A 23-year experience with the reversed elephant trunk technique for staged repair of extensive thoracic aortic aneurysm

Coselli, Joseph S.; Krause, Heidi; Green, Susan Y.; Zhang, Qianzi; Amarasekara, Hiruni S.; Price, Matt D.; Preventza, Ourania; LeMaire, Scott A.

doi:10.1016/j.jtcvs.2020.09.148

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…Adhesions from a previous DeBakey type I aortic dissection repair can interfere with preparing the proximal aorta for a cross-clamp. Placing an elephant trunk graft extension during the previous proximal aortic repair simplifies subsequent TAAA repair [32] . If the proximal repair during the index DeBakey type I aortic dissection included only the ascending aorta and hemiarch, a redo sternotomy and total arch replacement with an elephant trunk extension may be performed before the TAAA repair because an aortic arch aneurysm would be difficult to replace through a left thoracoabdominal exposure.…”

Section: Positioning Exposure and Left Heart Bypassmentioning

confidence: 99%

Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic dissection

Hong¹,

Coselli²

2022

Vessel Plus

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Chronic dissection of the thoracoabdominal aorta may require surgical repair for aneurysm, malperfusion, or rupture. Endovascular repair is made difficult by a noncompliant dissection septum, visceral vessels arising from different lumens, and the common use of diseased aortic landing zones. Thus, open repair remains the gold standard in terms of favorable outcomes and durability. During thoracoabdominal aortic repair, we use a multimodal strategy to prevent spinal cord and visceral or renal artery ischemia; key modalities include cerebrospinal fluid drainage, left heart bypass with and without visceral protection, cold renal protection, and aggressive reimplantation of intercostal or lumbar arteries. Patients with chronic dissection require lifelong surveillance, as there is a significant risk for subsequent intervention on unrepaired aortic segments.

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Section: Positioning Exposure and Left Heart Bypassmentioning

confidence: 99%

Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic dissection

Hong¹,

Coselli²

2022

Vessel Plus

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“…When the distal aortic pathology has higher surgical priority than the proximal one, the reversed elephant trunk operation has also been employed. 2 , 3) However, such an approach may sometimes be undesirable or impossible. While staged repair reduces surgical stress of each operation, it is associated with the risk of rupture while awaiting the second-stage surgery.…”

Section: Introductionmentioning

confidence: 99%

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

Shiiya

Washiyama

Takahashi

et al. 2023

ATCS

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Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.

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“…In this issue of the Journal, our colleagues from the Texas Heart Institute present an impressive series of patients who underwent a reverse elephant trunk procedure for descending and thoracoabdominal repairs. 1 Their cohort comprises 94 patients considered to have more urgent indications distal but either less aggressive arch aneurysms or other markers suggesting that the proximal aorta would degenerate. The reverse elephant trunk can be pulled proximally under circulatory arrest to move the suture line proximally, avoiding the need to sew to the previous suture line or native tissue.…”

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confidence: 99%

Commentary: Preparing for the worst, expecting the worst can make it better

Reece

Aftab²

2022

The Journal of Thoracic and Cardiovascular Surgery

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A 23-year experience with the reversed elephant trunk technique for staged repair of extensive thoracic aortic aneurysm

Cited by 6 publications

References 35 publications

Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic dissection

Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic dissection

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta

Commentary: Preparing for the worst, expecting the worst can make it better

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