Aortic Arch Replacement Procedure Extended Aortic Arch Replacement Through the L-lncision Approach

摘要

The operative results in surgery for aortic arch aneurysms are decided by several factors including preoperative patient condition, strategies for perfusion (how to cool patients), brain protection, myocardial protection, visceral organ protection, and adequate hemostasis at the anastomosis sites. Among various surgical approaches, a median sternot-omy is most frequently used for total aortic arch replacement. However, in patients who have arch aneurysms extended to the descending aorta, the exposure afforded by the median sternotomy is less than ideal. Inadequate visualization of the proximal descending aorta may result in distal anastomotic bleeding and pseudoaneurysmal formation. The combination of a full median sternotomy and left thoracotomy has been used in such patients who need the extended total arch replacement. This extensive incision may provide excellent operative exposure; however, the postoperative morbidity is considered excessive. The "L-incision" approach (a combination of a left anteriorthoracotomy and upper half median sternotomy) is thought to be less invasive and offer adequate operative field for extensive replacement of the aortic arch. We herein describe the L-incision approach1 in addition to our "proximal-first technique"2 for atherosclerotic extensive arch aneurysms.