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

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.

Bicuspid aortic valve with critical coarctation of the aorta: single- or two-stage operation?

“…In our center, we prefer using a bypass graft to avoid the neurological complications such as laryngeal nerve palsy or spinal cord ischemia, since the lesion is often long and complex in patients of BAV with CoA. However, the new single-stage procedure reported for such patients provides us another choice (8,12,19,21). During this operation, routine cardiopulmonary bypass is initiated, and the extra-anatomic bypass from the ascending aorta to the descending aorta is ideally anastomosed first to supply the descending aorta before cardioplegia is delivered.…”

“…The single-stage procedure commonly involved an extraanatomic bypass from the ascending aorta to the distal aorta of the narrow segment and other surgical repairs for cardiac defects (mainly aortic valve dysfunction) through a median sternotomy (8,12,19,21). In most cases, the extraanatomic bypass procedure was performed as soon as the cardiopulmonary bypass was initiated by cannulating the ascending aorta.…”

“…A bicuspid aortic valve (BAV) is the most common congenital heart disease with a reported incidence of about 1% to 2% in the general population (1)(2)(3)(4)(5). It may occur as either an isolated cardiac defect or in association with other congenital heart malformations (1,(3)(4)(5)(6)(7)(8)(9)(10). The most well-known anomaly associated with a BAV is aortopathy (1,(3)(4)(5)(6)(7)(8)(9)(11)(12)(13), which include coarctation of the aorta (CoA), aortic dissection, or aortic aneurysm.…”

“…It may occur as either an isolated cardiac defect or in association with other congenital heart malformations (1,(3)(4)(5)(6)(7)(8)(9)(10). The most well-known anomaly associated with a BAV is aortopathy (1,(3)(4)(5)(6)(7)(8)(9)(11)(12)(13), which include coarctation of the aorta (CoA), aortic dissection, or aortic aneurysm. According to previous literatures, patients with BAV had a higher incidence of CoA than other aortic defects (14)(15)(16)(17), leading to increased morbidity and mortality (1,(14)(15)(16)(17)(18).…”

Open Stented Grafts for Frozen Elephant Trunk Technique: Technical Aspects and Current Outcomes

“…In deployment, holding the grip handle in position and pulling back the release knob along with the sheath will release the whole prosthesis ( Figure 11) (see supplemental Video 4 at http:// dx.doi.org/10.12945/j.aorta.2015.14.062.vid.04). For distal anastomosis, four 4-0 polypropylene stay sutures are placed first, followed by running stiches of 4-0 polypropylene reinforced by a felt strip [62]. The arch vessels are reconstructed with a separate branched graft in an end-to-end fashion [61,63].…”