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Updated: May 7, 2026
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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
10.9K
[Total debranching through mini-sternotomy]
Kosuke Ujihira1, Kiyofumi Morishita, Tsuyoshi Shibata
1Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|October 10, 2013
Summary
Total debranching facilitates thoracic endovascular aortic arch repair (TEVAR) by creating adequate landing zones. This technique enhances safety and efficacy for complex aortic arch aneurysms.
Area of Science:
- Vascular Surgery
- Thoracic Surgery
- Endovascular Repair
Context:
- Aortic arch aneurysms present significant surgical challenges for thoracic endovascular aneurysm repair (TEVAR).
- Existing techniques like debranching or hybrid TEVAR offer partial solutions but require further optimization for adequate proximal sealing.
- Achieving sufficient proximal neck length (>2.5 cm) is crucial for successful TEVAR in the aortic arch.
Purpose:
- To describe a novel total debranching technique to facilitate TEVAR in aortic arch aneurysms.
- To present a modified surgical approach ensuring adequate proximal landing zones for TEVAR.
- To highlight the benefits of specific procedural elements in complex aortic arch aneurysm repair.
Summary:
- A total debranching strategy was employed to achieve a proximal neck length exceeding 2.5 cm for TEVAR.
- The procedure incorporates a mini-thoracotomy to reduce surgical stress and mitigate respiratory complications.
- Key technical features include side-to-side anastomosis with the ascending aorta to prevent kinking and the use of a Pruitt-Inahara shunt for carotid artery anastomoses.
Impact:
- This approach potentially improves the safety and feasibility of TEVAR for challenging aortic arch aneurysms.
- Minimally invasive techniques like mini-thoracotomy can reduce postoperative morbidity.
- Optimized graft anastomosis and shunting strategies contribute to better surgical outcomes in complex aortic reconstructions.
