Resternotomy Plus Left Thoracotomy Surgery after Previous Acute Type A Aortic Dissection Repair

Abstract

Background As the results of acute type A aortic dissection repair have improved, late reoperation for residual dissection has become increasingly important. We report our experience of graft replacement via extended approaches after a previous acute type A aortic dissection repair.

Methods From April 2003 to September 2016, 17 patients underwent reoperation via extended (repeat median sternotomy plus left thoracotomy) approaches after a previous repair of an acute type A aortic dissection at the Matsubara Tokushukai Hospital in Japan and were included in the analyses (males, 16; mean age at surgery, 60.0 ± 9.3 years).

Results The postoperative stroke and in-hospital mortality rates were 0 and 5.9%, respectively.

Conclusion Extended approach after a previous acute type A aortic dissection repair showed acceptable outcomes.

Keywords

resternotomy - reoperation - acute type A aortic dissection

Author Contributions

G.U. assisted with the concept/design of the manuscript and data analysis/interpretation.

T.Y., M.F., and B.K. approved the article.

• References

• 1 Inoue Y, Minatoya K, Oda T. , et al. Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection. Eur J Cardiothorac Surg 2016; 50 (03) 567-573
• 2 Omura A, Miyahara S, Yamanaka K. , et al. Early and late outcomes of repaired acute DeBakey type I aortic dissection after graft replacement. J Thorac Cardiovasc Surg 2016; 151 (02) 341-348
• 3 Kimura N, Itoh S, Yuri K. , et al. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2015; 149 (2, Suppl) S91-8.e1
• 4 Li B, Ma WG, Liu YM, Sun LZ. Is extended arch replacement justified for acute type A aortic dissection?. Interact Cardiovasc Thorac Surg 2015; 20 (01) 120-126
• 5 Poon SS, Theologou T, Harrington D, Kuduvalli M, Oo A, Field M. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis. Ann Cardiothorac Surg 2016; 5 (03) 156-173
• 6 Ishikawa N, Omoto T, Ono M. , et al. Antero-lateral partial sternotomy for extensive thoracic aortic aneurysm. Interact Cardiovasc Thorac Surg 2013; 16 (03) 327-331
• 7 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 (03) 443-449
• 8 Doss M, Woehleke T, Wood JP, Martens S, Greinecker GW, Moritz A. The clamshell approach for the treatment of extensive thoracic aortic disease. J Thorac Cardiovasc Surg 2003; 126 (03) 814-817
• 9 Iwasaki H, Satoh H, Ishizaka T, Matsuda H. Outcomes of single-stage total arch replacement via clamshell incision. J Cardiothorac Surg 2011; 6 (01) 114
• 10 Shimizu H, Takahashi T, Yamazaki M, Anzai T, Kudo M, Yozu R. Extensive total arch replacement via clamshell incision in a patient with aortic arch aneurysm and Stanford type B aortic dissection. Gen Thorac Cardiovasc Surg 2008; 56 (04) 183-186
• 11 Corvera JS, Fehrenbacher JW. Total arch and descending thoracic aortic replacement by left thoracotomy. Ann Thorac Surg 2012; 93 (05) 1510-1515 ; discussion 1515–1516
• 12 Oishi Y, Sonoda H, Tanoue Y. , et al. Advantages of the L-incision approach comprising a combination of left anterior thoracotomy and upper half-median sternotomy for aortic arch aneurysms. Interact Cardiovasc Thorac Surg 2011; 13 (03) 280-283
• 13 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 (06) 750-755
• 14 Okada K, Tanaka A, Munakata H. , et al. Extended replacement of aortic arch aneurysms through left posterolateral thoracotomy. Eur J Cardiothorac Surg 2009; 35 (02) 270-275
• 15 Malvindi PG, Van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation after acute type A aortic dissection repair: a series of 104 patients. Ann Thorac Surg 2013; 95 (03) 922-927
• 16 Preventza O, Price MD, Simpson KH. , et al. Hemiarch and total arch surgery in patients with previous repair of acute type I aortic dissection. Ann Thorac Surg 2015; 100 (03) 833-838
• 17 Kobuch R, Hilker M, Rupprecht L. , et al. Late reoperations after repaired acute type A aortic dissection. J Thorac Cardiovasc Surg 2012; 144 (02) 300-307
• 18 Bajona P, Quintana E, Schaff HV. , et al. Aortic arch surgery after previous type A dissection repair: results up to 5 years. Interact Cardiovasc Thorac Surg 2015; 21 (01) 81-85 ; discussion 85–86
• 19 Shijo T, Kuratani T, Shirakawa Y. , et al. The assessment of collateral communication after hybrid repair for Crawford extent II thoraco-abdominal aortic aneurysms. Eur J Cardiothorac Surg 2015; 48 (06) 960-967 ; discussion 967
• 20 Halstead JC, Meier M, Etz C. , et al. The fate of the distal aorta after repair of acute type A aortic dissection. J Thorac Cardiovasc Surg 2007; 133 (01) 127-135
• 21 Leontyev S, Haag F, Davierwala PM. , et al. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg 2017; 65 (02) 90-98
• 22 Kelly AM, Quint LE, Nan B. , et al. Aortic growth rates in chronic aortic dissection. Clin Radiol 2007; 62 (09) 866-875