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

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Aneurysm Disease

Background:

• Giant ascending aortic aneurysms pose significant surgical challenges.
• Aortic valve replacement with a mechanical valve is a relevant patient history.
• Accessing the distal ascending aorta can be complex and risky.

Purpose of the Study:

• To describe a modified surgical technique for giant ascending aortic aneurysm repair.
• To evaluate the safety and feasibility of early distal aortic control.
• To minimize risks associated with complex aortic surgeries.

Main Methods:

• A 79-year-old female patient with a giant ascending aortic aneurysm underwent surgical repair.
• Cardiopulmonary bypass was initiated with femoral artery and vein cannulation.
• A J-shaped partial upper sternotomy was performed for initial distal aortic access and control.
• A full sternotomy followed for ascending aorta replacement with a vascular prosthesis.

Main Results:

• The described surgical approach allowed for secure control of the distal ascending aorta.
• The procedure was completed without reported serious bleeding or need for deep hypothermia or circulatory arrest.
• The patient's history of mechanical aortic valve replacement was managed within this surgical context.

Conclusions:

• Early securing of the distal ascending aorta via partial upper sternotomy is a potentially beneficial strategy.
• This technique may reduce the risk of bleeding and the need for invasive measures like deep hypothermia or circulatory arrest.
• This approach offers a safer alternative for managing giant ascending aortic aneurysms, especially in patients with prior cardiac surgery.