Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy.

Abstract

OBJECTIVE:

Hybrid thoracic endovascular aortic repair (TEVAR) has expanded the surgical management of complex thoracic aneurysms. Aortic arch debranching generally requires a sternotomy. We describe our experience performing a right anterior minithoracotomy for hybrid TEVAR.

METHOD:

During a 3-year period, 7 patients (aged 76 ± 15 years; 57% were male) with aortic arch aneurysms underwent hybrid TEVAR via a right anterior minithoracotomy. Of all with prior thoracic or abdominal aortic surgery, 4 had a prior sternotomy. All patients included in this series had an American Society of Anesthesiology score of 4 or greater.

RESULTS:

Repairs were performed via a 5-cm incision at the third to fourth intercostal space to access the ascending arch. A Satinsky clamp on the ascending aorta facilitated bypass with the 10-mm arm of a bifurcated 10/12-mm graft to the innominate artery or right common carotid artery (12-mm arm: endoprosthesis conduit). The remaining arch vessels were bypassed as needed; subsequently, a thoracic stent graft was deployed by the 12- or 14-mm arm. Primary technical success was 86% (6 patients); 1 patient required conversion to sternotomy secondary to bleeding. Complications included cerebrovascular accident in 2 patients (28%) and respiratory failure in 2 patients (28%). The average length of stay was 12 days with no wound infection. One death occurred during the 30-day period.

CONCLUSIONS:

Right anterior minithoracotomy is a compelling, less invasive technique for hybrid TEVAR. Further experience will be necessary to completely evaluate the merits of this approach.

• Authors: Javier E Anaya-Ayala, Zulfiqar F Cheema, Mark G Davies, Jean Bismuth, Basel Ramlawi, Alan B Lumsden, Michael J Reardon
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 142 Issue 2 Pg. 314-8 (Aug 2011) ISSN: 1097-685X [Electronic] United States
• PMID: 21281945 (Publication Type: Journal Article)
• Copyright: Copyright © 2011. Published by Mosby, Inc.

Topics

• Aged
• Aged, 80 and over
• Aortic Aneurysm, Thoracic (surgery)
• Endovascular Procedures (methods)
• Female
• Humans
• Length of Stay
• Male
• Postoperative Complications
• Sternotomy
• Thoracotomy (methods)