Extensive aortic replacement including aortic arch for a mega aorta with chronic aortic dissection via posterolateral thoracotomy

• Published in: Journal of cardiothoracic surgery 2024-09, Vol.19 (1), p.519-6, Article 519
• Main Authors: Ikeda, Shinichiro, Yoshitake, Akihiro, Kumagai, Yu, Oki, Naohiko, Hori, Yuto, Gyoten, Takayuki, Kinoshita, Osamu, Tokunaga, Chiho, Asakura, Toshihisa
• Format: Article
• Language: English
• Subjects: Anastomosis; Aneurysms; Aorta; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - surgery; Aortic aneurysms; Aortic arch; Aortic dissection; Aortic Dissection - complications; Aortic Dissection - surgery; Blood Vessel Prosthesis Implantation - methods; Cardiovascular system; Case Report; Catheters; Chest tubes; Chronic Disease; Chronic kidney failure; Computed tomography; Coronary vessels; Dissecting aneurysm; Dissection; Electrocutions; Extensive thoracic-aortic replacement; Fistula; Humans; Kidney diseases; Male; Mega-aorta; Middle Aged; Mycotic aneurysm; Ostomy; Patients; Pericardium; Posterolateral thoracotomy; Pulmonary arteries; Renal failure; Surgery; Thoracotomy - methods; Thorax; Tomography, X-Ray Computed; Veins & arteries
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-03031-z

Mega-aortic syndrome including aortic arch and descending aortic aneurysm is a challenging surgical case. Because the aorta continuously dilates, creating the distal anastomosis sites becomes an issue. Despite the developments in endovascular techniques including frozen elephant trunk, in the case of mega-aortic syndrome or mycotic aneurysm, extensive surgical repair is still a strong armamentarium. Our patient had a mega-aorta with chronic aortic dissection. Herein, we show tips regarding concurrent ascending, aortic arch, and descending aortic replacement via posterolateral thoracotomy for this relatively young patient. A 46-year-old man with chronic kidney disease had chronic type A aortic dissection with an extensively dilated thoracic aorta from the distal ascending to the descending aorta measuring 63 mm in diameter and abdominal aorta measuring 50 mm. The short segment of the distal descending aorta was narrowed to 36 mm. The patient underwent a concurrent replacement of the distal ascending aorta, aortic arch, and descending aorta via a posterolateral thoracotomy. The patient was extubated on postoperative day (POD) 1 and discharged home without serious complications such as stroke, respiratory failure, or renal failure on POD 18. The 1-year follow-up computed tomography did not find issues in the anastomosis sites; however, the abdominal aorta enlarged from 50 to 58 mm. The patient underwent a thoracoabdominal aortic replacement and recovered well without any complications. Good exposure and meticulous organ protection methods are key to a safe concurrent replacement of the ascending, aortic arch, and descending aorta via posterolateral thoracotomy.