title: Total arch replacement for a subacute type A dissection in a patient with a terminal tracheostoma after total laryngectomy: report of a case.
abstract: Standard full median sternotomy for total arch replacement in tracheostomy patients may lead to mediastinitis and graft infection. Several approaches for typical cardiac surgery, including a T-shaped sternotomy, have been used in patients with both terminal and transient tracheostomas; however, these procedures offer inadequate surgical exposure of the arch vessels. We herein report the case of a 67-year-old man with a subacute type A aortic dissection with a terminal tracheostoma after total laryngectomy, who successfully underwent total arch replacement by a fourth intercostal thoracotomy performed using an anterior bilateral approach and the arch-first technique. To our knowledge, this is the first report of a case of total arch replacement in a patient with subacute aortic dissection and a terminal tracheostoma.
authors: Department of Cardiovascular Surgery, Osaka National Hospital, 2-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan.
authors: Daisuke
authors: D
authors: Yoshioka
authors: Toshiki
authors: T
authors: Takahashi
authors: Hitoshi
authors: H
authors: Suhara
authors: Takuya
authors: T
authors: Higuchi
authors: Takayuki
authors: T
authors: Sijo
authors: Shin
authors: S
authors: Yajima
authors: Toru
authors: T
authors: Ishizaka
authors: Hisashi
authors: H
authors: Satoh
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D008297:Male; D013908:Thoracotomy / Q000379:methods*; D014139:Tracheostomy; D058017:Vascular Grafting / Q000379:methods*