title: [Total Aortic Arch Replacement by Minimally Invasive Approach in a Patient with Permanent Tracheostomy;Report of a Case].
abstract: Standard full median sternotomy for total aortic arch replacement in patients with tracheostomy has higher risks for mediastinitis and graft infection. To avoid surgical site infection, it is necessary to keep a sufficient distance between the tracheostomy and the site of surgical skin incision. We herein report a case of a 74-year-old man with permanent tracheostomy after total laryngectomy, who underwent total aortic arch replacement for an aneurysm. Antero-lateral thoracotomy in the 2nd intercostal space with lower partial sternotomy( ALPS approach) provided an enough distance between the tracheostomy and the surgical field. It also provided a good view for surgical procedure and enabled the standard setup of cardiopulmonary bypass with ascending aortic cannulation, venous drainage from the right atrium and the left ventricular venting through the upper right pulmonary vein. The operation was completed in 345 minutes and the patient was discharged on the 11th postoperative day without any complications.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Adachi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Yuri
authors.forename: Harunobu
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.forename: Homare
authors.initials: H
authors.lastname: Okamura
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiraishi
authors.forename: Daijirou
authors.initials: D
authors.lastname: Hori
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome