Mini open Stent Grafting With Half Sternotomy For Aortic Arch Aneurysm
Tamaki Takano, Takamitsu Terasaki, Masayuki Sakaguchi, Taishi Fujii, Magumi Fuke.
Nagano Red-Cross Hospital, Nagano, Japan.
OBJECTIVE: Aortic arch replacement still considered invasive although organ protection and cardiopulmonary bypass during surgery have improved. Since March of 2015, we performed five cases of open stent grafting with half sternotomy (mini-OSG) for aortic arch aneurysm to reduce operation time and blood loss, which affect clinical outcomes and here reports initial results.
METHODS: Consecutive five cases of mini-OSG were enrolled in this study. Mean age was 62±21 (20-77) years old, and all patients were male. Etiology was dissection in two and aneurysm in three patients. An upper half sternotomy was performed until the fourth intercostal space was reached, and cardiopulmonary bypass was initiated with cannulation of right atrial, femoral artery, left common carotid artery, and right axillary artery. After induction of moderate hypothermia at 24-28ºC of rectal temperature, selective antegrade cerebral perfusion was begun. An open stent graft (Japan Lifeline, Tokyo, Japan) with a 21-33 mm in diameter and 6 or 9 cm in length was inserted via an aortotomy on the arch aortic arch during circulatory arrest. Proximal end of the stent was sutured with aortic wall. Two patients underwent reconstruction of left subclavian artery with prosthetic graft.
RESULTS: No mortality was observed. One patient recovered to live normal daily life although he presented with cerebral infarction. The total operation time was 368±74 min, the cardiopulmonary bypass time was 208±54 min, and the arrest time was 77±30 min. Blood loss was 528±196 ml during the surgery. The patients was weaned from the ventilator 7.1±4.9 hours after the surgery. No pseudoaneurysm or endoleaks was observed during 2-20 months of follow-up period.
CONCLUSIONS: Mini-OSG might be less invasive although further studies with a large number of cases and intensive follow-up are needed.
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