The antero-axillary thoracotomy for operations of the distal aortic arch and the proximal descending aorta

Abstract

Antero-axillary thoracotomy in a 45 degrees position has become the most frequent approach for lung resection in our country. This approach also offers an ideal view of the aortic arch with the supraaortic vessels being closer to the incision site than in sternotomy or standard thoracotomy. We have therefore used this approach in our last 14 patients with lesions of the distal aortic arch and proximal descending aorta. Operative diagnoses included three arteriosclerotic aortic arch aneurysms, one post-traumatic aneurysm and two acute traumatic transections, as well as four acute type B dissections, three aneurysms after coarctation patch plasty and one recurrent stenosis after primary interposition of a vascular graft. Two patients died of sudden cardiac arrest on the 4th and 6th postoperative day, respectively, both following repair of a ruptured aneurysm. Except for recurrent laryngeal nerve palsy in six patients there were no further operations or morbidity. All operations were performed with the aid of left heart bypass. Induction of deep hypothermia and circulatory arrest, as is advocated for some of these lesions, was not required. This approach is especially useful in those cases where there is indecision as to whether a median sternotomy or a standard thoracotomy would provide the most optimal exposure.