Partial upper median sternotomy for anterior aortopexy for innominate
artery compression syndrome: Our preferred technique.
Objectives: Innominate artery compression syndrome (IAS) is
caused by an anterior compression of the trachea by an abnormally
originating innominate artery. One option to relieve such a compression
is an anterior aortopexy (AA). In this paper we describe our technique
of an AA via a partial upper median sternotomy. Methods: A
retrospective review of a prospectively maintained database of patients
with IAS (July 2017 to November 2020) treated with AA via a partial
upper median sternotomy at University teaching hospitals in the US was
done. Results: Nine consecutive patients underwent AA for IAS
during the study period. The median age was 9 months (IQR 3- 16.5). The
male to female ratio was 1.25. All patients had > 70%
compression by flexible bronchoscopy. 2 patients had previous surgeries.
The follow-up was a median of 6 (IQR 4- 8.5) months. The indications for
the operation were: reflex apnea (4/9 patients), recurrent intubation
(4/9 patients), and severe stridor (1/9). IAS was a technical success
(defined as ≤ 20 % residual stenosis) in 78 % (7/9) of the patients.
Complete symptom resolution after an AA was seen in 71% (5/7) of the
patients. 2 patients had an unsuccessful AA, requiring a tracheal
resection and an innominate artery reimplantation, respectively.
Conclusion: An upper partial sternotomy approach provides a
very versatile approach to an AA for IAS. Besides facilitating an
adequate AA, it provides options for direct tracheal surgery or an
innominate artery reimplantation in case an optimal result is not
obtained by an AA.