TECHNICAL NOTES  VASCULAR SECTION 

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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.