P224. Muscle Sparing Technique for Open Descending Thoracic Aortic Aneurysm Repair
McGovern Medical School at UTHealth
Houston, TX
United States - Contact Me
Avanced Aortic Surgery Fellow at Memorial Hermann Hospital, Houston.
I currently live in Houston, where I am completing a two- year Fellowship in advanced aortic surgery. I am greatly engaged in open surgery for aortic aneurysms and dissections, as well as in modern vascular surgery, with large interest in vascular innovations, latest technology in vascular and aortic endovascular surgery, and greatly interested in medical and academic education, as well as surgical simulation.
I previously joined La Fe University Hospital in 2014 as a junior physician in angiology and vascular surgery, within the department of vascular surgery.
Prior to La Fe, I was the first Spanish junior vascular surgeon to complete a senior clinical Fellowship in aortic surgery at St. Mary’s Hospital, Imperial College of London, during an 18- month period,
and one of the first Spanish surgeons to become an official fellow of the European board of vascular and endovascular surgery (FEBVS).
Prior to this experience, I completed my residency in vascular surgery at Gregorio Marañón University hospital in Madrid, during a five- year period.
During my tenure in Madrid, I helped the hospital with the medical and residents training program, and participated in several national and international simulation courses, workshops, and meetings.
I am a graduate of the University of Alcala in Madrid, where I majored my bachelor in medicine.
Description
We report a case of open descending thoracic aortic aneurysm (DTAA) repair with muscle sparing left thoracotomy.
Methods:
A 47- year- old female with a past medical history of Raynaud syndrome, hypertension, smoking, and hyperlipidemia was referred to our institution for DTAA. The aneurysm was associated with severe aortic stenosis due to intraluminal calcific lesions. Because of the large calcified mass, the DTAA was not suitable for TEVAR. Thus, the decision was made to proceed with open aortic repair.
Results:
The patient underwent open repair and resection of the DTAA. The technique performed involves the following steps. A seven-inch-long incision was made from the inferior scapula border to anterior axillary line. The subcutaneous flaps were created and the auscultation triangle was identified. The latissimus dorsi and trapezius muscles were dissected and mobilized for retraction. The posterior border of the serratus anterior muscle was mobilized anteriorly. Following one-lung ventilation, the chest was entered through the sixth intercostal space. The proximal aortic clamp site was dissected distal to the subclavian artery. The diaphragm was retracted caudally using traction sutures around the aortic hilum to expose the distal clamp site. The left heart bypass was established using left inferior pulmonary vein drainage and left femoral artery return after systemic heparinization. The proximal aorta was clamped using a regular atraumatic clamp. The distal aorta was clamped using a flexible aortic clamp, which was inserted through a ninth intercostal space. DTAA repair was then performed in usual fashion after resecting the calcified mass en bloc with the aortic wall.
After surgery, the patient required pain management with acetaminophen and cyclobenzaprine. She was discharged home on the 9th postoperative day. CT scan after surgery showed no abnormalities. There was no chronic thoracic pain or infection during follow-up. Pathology demonstrated severe intimal atherosclerotic lesion with nodular calcification, and marked medial thinning with elastin fiber damage and loss by elastin stain.
Conclusions:
Muscle-sparing thoracotomy is a feasible option for open DTAA repair.
Authors
Lucas Ribe (1), Yuki Ikeno (1), Alexander Mills (2), Akiko Tanaka (3), Rana Afifi (4), Anthony Estrera (3)
Institutions
(1) McGovern Medical School at UTHealth, Houston, TX, (2) University of Texas Health Science Center at Houston (UTHealth Houston), N/A, (3) Memorial Hermann Heart and Vascular Institute, Houston, TX, (4) Memorial Hermann, Houston, TX