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Objectives: Atherosclerotic disease of the innominate artery can lead to symptoms of cerebral and upper extremity ischemia. Stenotic lesions can often be treated with endovascular angioplasty and stenting. Occlusions, however, generally require open bypass through a median sternotomy to correct. A mini-sternotomy, limited in extent to the 2nd or 3rd intercostal space, has been shown in the literature to be a safe and effective exposure technique for aortic valve reconstruction. To date, there is no published description of mini-sternotomy exposure for aorto-innominate bypass. We reviewed our outcomes of aorto-innominate bypass performed through a mini-sternotomy.
Methods: Single center, retrospective review of 3 consecutive patients who underwent an aorto-innominate bypass through a mini-sternotomy in 2014. Demographics, index procedural details, complications, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded.
Results: The cohort of 3 patients were women with a mean age of 67 years (range of 61-74). All were symptomatic. Two patients had occlusion of the innominate artery and one patient had a 70% stenosis and ulcerated plaque. Mini-sternotomy was performed down to and extending into the right 2nd or 3rd intercostal space. All underwent aorto-innominate end-to-end bypass with a 10 mm polytetrafluoroethylene (PTFE) graft tunneled beneath the innominate vein. One patient had an 8 mm PTFE side arm sewn end-to-end to the left common carotid artery. Technical success was 100% and there were no peri-operative deaths. Mean estimated blood loss was 500 cc (range 100-800 cc) and mean operative time was 167 minutes (range 145-181 minutes). Mean LOS was 4 days (range 3-5 days). All of patients recieved a post-operative carotid duplex and had a mean follow-up of 6.1 months (range 3 months - 8 months). All bypasses remained patent. There were no perioperative complications.
Conclusion: Aorto-innominate bypass surgery is routinely performed through a full median sternotomy. We have demonstrated that aorto-innominate bypass surgery can be safely and efficaciously performed through a limited mini-sternotomy. Post-operative carotid duplex imaging is sufficient to monitor graft patency. A mini-sternotomy is our exposure technique of choice when performing aorto-innominate bypass surgery.