[Upper J Partial Sternotomy during Re-do Surgery for a Giant Ascending Aortic Aneurysm]

A 79-year-old woman with a history of aortic valve replacement using a mechanical valve was referred to our hospital due to a giant ascending aortic aneurysm just beneath the sternum. As the initial step of the surgery, the upper sternum was partially divided in J shape under cardiopulmonary bypass with cannulae in the femoral artery and vein. After securing the distal portion of the ascending aorta, full sternotomy was performed, and the ascending aorta was replaced with a vascular prosthesis. Given the sefety of these procedures, we believe that securing the distal portion of the ascending aorta through an upper partial sternotomy at an early stage may be beneficial during surgery for giant ascending aortic aneurysm, as it could help avoid serious bleeding and reduce the risk of invasive strategies, such as deep hypothermia, circulatory arrest, or prolonged cardiopulmonary bypass.