Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy

J Thorac Cardiovasc Surg. 2011 Aug;142(2):314-8. doi: 10.1016/j.jtcvs.2010.10.032. Epub 2011 Feb 1.

Abstract

Objective: Hybrid thoracic endovascular aortic repair (TEVAR) has expanded the surgical management of complex thoracic aneurysms. Aortic arch debranching generally requires a sternotomy. We describe our experience performing a right anterior minithoracotomy for hybrid TEVAR.

Method: During a 3-year period, 7 patients (aged 76 ± 15 years; 57% were male) with aortic arch aneurysms underwent hybrid TEVAR via a right anterior minithoracotomy. Of all with prior thoracic or abdominal aortic surgery, 4 had a prior sternotomy. All patients included in this series had an American Society of Anesthesiology score of 4 or greater.

Results: Repairs were performed via a 5-cm incision at the third to fourth intercostal space to access the ascending arch. A Satinsky clamp on the ascending aorta facilitated bypass with the 10-mm arm of a bifurcated 10/12-mm graft to the innominate artery or right common carotid artery (12-mm arm: endoprosthesis conduit). The remaining arch vessels were bypassed as needed; subsequently, a thoracic stent graft was deployed by the 12- or 14-mm arm. Primary technical success was 86% (6 patients); 1 patient required conversion to sternotomy secondary to bleeding. Complications included cerebrovascular accident in 2 patients (28%) and respiratory failure in 2 patients (28%). The average length of stay was 12 days with no wound infection. One death occurred during the 30-day period.

Conclusions: Right anterior minithoracotomy is a compelling, less invasive technique for hybrid TEVAR. Further experience will be necessary to completely evaluate the merits of this approach.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Thoracic / surgery*
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Postoperative Complications
  • Sternotomy
  • Thoracotomy / methods*