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Early results of aortic arch surgery under partial sternotomy
Yosuke Inoue, Kenji Minatoya, Tatsuya Oda, Tatsuya Itonaga, Yoshimasa Seike, Hiroshi Tanaka, Hiroaki Sasaki, Junjiro Kobayashi
National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Department of Cardiovascular Surgery
Objective:
Partial sternotomy with limited skin incision has been utilized for cardiac surgery. With the establishment of the strategy for aortic arch surgery, the operative results have been remarkably improved in recent years. We, therefore, started to apply the partial sternotomy for aortic arch surgery since 2013 in selected cases. The aim of this study reported the results of our early experiences.
Methods:
Between July 2013 and December 2015, we retrospectively reviewed 23 cases (Median age: 70, range 38-84, 16 male) who underwent aortic arch surgery thorough partial sternotomy. All aortic pathology was degenerative disease except for 1 chronic dissection. Nine patients added the inguinal incision to establish the cardiopulmonary bypass. Main procedures consist of 8 case of hemiarch replacement and 15 cases of total arch replacements. As concomitant procedures, 2 cases had aortic valve surgery. All procedures were performed under moderate hypothermic circulatory arrest with selective cerebral perfusion.
Results:
Median skin incision was 8cm (range 7-15cm, 4.9 % of height) and partial sternotomy consisted of 21 upper and 2 lower partial sternotomy (L shape 11 and T shape 12 cases). Median operation time, cardiopulmonary bypass time, ischemic heart time, selective cerebral perfusion time and hypothermic circulatory arrest time were 406 [274-770], 218 [140-270], 135 [88-154], 134 [23-169], and 62 [25-90] minutes, respectively. Median duration of ventilator dependent time was 12 hours [5-38]. Median length of ICU stay and hospital stay were 2 [1-7], and 16 [10-55] days, respectively. Thirty days and in-hospital mortality were 0% without any neurological complications. There are two aorta-related reoperation due to graft inducing hemolytic anemia and no aorta related death during follow up (median: 360,range 31-867 days).
Conclusion:
The early results of aortic arch surgery through partial sternotomy were satisfactory. We need
long-term follow up data and try to establish the standardization of surgical strategy.