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Total Arch Replacement via Single Upper-Hemisternotomy Approach in Patients With Type A Dissection
Hui Jiang1, Yu Liu1, Zhonglu Yang1
1Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
The Annals of Thoracic Surgery
|October 8, 2019
Summary
Single upper hemisternotomy (UHS) is safe for acute type A dissection repair with frozen elephant trunk (FET) implantation. This approach offers shorter ventilation times and less chest tube drainage compared to full sternotomy.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Upper hemisternotomy (UHS) is common for aortic valve replacement.
- The safety of UHS for total arch replacement with frozen elephant trunk (FET) implantation in acute type A dissections is not well-established.
Purpose of the Study:
- To evaluate the safety and efficacy of UHS for total arch replacement combined with FET implantation in patients with acute type A dissections.
Main Methods:
- Retrospective analysis of 153 patients with acute type A dissections undergoing total arch replacement with FET implantation.
- Patients were divided into two groups: single upper hemisternotomy (UHS, n=73) and full sternotomy (FS, n=80).
- Perioperative characteristics and outcomes were compared between the groups.
Main Results:
- No significant differences in preoperative or intraoperative variables between UHS and FS groups.
- Significantly shorter ventilation times were observed in the UHS group (18 hours) compared to the FS group (20.5 hours).
- The UHS group showed significantly less chest tube drainage in the first 24 hours (160 mL) than the FS group (267.5 mL).
Conclusions:
- Total arch replacement with FET implantation via UHS is a safe procedure for acute type A dissections.
- The UHS approach offers potential benefits including reduced ventilation time, less drainage, and a more cosmetic incision.
