Advantages of the L-incision approach comprising a combination of left anterior thoracotomy and upper half-median sternotomy for aortic arch aneurysms

• Published in: Interactive cardiovascular and thoracic surgery 2011-09, Vol.13 (3), p.280-283
• Main Authors: Oishi, Yasuhisa, Sonoda, Hiromichi, Tanoue, Yoshihisa, Nishida, Takahiro, Tokunaga, Shigehiko, Nakashima, Atsuhiro, Shiokawa, Yuichi, Tominaga, Ryuji
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortography - methods; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Female; Hospital Mortality; Humans; Japan; Kidney Diseases - etiology; Lung Diseases - etiology; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; Sternotomy - adverse effects; Sternotomy - mortality; Surgical Wound Infection - etiology; Thoracotomy - adverse effects; Thoracotomy - mortality; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vocal Cord Paralysis - etiology
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2011.266791

Although surgical outcomes of total arch replacement have improved, the strategy for extended arch aneurysms remains controversial. We have applied the L-incision approach (combination of left anterior thoracotomy and upper half-median sternotomy) for total arch replacement for single-stage repair of extensive arch aneurysms. We retrospectively reviewed the operative outcomes of patients who underwent total arch or extended total arch replacement for degenerative aneurysms from 1999 to 2010. Operations were performed via median sternotomy in 47 patients (M group) and the L-incision approach was used in 38 patients (L group). Through the L-incision approach, we were able to complete distal anastomosis below the pulmonary hilus. The L-incision approach has advantages of reducing selective antegrade cerebral perfusion and lower body circulatory arrest times compared with the M group. Recurrent laryngeal nerve palsy and renal dysfunction were less frequent in the L group than those in the M group. Respiratory dysfunction and wound infection were similar between the groups. Hospital mortalities were 5.3% in the L group and 6.4% in the M group. The L-incision approach has similar or better postoperative outcomes compared with the median sternotomy approach. This approach could be useful for single-stage extended total arch replacement with relatively low risk.