The clamshell approach for the treatment of extensive thoracic aortic disease

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Management

Background:

• Extensive thoracic aortic disease poses significant surgical challenges.
• Surgical access and exposure dictate single-stage versus two-stage operative approaches.
• Optimal management strategies for complex aortic conditions are continuously sought.

Purpose of the Study:

• To evaluate the safety and efficacy of a single-stage surgical approach for extensive thoracic aortic disease.
• To assess the feasibility of using a bilateral anterior thoracosternotomy (clamshell incision) for complex aortic resections.
• To determine outcomes in patients undergoing single-stage repair of ascending, arch, and descending aorta.

Main Methods:

• Fifteen patients with extensive thoracic aortic disease underwent aortic resection (ascending, arch, descending aorta).
• A single-stage surgical approach utilizing a bilateral anterior thoracosternotomy (clamshell incision) was employed for all patients.
• Concomitant procedures included coronary artery bypass grafting (4 patients) and aortic valve reconstruction (3 patients).

Main Results:

• One hospital death (6.6%) occurred.
• Reoperation for bleeding was required in two patients (13.3%).
• Stroke occurred in three patients (20%), with two experiencing transient neurologic dysfunction (13.3%). No renal failure or wound infections were observed.

Conclusions:

• The single-stage approach via a clamshell incision is a safe and effective strategy for extensive thoracic aortic disease.
• This technique facilitates simultaneous management of complex aortic pathology and concomitant cardiac lesions.
• The clamshell incision provides adequate exposure for complex aortic reconstructions in a single operative session.