Anterolateral thoracotomy with partial sternotomy: a feasible approach for the complex pathology of the aortic arch.

OBJECTIVES: To review our surgical experiences in patients with complex pathology of the aortic arch who have undergone antero-lateral thoracotomy with partial sternotomy (ALPS).

METHODS: From October 2019 to November 2023, 23 patients underwent one-stage repair of complex pathology of the aortic arch through the ALPS approach. The mean age was 61.9 ± 16.7 years old. The aortic pathology was as follows: aorta-related infection in eleven (aorto-oesophageal fistula: four, graft infection: six, native aortic infection: one), aortic dissection in nine including shaggy aorta in two, non-dissecting aneurysm in one, and coarctation of the aorta (CoA) in two.

RESULTS: The extent of aortic replacement was as follows: 18 patients underwent replacement from either the sinotubular junction or the ascending aorta to the descending aorta, 1 patient underwent it from the aortic root to the descending aorta (redo Bentall procedure and extensive aortic arch replacement), 3 patients underwent it from the aortic arch between the left carotid artery and left subclavian artery to the descending aorta, and 1 patient underwent the descending aortic replacement. Ten patients underwent omentopexy, latissimus dorsi muscle flap installation, or both procedures. The hospital mortality rate was 13.0% (3/23). The overall survival and freedom from aortic events were 73.3%±10.2% and 74.1%±10.2%, respectively, at the 3-year follow-up. There was an absence of aorta-related mortality, and no recurrent infections were identified.

CONCLUSIONS: The short-term outcomes using the ALPS approach for the treatment of complex pathologies of the aortic arch were feasible. Further studies will be required to determine the long-term results.