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Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy

^a Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
^b Department of Thoracic and Cardiovascular Surgery, Japan Self-Defence Force Central Hospital, Japan
^c Department of Surgery II, National Defense Medical College, Japan

Received 30 March 2008; received in revised form 11 September 2008; accepted 23 September 2008.

^_* Corresponding author. Address: Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. Tel.: +81 78 382 5942; fax: +81 78 382 5959. (Email: yutamo{at}aol.com).

Objective: To present our experience of total aortic arch replacement through a left posterolateral thoracotomy. Methods: Sixteen patients (13 males; mean age 62.1 ± 11.3 years) with extended thoracic aortic aneurysms, including those in the thoracoabdominal aorta, underwent replacement through a left posterolateral thoracotomy. The pathology of the diseased aorta was non-dissecting aneurysm due to aortitis in 1 patient and aortic dissection in 15 patients (acute type A: 1, chronic type A: 12, chronic type B: 2). In a prior operation, the patient with aortitis had undergone the Bentall procedure with endovascular stenting of the brachiocephalic artery, and among the other 15 patients, one previously had endovascular stenting for the aortic arch and 12 had hemi-arch replacement for acute type A dissection. Extension of arch replacement was the aortic arch and descending aorta in eight patients, the ascending arch and descending aorta in five patients and the descending arch, and thoracoabdominal aorta in three patients. Additional retroperitoneal dissection was required for the repair of a thoracoabdominal aortic aneurysm. Results: One patient died of traumatic cerebral hemorrhage on day 145 (hospital mortality 6.3%). Average duration of ventilation support was 19.4 ± 17.0 h and length of ICU stay was 3.6 ± 1.6 days. Actuarial survival at 2 years after the operations was 67.7%. However, no aortic-related mortality was observed during follow-up. Conclusions: Early results of extended aortic arch replacement through a left posterolateral thoracotomy were satisfactory in selected patients.

Key Words: Extended thoracic aneurysm • Left side thoracotomy