Ask the Editors

Download PDF (935.4 KB)

AORTA, June 2013, Volume 1, Issue 1:67-68
DOI: 10.12945/j.aorta.2013.13.021

How Do You Manage the Diaphragm During Open Thoracoabdominal Interventions on the Aorta?

Bulat A. Ziganshin

(on behalf of the Editorial Office)

Abstract

With this article, we would like to introduce, starting from the inaugural issue of the Aorta journal, our special feature, “Ask the Editors.” In this feature, the readers have the opportunity to ask questions of the editors in any of the topic categories of the journal. One or several editors will reply, presenting their expert opinions. This is an opportunity to get detailed answers to difficult questions; questions will be selected to be of general interest to readers of Aorta

With this article, we would like to introduce, starting from the inaugural issue of the Aorta journal, our special feature, “Ask the Editors.” In this feature, the readers have the opportunity to ask questions of the editors in any of the topic categories of the journal. One or several editors will reply, presenting their expert opinions. This is an opportunity to get detailed answers to difficult questions; questions will be selected to be of general interest to readers of Aorta.

For the first issue the question is:

How do you manage the diaphragm during open thoracoabdominal interventions on the aorta?

  1. Radial incision (Fig. 1)

  2. Circumferential incision (Fig. 2)

  3. No incision, enlargement of the hiatus without disturbing the diaphragm

Figure 1.

Radial incision of the diaphragm.

media/vol1/issue1/images/ata0011300170001.c.jpg
Figure 2.

Circumferential incision of the diaphragm.

media/vol1/issue1/images/ata0011300170002.c.jpg

We asked two renowned experts in the field to respond to this question and share their extensive experience with the readers.

Professor Michael Jacobs

(Chairman, Department of Surgery, Maastricht University Medical Center, The Netherlands)

I routinely make a limited circumferential incision (response B) of 8–10 cm to allow opening and exposure of the thoracic and abdominal aorta. In addition, I open the hiatus and put a sling around the remaining part of the diaphragm. This sling can be pulled up and aside to expose the aorta from all directions. The majority of the diaphragm remains intact.

Professor Anthony L. Estrera

(Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, USA)

I manage the diaphragm during thoracoabdominal aortic aneurysm repair with an incomplete circumferential incision (B). The incision length is based on how much exposure is required. This incision was adopted based on work performed by our group in 1999. (Engle J, Safi HJ, Miller CC 3rd, Campbell MP, Harlin SA, Letsou GV, Lloyd MD KS, Root DB: The impact of diaphragm management on prolonged ventilator support after thoracoabdominal aortic repair. J Vasc Surg. 1999 Jan;29(1):150–156.) This demonstrated improved pulmonary outcomes with the incomplete circumferential incision.

We encourage the readers to submit their questions to the editors of Aorta. We will ask an expert in the field to provide a response and publish it in a subsequent issue.

PDF

Download the article PDF (935.4 KB)

Download the full issue PDF (21.36 MB)

Mobile-ready Flipbook

View the full issue as a flipbook (Desktop and Mobile-ready)

Cite this article as: Ziganshin BA. How Do You Manage the Diaphragm During Open Thoracoabdominal Interventions on the Aorta?. AORTA (Stamford). 2013;1(1):67-68. DOI: 10.12945/j.aorta.2013.13.021

You must be registered and logged in to leave comments.

There have been no comments posted yet

All comments will be screened and reviewed before posting. Statements, opinions, and results of studies published in AORTA Journal are those of the authors and do not reflect the policy or position of The Journal and Science International and the Editorial Board and provides no warranty as to their accuracy or reliability. Material is copyrighted and owned by Science International and cannot be used without expressed permission.