RESUMEN

PURPOSE: We have introduced a new surgical approach for extended thoracic aortic repair, anterolateral thoracotomy with partial sternotomy (ALPS). DESCRIPTION: The surgical approach to the chest was made via left anterolateral thoracotomy and lower median sternotomy through the third or fourth intercostal space. All cannulations (arterial, venous, venting, and cardioplegia) could be easily performed using a retractor in this approach. EVALUATION: From November 2005 to December 2010, we performed surgical treatment in 12 patients by employing the ALPS approach for a complex, extended thoracic aortic diseases with different pathologies, i.e., arteriosclerotic aneurysms in 5, acute type B dissection in 5, and chronic type B dissection in 2 patients. One patient died in the hospital, and 1 had temporary spinal cord injury. CONCLUSION: The ALPS approach might become an alternative for a complex, extended thoracic aortic replacement.

Asunto(s)

Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular , Esternotomía/métodos , Toracotomía/métodos , Anciano , Anciano de 80 o más Años , Enfermedades de la Aorta/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Traumatismos de la Médula Espinal/etiología , Esternotomía/efectos adversos , Esternotomía/mortalidad , Toracotomía/efectos adversos , Toracotomía/mortalidad , Resultado del Tratamiento

RESUMEN

BACKGROUND: The objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of our 7 years of experience. METHODS: Between December 2003 and December 2010, we performed surgical treatments in 23 patients (for the thoracic aorta in 6 patients, for the thoracoabdominal aorta in 8 patients, and for the abdominal aorta in 9 patients; 7 emergency, 10 urgent, and 6 elective operations) with mycotic aneurysm by using rifampicin-bonded grafting and omental pedicle grafting. RESULTS: One patient died in hospital because of local recurrent infection. One patient required an additional operation on another aortic site, and 3 patients had spinal cord injuries (2 transient and 1 permanent). Overall survival at 5 years was 95%, and the rate of freedom from aortic events at 5 years was 86%. CONCLUSIONS: In situ replacement using rifampicin-bonded grafting and omental pedicle grafting is effective for treating mycotic aneurysms of the thoracic and abdominal aorta.

Asunto(s)

Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Colgajos Quirúrgicos , Anciano , Anciano de 80 o más Años , Aneurisma Infectado/tratamiento farmacológico , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Abdominal/tratamiento farmacológico , Aneurisma de la Aorta Torácica/tratamiento farmacológico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Terapia Combinada , Procedimientos Quirúrgicos Electivos , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/cirugía , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Epiplón , Tereftalatos Polietilenos , Estudios Retrospectivos , Rifampin/farmacología , Stents , Resultado del Tratamiento

RESUMEN

A 65-year-old man had received closure of the entry and false lumen Stanford type B acute aortic dissection via left thoratectomy 23 years previously. The patient underwent emergency graft replacement for a ruptured aneurysm of the thoraco-abdominal aorta 10 years previously. Enhanced computed tomography (ECT) revealed that the residual aortic dissection of the distal arch and the descending aorta were dilated. Reoperation via left thoracotomy usually requires a long cardiopulmonary bypass time and intraoperative bleeding. So we selected to perform open stent-grafting through median sternotomy alone, avoiding a left thoracotomy.

RESUMEN

An 82-year-old woman fell into a state of shock during the treatment for a urinary tract infection. Computed tomography and transthoracic echocardiography revealed massive pericardial effusion. Pericardiectomy was performed in the operating room and hemorrhagic effusion was observed. Emergent sternotomy was performed, and the bleeding site was located at the posterior portion of the left ventricular outflow. We diagnosed a rupture of a left ventricular outflow tract pseudoaneurysm after infectious endocarditis. A pericardium patch closure of the pseudoaneurysm and an aortic valve replacement were performed. The patient was discharged 35 days after the operation without recurrence of infection. Left ventricular outflow tract pseudoaneurysms is an uncommon complication following infective endocarditis, aortic valve surgery or chest trauma. Transesophageal echocardiography and multidetector-row computed tomography (MDCT) is useful for identifying such lesions.