Clamshell thoracosternotomy for single-stage repair of select aortic arch pathologies

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Median sternotomy limits distal aortic arch repair.
• Bilateral thoracosternotomy (clamshell) is an alternative for extensive aortic arch and descending aorta repair.
• This approach allows for single-stage repair.

Purpose of the Study:

• To evaluate the institutional experience with bilateral thoracosternotomy (clamshell) for aortic arch surgery.
• To assess the safety and efficacy of the clamshell approach for complex aortic arch repairs.

Main Methods:

• Retrospective review of 18 patients undergoing clamshell thoracosternotomy for aortic arch surgery (2005-2022).
• Primary outcomes: 30-day/in-hospital mortality and major morbidity (stroke, paraplegia, renal failure).
• Secondary outcomes: Late survival and reintervention rates.

Main Results:

• 18 patients (67% male, median age 52) underwent clamshell repair.
• Indications included dissection, aneurysm, and coarctation.
• Low operative mortality (6%) and no major morbidity (stroke, paraplegia, renal failure).
• 1-year survival 94%, 5-year survival 72%. Aorta-specific survival 94% at 1 and 5 years.
• No aortic reinterventions at median 60-month follow-up.

Conclusions:

• Clamshell thoracosternotomy is a safe and effective approach for single-stage complex aortic arch and descending aorta repair.
• This technique is particularly beneficial for patients with heritable thoracic aortic disease or anatomy unsuitable for endovascular repair.