Total Arch Replacement via Single Upper-Hemisternotomy Approach in Patients With Type A Dissection

Abstract

Background: An upper hemisternotomy (UHS) tends to be performed for aortic valve replacement. However, the safety of UHS for total arch replacement combined with frozen elephant trunk implantation in patients with acute type A dissections is ambiguous.

Methods: We retrospectively analyzed 162 consecutive patients with acute type A dissections who underwent total arch replacement combined with frozen elephant trunk implantation between May 2016 and April 2018. A total of 153 patients enrolled were included, divided into the UHS group (n = 73, single upper hemisternotomy) and full sternotomy (FS) group (n = 80). Perioperative characteristics were recorded.

Results: There was no significant difference in any preoperative or intraoperative variables between groups. However, ventilation times (18 hours [range, 12-303 hours] versus 20.5 hours [range, 3-244 hours]; P = .002) were significantly shorter in the UHS group compared with the FS one. Results for the first 24 hours of chest tube drainage (160 mL [range, 70-700] versus 267.5 mL [range, 10-1,455 mL]; P = .001) were significantly less in the UHS group than the FS group.

Conclusions: Total arch replacement combined with frozen elephant trunk implantation through a single upper-hemisternotomy approach in patients with acute type A dissections is a safe procedure that adds the benefit of a more cosmetic incision.