Extended aortic replacement in acute dissection by the separated elephant trunk technique

Konishi, Toshio; Higuchi, Kazuhiko; Fukata, Mutsumu; Takeda, Makoto; Akisima, Shinji; Fukuda, Shoji

doi:10.1016/s0003-4975(99)00304-5

Cited by 10 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neurologic complications with permanent or transient stroke incidences between 1.2 and 20 % have been reported in the literature [18,23,24]. In our small cohort one patient suffered permanent stroke and one patient a lethal intracerebral hemorrhage (n = 2, 10 %).…”

Section: Commentmentioning

confidence: 50%

Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis

et al. 2014

View full text Add to dashboard Cite

We report on our experience with a simplified elephant trunk (ET) procedure with a multi-branched prosthesis (Vascutek(®) Siena™ Collared Graft). It consists of a proximal portion (20 cm) with prefabricated side branches, a collar and a distal portion (30 cm). The collar, which can be trimmed into any desired diameter, constitutes the suture portion to the descending aorta. Radiopaque markers in the distal portion indicate the landing zone. Between January 2011 and June 2013, 20 consecutive patients (10 women; mean age, 66 ± 9.3 years) underwent ET procedure, including 6 re-do cases. Underlying aortic diseases were acute dissection (n = 6), chronic dissection (n = 4), aneurysm (n = 8) and PAU (n = 2). Mean preoperative diameter of the descending aorta was 49.1 ± 12.9 mm (range 74.7-29.7 mm). Concomitant procedures included ascending aortic replacement in 16 patients; root replacement in 2; AVR in 2, CABG in 3 and mitral repair in 1 patient. CPB time was 263 ± 94 min; mean duration of ACP was 65 ± 14 min. Two patients died on POD 8 and 78, respectively. Major adverse events included stroke (n = 1), resternotomy for bleeding (n = 2), renal failure requiring temporary dialysis (n = 1) and recurrent nerve paresis (n = 2). After a mean follow-up of 10 ± 8 months, all discharged patients were alive. Seven patients underwent stent-graft implantation of the descending aorta and one patient underwent open descending aortic replacement. The last generation of multi-branched arch prosthesis and especially the Vascutek(®) Siena™ Collared Graft make ET procedure a reasonable treatment option even in patients with acute aortic dissection.

show abstract

Section: Commentmentioning

confidence: 50%

Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The ability of an ET to favor aneurysmal or false-lumen thrombosis and obliteration had been already reported by Borst and other authors, especially if long ETs are used [10,[14][15][16][17][18][19][20][21]24]. However, its sealing capacity was far from complete, allowing distal perfusion of the aneurysm or false lumen and subsequent expansion and potential rupture.…”

Section: Fet Techniquementioning

confidence: 87%

“…Table 1 shows the most up-to-date conventional ET case series reports. Even if the cumulative in-hospital mortality and neurological complications including first and second stages are reported, the results are excellent [8,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25]. As confidence grew and technical adjuncts, such as cerebral protection with retrograde and eventually selective antegrade cerebral perfusion during arrest [26] and various supraaortic vessels reconstruction techniques, were introduced, ET indications were further extended.…”

Section: Conventional Et Techniquementioning

confidence: 99%

“…For example, in patients scheduled for descending or thoraco-abdominal aortic surgery, who presented at the same time with a severe coronary artery or valvular disease requiring operation, an ET was placed in the descending aorta to facilitate subsequent aortic repair and similarly, so to speak prophylactically, in selected patients undergoing aortic arch replacement with a downstream aneurysm not requiring immediate surgery at the time, but whose diameter and growth pattern, along with patient risk factors and characteristics (e.g., Marfan syndrome and connective tissue disorders, blood hypertension, and young patients) would suggest an unfavorable development toward further dilation and earlier need for operation [13,14,[20][21][22]25]. Evidence for false-lumen obliteration and healing following the use of the ET technique in patients with acute aortic dissection further encouraged its use [10,[14][15][16][17][18][19][20][21]24]. Even in aneurysmal disease, some authors have described stabilization or total thromboexclusion using only a long ET.…”

Section: Conventional Et Techniquementioning

confidence: 99%

See 1 more Smart Citation

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

show abstract

“…Arch replacement in acute aortic dissection still has a certain mortality and morbidity [1] despite the introduction of the elephant trunk technique, which has reduced the risk of complications at the distal anastomosis such as uncontrollable bleeding and formation of a new intimal tear [2,3]. Recently, the stented graft has been shown to be a useful tool when replacing a distal arch aneurysm [4].…”

Section: Introductionmentioning

confidence: 99%

Scope-Guided Implantation of a Stented Elephant Trunk in Acute Aortic Dissection

Tabuchi¹,

Mizuno²,

Toyama³

et al. 2001

Thorac cardiovasc Surg

View full text Add to dashboard Cite

A reliable guide is essential for implanting a stented graft safely into a recently dissected, fragile aorta. In 4 patients with acute aortic dissection, the implantation of a stented elephant trunk was done safely using an endoscope for direct visualization. In all patients, the operation went well. The placement of a stent appears to enhance the benefit of the elephant trunk, which itself reduces the complications of an arch replacement in acute dissection.

show abstract

Extended aortic replacement in acute dissection by the separated elephant trunk technique

Cited by 10 publications

References 9 publications

Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis

Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Scope-Guided Implantation of a Stented Elephant Trunk in Acute Aortic Dissection

Contact Info

Product

Resources

About