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J Thorac Cardiovasc Surg 2005;129:1207
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Reply to the Editor

Cardiac, Thoracic and Vascular Surgery Inc, St Louis, MO 63131

My coauthors and I are indebted to Dr Minale and colleagues for reporting their initial experience with the single-stage technique for extensive thoracic aortic resections in 1994,¹ which stimulated us to use and evaluate it in our surgical practice. We also appreciate the update of their experience with this technique, which indicates outcomes very similar to those that we have reported.² We prefer, however, to cool to systemic temperatures lower than 25°C to provide additional protection in the event that the ischemic intervals for the brain and spinal cord are prolonged beyond the usual safe intervals. We do not believe that the lower temperatures are associated with increased morbidity. We have found that an incision through the fourth intercostal space bilaterally provides excellent exposure of the aortic root, entire aortic arch, interatrial groove, and most distal portion of the descending thoracic aorta.

We agree with Dr Minale that the single-stage technique is of particular value in patients who require reoperation after previous repair of an acute type A aortic dissection or who have a type A dissection after previous coronary artery or valve surgery. Chronic type A dissection was the indication for use of the single-stage procedure in 30 of the 46 patients in our series, and the procedure remains our technique of choice in this setting.² It permits, as Dr Minale has emphasized, easy access to both the aortic root and the distal descending thoracic aorta.

References

1. Minale C, Splittgerber FH, Wendt G, Messmer BJ. One-stage intrathoracic repair of extended aortic aneurysms. J Card Surg. 1994;9:604-613.[Medline]
   
2. Kouchoukos NT, Mauney MC, Massetti P, Castner CF. Single-stage repair of extensive thoracic aortic aneurysms. experience with the arch-first technique and bilateral anterior thoracotomy. J Thorac Cardiovasc Surg. 2004;128:669-676.[Abstract/Free Full Text]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nicholas T. Kouchoukos Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kouchoukos, N. T. Search for Related Content PubMed Articles by Kouchoukos, N. T. Related Collections Great vessels