title: An alternative method for reconstructing the distal aortic arch through median sternotomy via the pleural window.
abstract: We describe an alternative technique through median sternotomy to perform total arch replacement for an extended distal arch aneurysm. After initiating cardiopulmonary bypass, the left pleura is opened widely from the aortic arch to the diaphragm and the left lung is mobilized to the right side with the heart. The descending aorta is visible through the window of the pleural incision. This technique provides excellent exposure, facilitating aneurysm resection, control of the descending aorta and successful completion of the distal anastomosis. In our experience of 26 cases who had distal aortic arch aneurysm with downstream extension, total arch replacement was achieved through a median sternotomy without the need for left anterolateral thoracotomy. This procedure reduced perioperative bleeding and resulted in satisfactory clinical outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Japan. shogo4405jp@yahoo.co.jp
authors.forename: Shogo
authors.initials: S
authors.lastname: Mukai
authors.forename: Shogo
authors.initials: S
authors.lastname: Obata
authors.forename: Hironobu
authors.initials: H
authors.lastname: Morimoto
authors.forename: Naomichi
authors.initials: N
authors.lastname: Uchida
mesh_terms: 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 / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome