approach could be useful for single-stage extended total arch replacement with relatively low risk.
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8552, Japan. yooo@heart.med.kyushu-u.ac.jp
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Oishi
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Sonoda
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tanoue
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nishida
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Tokunaga
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakashima
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007674:Kidney Diseases / Q000209:etiology; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013530:Surgical Wound Infection / Q000209:etiology; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology