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. 2016 Jun;22(6):750-5.
doi: 10.1093/icvts/ivw034. Epub 2016 Feb 29.

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

Yoshiyuki Tokuda  1 , Hideki Oshima  2 , Yuji Narita  2 , Tomonobu Abe  2 , Masato Mutsuga  2 , Kazuro Fujimoto  2 , Sachie Terazawa  2 , Hideki Ito  2 , Makoto Hibino  2 , Wataru Uchida  2 , Kimihiro Komori  3 , Akihiko Usui  2
Affiliations

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

Yoshiyuki Tokuda et al. Interact Cardiovasc Thorac Surg. 2016 Jun.

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.

Keywords: Extensive thoracic aortic aneurysm; Total arch replacement.

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Figures

Figure 1:
Figure 1:
An L-incision made by a combination of left anterior thoracotomy and upper median sternotomy.
Figure 2:
Figure 2:
Long-term survival by Kaplan–Meier estimate.
Figure 3:
Figure 3:
Freedom from aortic event.
See this image and copyright information in PMC

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