title: Outcomes of single-stage total arch replacement via clamshell incision.
abstract: BACKGROUND
  Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction.
  
  
  METHODS
  The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest.
  
  
  RESULTS
  Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days.
  
  
  CONCLUSIONS
  The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.
authors.affiliation: Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1 Takarazuka, Hyogo 665-0873, Japan. hiroto@cdb.riken.go.jp
authors.forename: Hiroto
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Satoh
authors.forename: Toru
authors.initials: T
authors.lastname: Ishizaka
authors.forename: Hikaru
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome