Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta.

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic and Cardiovascular Surgery Pub Date : 2023-02-20 DOI:10.5761/atcs.ra.22-00148
Norihiko Shiiya, Naoki Washiyama, Daisuke Takahashi, Kazumasa Tsuda, Yuko Ohashi, Kayoko Natsume, Masahiro Hirano
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Abstract

Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.

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从升主动脉到远降主动脉单期扩展主动脉修复的手术入路。
从升主动脉到远降主动脉或更远的单阶段扩展置换术是一项艰巨的手术,应该为那些没有其他选择或身体健康的人保留,并应在经验丰富的中心进行。经胸骨正中切口胸椎血管内主动脉修补术与开放式主动脉修补术相结合的混合手术,其创伤性比开放式主动脉修补术小,脊髓缺血风险比冷冻象鼻手术低。然而,这些手术与血管内动脉瘤排除术的固有缺点有关。当潜在的主动脉病理需要在单期扩大开放主动脉修复时,如胸骨前外侧部分切开、肋骨交叉直切口、胸骨横断扩大开胸等入路可为主动脉重建和器官保护提供足够的暴露,对患者的手术压力较小。
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来源期刊
Annals of Thoracic and Cardiovascular Surgery
Annals of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-SURGERY
CiteScore
2.80
自引率
0.00%
发文量
56
审稿时长
4-8 weeks
期刊介绍: Information not localized
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