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Mini-access open arch repair

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Abstract
Background: The use of minimally invasive approaches is scarce in open aortic arch repair because of its perceived high operative risk and technical difficulty.

Methods: This study enrolled 59 consecutive patients (aged 58.2 +/- 13.2 years) undergoing elective arch replacement either through upper hemi-sternotomy (n=58) or mini-thoracotomy (n=1) between 2015 and 2020. Of these, 44 underwent hemiarch replacement and 15 underwent total arch replacement. Moderate hypothermic circulatory arrest was used for all patients while antegrade cerebral perfusion was selectively used for total arch repair. For more efficient distal aortic anastomosis in limited spaces, inverted graft anastomosis was utilized whenever possible.

Results: Hemi-sternotomy involved upper sternal separation down to the second, third, and fourth intercostal spaces in 1 (1.7%), 30 (50.8%), and 27 (45.8%) patients, respectively. Concomitant cardiac procedures included root replacement in 19 patients (32.2%) and aortic valve replacement in 21 patients (35.6%). Circulatory arrest, cardiac ischemic, cardiopulmonary bypass, and total procedural times were 8.9 +/- 3.4, 91.1 +/- 31.1, 114.6 +/- 46.2, and 250.3 +/- 79.5 min, respectively for total arch repair, and 25.0 +/- 12.1, 72.3 +/- 16.6, 106.0 +/- 16.9, and 249.1 +/- 41.7 min, respectively for hemiarch repair. Conversion to full-sternotomy was required in 1 patient (1.7%) due to bleeding. There was one case of mortality (1.7%) attributable to low-cardiac output syndrome following hemiarch repair concomitantly with Bentall procedure. Major complications included requirement for mechanical support in 1 (1.7%), temporary neurologic deficit in 1 (1.7%), newly initiated dialysis in 3 (5.1%), and re-exploration due to bleeding in 2 (3.4%).

Conclusions: Mini-access open arch repair is technically feasible and achieved excellent early outcomes.
Author(s)
김시아옥유정표원경김호진김준범
Issued Date
2021
Type
Article
Keyword
Aortic arch surgeryminimally invasiveOriginalpartial sternotomy
DOI
10.21037/jtd-20-3254
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8765
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8107538&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Mini-access%20open%20arch%20repair&offset=0&pcAvailability=true
Publisher
JOURNAL OF THORACIC DISEASE
Location
홍콩
Language
영어
ISSN
2072-1439
Citation Volume
13
Citation Number
4
Citation Start Page
2233
Citation End Page
2241
Appears in Collections:
Medicine > Medicine
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