Abstract
The initial stage mortality rate in hospital of type B acute aortic dissection is still as high as 8.8 to 15%. The survival rate in cases in which rupture is cited as a cause is reported to be 50% or lower. We report that we were able to save the lives of 2 patients who had suffered ruptures, using the type B acute aortic dissection by the L-incision approach proposed by Tominaga et al.
Case 1 was a 60-year old man given a diagnosis of rupture according to the results of computed tomography (CT) obtained 3 days after the onset. Arch replacement was performed by an L-incision approach under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. The postoperative complication of left lower limb paresis improved and the patient was able to walk by himself when he was discharged.
Case 2 was a 43-year old man given a diagnosis of a rupture, according to the results of CT obtained after the onset of back pain. While being examined, he fell in to a semi-shock state. Extracorporeal circulation was established by an upper left partial sternotomy for proximal aortic perfusion, after which left anterolateral thoracotomy was also performed in combination with arch replacement. No postoperative complication occurred and the patient was discharged.
Since the L-incision enables both a median incision of the sternum and left thoracotomy, it is possible to promptly establish antegrade extracorporeal circulation, which enables the selection of the most appropriate prophylactic measures against cerebral and cardiac complications. Therefore, the L-incision is expected to contribute to an improvement in survival in cases of type B acute aortic dissection.
