Mini-Aortic Repair For Thoracic Aortic Aneurysm
Daisuke Yasumizu, Takashi Murakami, Hiromichi Fujii, Masanori Sakaguchi, Yosuke Takahashi, Shisuke Nishimura, Yoshito Sakon, Toshihiko Shibata.
Osaka City University, Osaka, Japan.
Minimally invasive procedures are widely adopted in contemporary cardiac surgery, expecting several advantages. However, surgical management of thoracic aortic aneurysms (TAA) remains a complex and challenging operation. We describe our preliminary experiences of mini-aortic repair for TAA via partial upper sternotomy in 6 patients.
This retrospective study includes six patients who underwent mini-aortic repair for TAA between May 2016 and December 2016. Indications for mini aortic repair were: (1) predicted distal anastomosis is close to the sternum, (2) supra aortic vessels are close to the sternum when total arch replacement (TAR) was indicated, and (3) the aneurysms are limited at ascending aorta. For TAR, antegrade cerebral perfusion (ACP) was used, and for hemiarch replacement retrograde cerebral perfusion (RCP) was used. Body temperature during circulatory arrest was 25 ℃ in all cases. The patient’s mean age was 71 years, and four patients (66%) were male.
The surgical procedure was successfully completed in all patients without conversion to full sternotomy. Three patients underwent TAR with frozen elephant trunk (FET), and others underwent ascending aortic replacement. Concomitant operation includes aortic valve repair in 2 patients and aortic valve replacement in one. There was no perioperative death or 30-day mortality.
The mean cardiopulmonary bypass time was 217 min, and circulatory arrest time was 43 min. Even with moderate hypothermia, circulatory arrest with retrograde cerebral perfusion for 27 to 41 min was well tolerated. No postoperative permanent neurological complication occurred. Three patients (50%) experienced pericardiocentesis.
Our preliminary experience suggests that mini-aortic repair for TAA was feasible and could be safely performed despite a limited operative field, without compromising surgical outcomes.
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