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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Antero-lateral partial sternotomy for extensive thoracic aortic aneurysm.
Noboru Ishikawa1, Tadashi Omoto, Masahiro Ono
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan. nobo.ishikawa@gmail.com
Interactive Cardiovascular and Thoracic Surgery
|December 18, 2012
Summary
The antero-lateral partial sternotomy (ALPS) approach offers a less invasive option for extensive thoracic arch aneurysm (ETAA) repair. This technique allows for accurate reconstruction of distal anastomosis without major complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Surgical management of aortic arch aneurysms extending to the descending aorta is complex.
- The antero-lateral partial sternotomy (ALPS) approach is a less invasive alternative for extensive thoracic arch aneurysm (ETAA).
Purpose of the Study:
- To evaluate the efficacy and outcomes of the ALPS approach for ETAA.
- To compare ALPS with conventional median sternotomy (MS) for total arch replacement.
Main Methods:
- 18 patients with ETAA underwent total arch replacement using the ALPS approach.
- Outcomes were compared to 22 patients who had total arch replacement via median sternotomy.
- Key outcome measures included operative time, cardiopulmonary bypass time, distal anastomosis level, complications, and mortality.
Main Results:
- No hospital mortality was observed in the ALPS group.
- Operative time and cardiopulmonary bypass time were similar between ALPS and MS groups.
- The ALPS approach achieved a significantly lower (more distal) vertebral level for anastomosis compared to MS (P < 0.0001).
Conclusions:
- The ALPS approach provides adequate surgical exposure for complex aortic arch aneurysms.
- It facilitates accurate reconstruction of the distal anastomosis.
- The ALPS technique is associated with minimal major complications for ETAA repair.
