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J Thorac Cardiovasc Surg 2003;126:814-817
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

The clamshell approach for the treatment of extensive thoracic aortic disease

^a From the Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University, Frankfurt am Main, Germany

Received for publication September 12, 2002; revisions received October 1, 2002; revisions received October 14, 2002; accepted for publication October 25, 2002.

^* Address for reprints: M. Doss, MD, Department of Thoracic and Cardiovascular Surgery, J.W. Goethe University Frankfurt am Main, Theodor Stern Kai 7, 60599, Frankfurt am Main, Germany
mirkodoss{at}aol.com

OBJECTIVE: Management of extensive thoracic aortic disease may present an immense technical challenge. The choice of surgical access and subsequent exposure determines whether a single-stage or a 2-stage approach can be adopted.

METHODS: Fifteen patients with extensive thoracic aortic disease underwent resection of the ascending aorta, the aortic arch, and varying segments of the descending aorta. Four patients had concomitant coronary artery bypass grafting and 3 patients had aortic valve reconstruction. All patients were treated with a single-stage approach via a bilateral anterior thoracosternotomy (clamshell incision).

RESULTS: There was 1 hospital death (6.6%). Two patients required reoperation for bleeding (13.3%). Two patients needed mechanical ventilation for more than 48 hours. Three patients suffered a stroke (20%). Two patients (13.3%) had transient neurologic dysfunction. None of the patients had renal failure. There were no wound infections in this group.

CONCLUSION: The single-stage approach, via a clamshell incision, is a safe and effective procedure for patients who require treatment of extensive thoracic aortic disease and concomitant cardiac lesions.

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