Mini-Total Aortic Arch Repair
TAKASHI MURAKAMI, MD, PhD, Hiromichi Fujii, Yosuke Takahashi, Akimasa Morisaki, Shinsuke Nishimura, Yoshito Sakon, Kokoro Yamane, Toshihiko Shibata.
Osaka City University Graduate School of Medicine, Osaka, Japan.
OBJECTIVE: In mini-aortic arch repair, access to the distal supra-aortic branches from limited operative field is challenging. We adopted supraclavicular medial approach to expose both the left common carotid artery and the left subclavian artery, where reconstruction of both arteries is easily accomplished.
METHODS: The patient is a 74-year-old woman with distal arotic arch aneurysm. L-shaped upper partial sternotomy to the left 4th intercostal space is performed, and cardiopulmonary bypass (CPB) is established with central aortic cannulation and femoral venous cannulation. The left common carotid and the left subclavian artery are exposed through supracalavicular medial approach with 3 cm skin incision, where anastomosis of the prosthetic graft is easily performed. Frozen elephant trunk is inserted to the distal aorta under hypothermic circulatory arrest and selective cerebral perfusion.
RESULTS: CPB and circulatory arrest time was 251 minutes and 52 minutes, respectively. Postoperative complications included delayed cardiac tamponade. Postoperative computed tomography revealed complete exclusion of the aortic aneurysm and patent supraaortic branches.
CONCLUSIONS: Supraclavicular medial approach for the exposure and reconstruction of the left common carotid and the left subclavian artery seemed to be safe and feasible option in mini-aortic arch repair.
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