Left antero-axillary thoracotomy as an alternative approach for aortic arch reconstruction.

Antero-axillary thoracotomy--a new approach for the reconstruction of the aortic arch--provides a wide view of the arch and makes accessible the superior vena cava for retrograde cerebral perfusion as well as the coronary sinus for retrograde infusion of cardioplegia. This procedure has been used over 22 months for 26 patients with aortic arch aneurysm or aortic dissection, and the surgical results were evaluated. The distal arch was replaced in 16 patients, the total arch in 9 patients, and the proximal arch in 1 patient, using this technique. The mean duration of deep hypothermic circulatory arrest was 38 min, and the hospital mortality was 15.4%. Antero-axillary thoracotomy may be an excellent approach for the reconstruction of the aortic arch, minimizing the duration of hypothermic circulatory arrest.