Extended total arch replacement via the L-incision approach: Single-stage repair for extensive aneurysms of the aortic arch

Yoshiyuki Tokuda, Hideki Oshima, Yuji Narita, Tomonobu Abe, Masato Mutsuga, Kazuro Fujimoto, Sachie Terazawa, Hideki Ito, Makoto Hibino, Wataru Uchida, Kimihiro Komori, Akihiko Usui

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Original languageEnglish
Pages (from-to)750-755
Number of pages6
JournalInteractive Cardiovascular and Thoracic Surgery
Volume22
Issue number6
DOIs
Publication statusPublished - 25-06-2016
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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