A dual strategic approach to mega-aortic aneurysms

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Aortic Disease Management

Background:

• Borst's two-stage elephant trunk (ETK) is the standard for mega-aorta resection but carries significant risks.
• Single-segment repair has lower morbidity but may not be suitable for all mega-aorta cases.
• Covered-stent interventions for aortic disease often fail due to issues with the proximal landing zone.

Observation:

• A novel combined surgical and covered-stent approach was successfully implemented in Europe.
• The elephant trunk technique provides a stable and easily identifiable landing zone for stent placement.
• This approach was utilized in a high-risk patient unsuitable for traditional surgical resection.

Findings:

• The combined approach demonstrated feasibility and potential advantages over traditional methods.
• The ETK facilitated excellent stent sealing, overcoming common landing zone challenges.
• The absence of thoracotomy in the stenting phase potentially shortens intensive care unit (ITU) stay and benefits frail patients.

Implications:

• This combined strategy presents a viable alternative for selected high-risk patients with mega-aortas.
• It may expand treatment options for patients previously deemed inoperable.
• Further research is warranted to establish long-term outcomes and optimize patient selection for this hybrid approach.