Total arch and descending thoracic aortic replacement by left thoracotomy

Area of Science:

• Cardiovascular Surgery
• Thoracic Aortic Aneurysm Repair
• Minimally Invasive Techniques

Background:

• Hybrid treatments for transverse aortic arch pathologies have high morbidity and mortality.
• Traditional two-stage open repair for extensive thoracic aortic aneurysms carries significant interval mortality.
• A single-stage left thoracotomy technique for total arch and descending thoracic aorta replacement is presented.

Purpose of the Study:

• To evaluate the safety and efficacy of a single-stage left thoracotomy for total aortic arch and descending thoracic aorta replacement.
• To assess short-term and long-term outcomes of this technique.
• To compare this approach with traditional multi-stage or hybrid methods.

Main Methods:

• A cohort of 27 highly selected patients underwent total arch and descending thoracic/thoracoabdominal aortic replacement via left thoracotomy between 1995 and 2011.
• Procedures utilized hypothermic circulatory arrest and selective antegrade cerebral perfusion.
• Concomitant cardiac procedures were performed in some patients.

Main Results:

• No hospital deaths or cerebrovascular accidents occurred.
• One case of transient spinal cord ischemia and three instances of acute renal failure (not requiring hemodialysis) were reported.
• Survival rates at 1, 3, and 5 years were 95%, 78%, and 73%, respectively.

Conclusions:

• Single-stage total arch and descending thoracic aorta replacement via left thoracotomy yields excellent short- and long-term results for extensive aortic pathology.
• This technique eliminates the need for a second-stage operation.
• Concurrent treatment of other cardiac conditions, like coronary and mitral valve disease, is feasible.