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Chirurgia 2017 August;30(4):128-31

DOI: 10.23736/S0394-9508.16.04627-1

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Early and late results of distal arch replacement through median sternotomy

Takamitsu TERASAKI, Kazunori NISHIMURA, Tamaki TAKANO , Masayuki SAKAGUCHI, Megumi FUKE, Taishi FUJII

Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan


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BACKGROUND: We performed distal arch replacement through a median approach with preservation of the healthy proximal arch and neck vessels for treatment of distal arch aneurysm. We herein report the early operative results and late outcomes of this procedure, including changes in the size of the remaining arch and thoracic aorta.
METHODS: Twenty-three patients underwent elective distal arch replacement through a median approach at Nagano Red Cross Hospital. The proximal end of the aneurysm was located in zone 1 in 21.7% of the patients, zone 2 in 39.1%, and zone 3 in 39.1%. We performed distal arch replacement without ascending aortic reconstruction. We utilized selective cerebral perfusion and hypothermic circulatory arrest for organ protection.
RESULTS: Neither operative mortality nor postoperative low cardiac output syndrome occurred in all 23 patients. Two patients (8.7%) developed perioperative stroke. Two cardiovascular-related deaths occurred in the late period. Postoperative computed tomography showed that the maximal aortic diameter of the proximal arch increased by 0.8±1.9 mm while that of the distal arch increased by 3.9±9.4 mm during a postoperative follow-up period of 9.2±4.7 years.
CONCLUSIONS: The early results of distal arch replacement through a median sternotomy showed clinical outcomes equivalent to those of total arch replacement via a median approach for treatment of distal arch aneurysm. This procedure could be an alternative technique for distal arch aortic aneurysm repair when the proximal arch and neck vessels are not diseased.


KEY WORDS: Sternotomy - Treatment outcome - Aneurysm

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