Extended Replacement of the Aortic Arch and Descending Aorta

  • Yutaka Okita
    Address reprint requests to Yutaka Okita, Cardio-Aortic Center, Takatsuki General Hospital, Kosobe 1-3-13, Takatsuki, Osaka 569-1192, Japan.
    Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan

    Kobe University Graduate School of Medicine, Kobe, Japan
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      Objective: Reporting our experience of total arch replacement through the left thoracotomy. Patients: From October 1999 to April 2021, 69 patients, aging 62.4 ± 13.7 years (26-84), underwent extensive aortic arch replacement from the ascending aorta, aortic arch, and to the descending aorta. The aneurysm consisted with 2 acute type A dissection, 35 chronic type A dissection, 1 acute type B dissection, 11 chronic type B dissection, 12 non-dissection plus chronic type B dissection, 11 nondissection with mega-aorta, and 4 Kommerell diverticulum. Various segments of aorta were replaced prior to extensive surgery, such as aortic root 7, ascending aorta 25, arch 3, descending aorta 1, thoracoabdominal aorta 1, and AAA 3. Two had ruptured aneurysm, 2 had intraoperative aortic dissection, 3 had graft infection, 2 had tracheotomy, and 1 had cardiac arrest. Methods: Forty-five patients had left posterolateral thoracotomy, 8 had anterolateral left thoracotomy plus partial midsternotomy, 2 had midsternotomy plus left thoracotomy, 2 had right posterolateral thoracotomy, I had Clamshell bilateral thoracotomy, and 13 had left thoracotomy + retroperitoneal approach. All patients underwent total arch and descending aorta replacement. In addition, three had aortic root replacement, 3 had ST junction plication, on had AVR, 12 had reconstruction of the segmental arteries, 13 had replacement of the thoracoabdominal aorta, and 2 had esophagus resection. Sixty-five had antegrade cerebral perfusion and 4 had deep hypothermic circulatory arrest with retrograde cerebral perfusion. Results: There were 4 early deaths (5.8 %). The causes of deaths were preoperative cardiac arrest due to aneurysm rupture, low cardiac output, acute myocardial infarction, and head injury. Conclusion: Extended replacement of the aortic arch and the descending aorta might be useful for the selected patients.


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        • Borst HG
        • Walterbusch G
        • Schaps D
        Extensive aortic replacement using “elephant trunk” prosthesis.
        Thorac Cardiovasc Surg. 1983; 31: 37-40
        • Svensson LG
        • Shahian DM
        • Davis FG
        • et al.
        Replacement of entire aorta from aortic valve to bifurcation during one operation.
        Ann Thorac Surg. 1994; 58: 1164-1166
        • Kouchoukos NT
        • Mauney MC
        • Masetti P
        • et al.
        Optimization of aortic arch replacement with a one-stage approach.
        Ann Thorac Surg. 2007; 83: S811-S814
        • Safi HJ
        • Miller III CC
        • Estrera AL
        • et al.
        Optimization of aortic arch replacement: two-stage approach.
        Ann Thorac Surg. 2007; 83: S815-S818
        • Tsukube T
        • Yoshimura M
        • Matsuda H
        • et al.
        Rib-cross thoracotomy for replacement of the thoracoabdominal or total descending aorta.
        J Vasc Surg. 2003; 37: 219-221
        • Crawford ES
        • Coselli JS
        • Svensson LG
        • et al.
        Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation.
        Ann Surg. 1990; 211: 521-537
        • Massimo CG
        • Perna AM
        • Cruz Quadron EA
        • et al.
        Extended and total simultaneous aortic replacement: latest technical modifications and improved results with thirty-four patients.
        J Card Surg. 1997; 12: 261-269
        • Minale C
        • Splittgerber FH
        • Reifschneider HJ
        Replacement of the entire thoracic aorta in a single stage.
        Ann Thorac Surg. 1994; 57: 850-855
        • Safi HJ
        • Miller CC
        • Subramaniam MH
        • et al.
        Thoracic and thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass, profound hypothermia, and circulatory arrest via left side of the chest incision.
        J Vasc Surg. 1998; 28: 591-598
        • Mommertz G
        • Langer S
        • Koeppel TA
        • et al.
        Brain and spinal cord protection during simultaneous aortic arch and thoracoabdominal aneurysm repair.
        J Vasc Surg. 2009; 49: 886-892
        • Hino Y
        • Okada K
        • Oka T
        • et al.
        Extended replacement of the thoracic aorta.
        Eur J Cardiothorac Surg. 2013; 43: 176-181
        • Matsueda T
        • Ikeno Y
        • Yokawa K
        • et al.
        One-stage replacement of the aorta from arch to thoracoabdominal region.
        J Thorac Cardiovasc Surg. 2018; 155: 498-504
        • Uchino G
        • Yunoki K
        • Sakoda N
        • et al.
        Operative results of the anterolateral thoracotomy with partial sternotomy approach for chronic-type B aortic dissection involving the aortic arch.
        Interact Cardiovasc Thorac Surg. 2017; 24: 443-449
        • Minatoya K
        • Seike Y
        • Itonaga T
        • et al.
        Straight incision for extended descending and thoracoabdominal aortic replacement: novel and simple exposure with rib-cross thoracotomy.
        Interact Cardiovasc Thorac Surg. 2016; 23: 367-370
        • Hu XP
        • Chang Q
        • Zhu JM
        • et al.
        One-stage total or subtotal aortic replacement.
        Ann Thorac Surg. 2006; 82: 542-546
        • Tokuda Y
        • Oshima H
        • Narita Y
        • et al.
        Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch.
        Interact Cardiovasc Thorac Surg. 2016; 22: 750-755
        • Etz CD
        • Zoli S
        • Kari FA
        • et al.
        Redo lateral thoracotomy for reoperative descending and thoracoabdominal aortic repair: a consecutive series of 60 patients.
        Ann Thorac Surg. 2009; 88: 758-766