eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive About the journal Supplements Editorial board Abstracting and indexing Contact Instructions for authors Ethical standards and procedures
SCImago Journal & Country Rank

 
2/2021
vol. 18
 
Share:
Share:
more
 
 
abstract:
Original paper

Surgical “elephant trunk” arch replacement with a branched arch prosthesis: two alternative operative techniques

Carlo Bassano
1
,
Dario Buioni
1
,
Antonio Scafuri
1
,
Paolo Nardi
1
,
Calogera Pisano
1
,
Fabio Bertoldo
1
,
Giovanni Ruvolo
1

1.
OU of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
Kardiochirurgia i Torakochirurgia Polska 2021; 18 (2): 67-70
Online publish date: 2021/07/05
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Introduction
Elephant trunk repair of the aortic arch cannot be performed with a branched prosthesis. Aim: We conceived two different modifications of the original technique to perform an arch replacement with a branched graft, while arranging an adequate landing zone for a subsequent thoracic endovascular aortic repair, without the need of dedicated material.

Material and methods
Eight consecutive patients underwent arch replacement with one of our techniques. Five were emergency patients with acute aortic dissection, and 3 suffered chronic expansive disease. The “modified elephant trunk” includes a separate anastomosis of an endo-luminal prosthetic segment in the descending aorta. Subsequently, the branched arch prosthesis is anastomosed to the distal aortic stump with the attached trunk. In the “prophylactic debranching”, a tail is left on the distal end of the arch prosthesis, so that the branches for the supra-aortic vessels will remain displaced proximally, allowing a “zone 1” available for landing.

Results
Three patients experienced transient cerebral deficits (1 transient ischemic attack and post-operative delirium in 2 cases), 1 required re-operation for bleeding and 2 needed prolonged intubation. One died of multi-organ failure.

Conclusions
Both techniques proved to be easily reproducible, and allow an adequate landing zone for a subsequent endovascular procedure, while retaining the advantages of using a tetra-furcated prosthesis. They are a viable alternative when a hybrid prosthesis cannot be implanted.

keywords:

aortic arch surgery, thoracic aorta aneurysms

Quick links
© 2021 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe