Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy

Javier E. Anaya-Ayala, Zulfiqar Cheema, Mark G. Davies, Jean Bismuth, Basel Ramlawi, Alan B. Lumsden, Michael J. Reardon

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)314-318
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Thorax
Sternotomy
Arm
Thoracic Aorta
Brachiocephalic Trunk
Transplants
Anesthesiology
Aortic Aneurysm
Common Carotid Artery
Wound Infection
Respiratory Insufficiency
Stents
Aneurysm
Aorta
Length of Stay
Stroke
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Anaya-Ayala, J. E., Cheema, Z., Davies, M. G., Bismuth, J., Ramlawi, B., Lumsden, A. B., & Reardon, M. J. (2011). Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy. Journal of Thoracic and Cardiovascular Surgery, 142(2), 314-318. https://doi.org/10.1016/j.jtcvs.2010.10.032

Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy. / Anaya-Ayala, Javier E.; Cheema, Zulfiqar; Davies, Mark G.; Bismuth, Jean; Ramlawi, Basel; Lumsden, Alan B.; Reardon, Michael J.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 2, 08.2011, p. 314-318.

Research output: Contribution to journalArticle

Anaya-Ayala, JE, Cheema, Z, Davies, MG, Bismuth, J, Ramlawi, B, Lumsden, AB & Reardon, MJ 2011, 'Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy', Journal of Thoracic and Cardiovascular Surgery, vol. 142, no. 2, pp. 314-318. https://doi.org/10.1016/j.jtcvs.2010.10.032
Anaya-Ayala, Javier E. ; Cheema, Zulfiqar ; Davies, Mark G. ; Bismuth, Jean ; Ramlawi, Basel ; Lumsden, Alan B. ; Reardon, Michael J. / Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 2. pp. 314-318.
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