A New Approach Through a Median Sternotomy for Primary Reconstruction of Extensive Distal Aortic Arch

Abstract

We report a new approach through a median sternotomy for the primary reconstruction of extensive distal aortic arch. Cardiopulmonary bypass was established by cannulating the ascending aorta, and either the femoral or right axillary artery. We opened the left pleura extensively from the aortic arch to the diaphragm and moved the left lung to the right side, together with the heart. Most of the descending aorta was visible from a high-angle view. At the aneurysmal site we skeletonized and resected the descending aorta and anastomosed the distal end of a four-branched graft by the ‘turn-up’ method. This technique includes eversion of the ends of the graft, which allows excellent cross-sectional exposure of the aorta and the graft. In our experience of 24 cases with distal aortic arch aneurysm and downstream extension, total arch replacement was achieved through median sternotomy without the need for left anterolateral thoracotomy. This procedure reduced perioperative bleeding and resulted in satisfactory clinical outcomes.