title: Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch.
abstract: Total arch replacement via the L-incision approach (a combination of left anterior thoracotomy and upper median sternotomy) can be used to achieve more extensive replacement.
  
  
  
  In the period between 2002 and 2014, 279 total arch replacement procedures were performed. After excluding cases of acute aortic dissection and cases involving concomitant, hybrid or frozen elephant trunk procedures, patients who underwent isolated total arch replacement via an L-incision (n = 29) and via median sternotomy (n = 143) were identified and the data pertaining to their cases were analysed.
  
  
  
  Operative mortality was higher in the L-incision group than in the median sternotomy group (6.9 vs 2.1%); however, the difference was not statistically significant. The L-incision group displayed a higher rate of respiratory complications, including pneumonia (28 vs 7.0%, P = 0.0034), the need for tracheostomy (17 vs 2.1%, P = 0.0038) and pulmonary haemorrhage (6.9 vs 0%, P = 0.028). The rate of paraplegia was similar between the groups (0 vs 1.4%, P = 1.00), despite the wider range replaced via the L-incision approach (7.3 ± 1.5 vs 4.7 ± 0.8 anatomical zones, P < 0.001). The rates of other complications and functional recovery were similar. The long-term survival (73 vs 84% at 5 years) and aortic event-free rates (94 vs 96% at 5 years) were similar in both groups.
  
  
  
  A combination of left anterior thoracotomy and upper median sternotomy can be applied to the single-stage repair of extended aneurysms with acceptable results in appropriately selected patients.
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan tokuda@mxb.mesh.ne.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Tokuda
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Narita
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Mutsuga
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Kazuro
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Sachie
authors.initials: S
authors.lastname: Terazawa
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hibino
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Uchida
authors.affiliation: Department of Vascular Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Komori
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D013908:Thoracotomy / Q000379:methods*
keywords: Extensive thoracic aortic aneurysm; Total arch replacement