Surgical management of extensive dissecting thoracic aortic aneurysm via the semi-clamshell approach

We retrospectively evaluated the initial clinical experience of the surgical management of extensive dissecting thoracic aortic aneurysm (TAA) via the semi-clamshell approach.

Thirteen patients (3 women and 10 men, mean age 67 ± 15 years) who underwent elective surgical intervention for extensive dissecting TAA via semi-clamshell approach in our institute between May 2007 and April 2017 participated in this study. Regarding surgical techniques, left thoracotomy with transverse sternotomy was initially performed via the third or fourth intercostal space following an incision from the right sternal borderline to the anterior axillary line on the left sternal borderline. Cardiopulmonary bypass was then established and extensive graft replacement was conducted with hypothermia.

Extensive total arch replacement (TAR) was performed on 4 patients, TAR with descending thoracic aortic replacement (DTAR) on 4, distal hemiarch replacement with DTAR on 3, and extensive graft replacement from the ascending to descending thoracic aorta on 2. There was one (7.7%) case of surgical and hospital mortality due to low-output syndrome. None of our patients developed respiratory failure requiring secondary tracheotomy; however, new-onset cerebrovascular infarction was noted in 2 (15.4%). No mediastinitis or serious infectious complications were observed after surgery. With a mean follow-up period of 45.1 ± 44.1 months, a Kaplan-Meier analysis revealed that 1- and 5-year survival rates were both 92.3%, respectively.

The surgical management of extensive dissecting TAA by semi-clamshell approach may contribute to acceptable early clinical outcomes in high-risk patients, and represents an alternative surgical option in the current endovascular era.