title: Staged resternotomy for a retrosternal giant aneurysm of the thoracic aorta using an inferior T-shaped ministernotomy.
abstract: We describe a staged resternotomy technique using an inferior T-shaped ministernotomy for three redo cases with a retrosternal aortic arch aneurysm. To minimize the disadvantages of resternotomy during closed-chest hypothermia, an inferior T-shaped ministernotomy was performed before approaching the aneurysm. After establishment of the cardiopulmonary bypass with femoral or axillary arterial cannulation, or both, and right atrial drainage, a venting catheter was inserted into the left ventricle and core cooling was induced at 25°C. The retrosternal aneurysm was then exposed by additional superior sternotomy. Under hypotherma with antegrade cerebral perfusion, the distal side of a four-branched graft was anastomosed. During rewarming, reconstruction of the arch vessels and proximal anastomosis of the branched graft were performed. In the 3 patients operated on using this technique, there were no perioperative deaths or serious complications. This suggests that the technique can be safely performed and minimizes the disadvantages of the widely used resternotomy technique.
authors: Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan. keijikamohara@hotmail.com
authors: Keiji
authors: K
authors: Kamohara
authors: Kojiro
authors: K
authors: Furukawa
authors: Kazuyoshi
authors: K
authors: Doi
authors: Manabu
authors: M
authors: Itoh
authors: Akira
authors: A
authors: Furutachi
authors: Yukio
authors: Y
authors: Okazaki
authors: Shigeki
authors: S
authors: Morita
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D056346:Sternotomy / Q000379:methods*