An alternative method for reconstructing the distal aortic arch through median sternotomy via the pleural window.

Interactive Cardiovascular and Thoracic Surgery
Shogo MukaiNaomichi Uchida

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.

References

Dec 31, 1998·The Journal of Thoracic and Cardiovascular Surgery·C K Rokkas, N T Kouchoukos
Sep 23, 2003·The Journal of Thoracic and Cardiovascular Surgery·Mirko DossAnton Moritz
Feb 3, 2007·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Nobushige TamuraTaira Kobayashi
Jun 17, 2008·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Christian D EtzRandall B Griepp

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