Minatoya Kenji
Nationality
Japan
Current Position
Professor and Chairperson
Organization
Graduate School of Medicine, Kyoto University
Thoracic Aorta Session

Topic: One stage repair whole diseased thoracic aorta through left thoracotomy

Abstract

Surgical treatment of extensive aortic lesions often requires staged surgeries or hybrid treatment using stent grafts. However, the staged operations may cause rupture or complications between the operations, and hybrid treatment might cause problems during the remote period of stent grafting. One-stage operation, although more invasive, could solve the issues in that two-stage operations. The surgical field of view is in demand in the one-stage operation, and a variety of approaches are reported.
To obtain the better exposure of the ascending aorta to abdominal aorta, we have utilized novel incision named as Straight Incision with Rib-Cross (SIRC). The skin incision was made from left armpit to left side of umbilicus, and several ribs were divided on the incision. Latissimus dorsi muscle and thoracodorsal artery, which could be an important collateral source to Adamkiewicz artery were preserved. Cardiopulmonary bypass can be established with standard cannulations at femoral artery or ascending aorta as aortic return and femoral vein or pulmonary artery as venous return.
The SIRC approach allows easy exposure of a wide range of aortas from the ascending aorta to the abdominal aorta, even in cases with a flat chest. When the aortic root surgery is needed or the aortic arch is severely atherosclerotic, median sternotomy should be added for the safe procedure.
Although not all cases require one-stage repair, and staged operations should be selected on a case-by-case basis, there may be cases in which one-stage operation is necessary, and therefore, extensive replacement should be considered as a realistic solution.

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