Anterolateral Thoracotomy for Distal Aortic Arch Disease

Abstract

Optimal exposure and antegrade arterial perfusion are keys to avoiding complications in the repair of distal aortic arch disease. To achieve these ends, we performed distal aortic arch repair through a left anterolateral thoracotomy while also using axillary artery perfusion. From Mach 1998 to December 2004, 28 patients (23 men and 5 women, age 65.2 +/- 12.0 years) underwent a distal aortic arch repair through a left anterolateral thoracotomy. All cases had atherosclerotic aneurysms. Emergency surgery was performed in 1 of these cases (1/28, 3.6%) with an aortic rupture. The right axillary artery was used for arterial perfusion in all cases. No perfusion problems occurred during surgery, and the left anterolateral thoracotomy approach provided an excellent view of both the aortic arch and descending aorta. There was no hospital mortality. Morbidity included one incident of transient convulsion without computed tomographic evidence of an embolism and one incident of heart failure that required temporary mechanical support. No other significant event or morbidity occurred related to the surgical methods. There was no late death during the 1 to 81-month follow-up. A left anterolateral thoractomy provides an ideal view of distal aortic arch disease, and antegrade arterial perfusion is effective in the prevention of retrograde embolism. These results suggest this treatment modality to be a reliable alternative approach for the repair of distal aortic arch disease.