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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2001 June;42(3):397-402

language: English

Replacement of the entire thoracic aorta according to the reversed Elephant Trunk technique

Zanetti P. P.

From the “­Heart” Depart­ment Vascular and Tho­racic Sur­gery ­Ward High Spe­cial­isa­tion Hos­pital “G. ­Brotzu”, Cag­liari, ­Italy


The aim of ­this ­work is to ­present our mod­i­fied Ele­phant ­Trunk tech­nique to ­reduce cir­cu­la­tory ­arrest ­time and con­se­quently mor­tality and mor­bidity ­rates. ­According to ­Borst’s tech­nique the ­ascending ­aorta and ­aortic ­arch are ­replaced ­first, ­under ­deep hypo­thermic cir­cu­la­tory ­arrest, ­while a ­graft seg­ment is ­left in the ­descending tho­racic ­aorta. In the ­second ­stage of the oper­a­tion, the ­descending tho­racic ­aorta is ­replaced ­through ­left thor­a­cotomy ­using ­this ­graft seg­ment. In our mod­i­fied tech­nique, ­after the ­flexion in the prox­imal seg­ment of the ­graft, the ­descending tho­racic ­aorta is ­replaced ­first ­through ­left thor­a­cotomy in Bio-­Pump pro­tec­tion, ­choosing the ­best ­aortic seg­ment for prox­imal anas­tom­osis. In the ­second ­stage we ­replace the ­ascending ­aorta and the ­aortic ­arch ­using the ­graft and ­applying ­Carrel ­patch anas­tam­osis ­only to the epi­aortic ves­sels, ­under ­deep hypo­thermic cir­cu­la­tory ­arrest. It is our ­opinion ­that the mor­tality inci­dence of ­this tech­nique is sim­ilar to ­that ­obtained ­with ­Borst’s tech­nique, ­though cer­tainly infe­rior to the “one ­stage pro­ce­dure”, ­while the mor­bidity ­results are ­better ­than ­those ­obtained ­with the ­Borst Ele­phant ­Trunk tech­nique and ­with the “one ­stage pro­ce­dure”. ­Infact ­there are ­fewer ­stroke inci­dents ­thanks to the ­reduced ­times of ­deep hypo­thermic cir­cu­la­tory ­arrest, and ­fewer post­op­er­a­tive bleed­ings and res­pir­a­tory fail­ures ­thanks to the ­reduced ­times of the ­total ­cardiopul­mo­nary ­bypass. At the begin­ning we ­used ­this tech­nique to ­replace symp­to­matic aneu­rysms, cov­ered rup­tures, and hemat­omas of the ­wall of the ­descending tho­racic ­aorta, ­which ­required replace­ment of the ­descending tho­racic ­aorta ­first; we ­later ­extended the treat­ment to all ­types of tho­racic ­aorta aneu­rysms.

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