Mukai Shogo, Obata Shogo, Morimoto Hironobu, Uchida Naomichi
Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
Interact Cardiovasc Thorac Surg. 2012 May;14(5):526-8. doi: 10.1093/icvts/ivs013. Epub 2012 Feb 16.
We describe an alternative technique through median sternotomy to perform total arch replacement for an extended distal arch aneurysm. After initiating cardiopulmonary bypass, the left pleura is opened widely from the aortic arch to the diaphragm and the left lung is mobilized to the right side with the heart. The descending aorta is visible through the window of the pleural incision. This technique provides excellent exposure, facilitating aneurysm resection, control of the descending aorta and successful completion of the distal anastomosis. In our experience of 26 cases who had distal aortic arch aneurysm with downstream extension, total arch replacement was achieved through a median sternotomy without the need for left anterolateral thoracotomy. This procedure reduced perioperative bleeding and resulted in satisfactory clinical outcomes.
我们描述了一种通过正中胸骨切开术进行全弓置换以治疗累及远端弓部的动脉瘤的替代技术。开始体外循环后，将左胸膜从主动脉弓至膈肌广泛切开，将左肺与心脏一起向右侧游离。通过胸膜切口的窗口可看到降主动脉。该技术提供了极佳的视野，便于动脉瘤切除、降主动脉控制以及远端吻合的顺利完成。在我们对26例伴有下游延伸的远端主动脉弓动脉瘤患者的经验中，通过正中胸骨切开术成功实现了全弓置换，无需进行左前外侧开胸手术。该手术减少了围手术期出血，并产生了令人满意的临床结果。
