Staged repair of extensive aortic aneurysms

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• The elephant trunk procedure, a two-stage approach, was implemented for extensive aortic aneurysm repair starting in 1991.
• A total of 241 procedures were performed on 155 patients.

Purpose of the Study:

• To evaluate the efficacy and safety of the two-stage elephant trunk technique in repairing extensive aortic aneurysms.
• To assess the outcomes, including mortality and morbidity, associated with the elephant trunk procedure.

Main Methods:

• A retrospective analysis of 241 extensive aortic aneurysm repairs using a two-stage elephant trunk technique between 1991 and the study period.
• 18 patients underwent a reversed elephant trunk procedure (descending thoracic aorta graft replacement followed by ascending/arch replacement).
• The remaining patients were treated with conventional staged repair, with 137 undergoing the first stage and 86 completing the second stage.

Main Results:

• The 30-day mortality for the first stage was 9.5% (13/137).
• The second stage had a mortality rate of 7.0% (6/86), with no immediate neurologic deficits reported.
• Mortality during the interval between stages (31 days to 6 weeks) was 8% (10/124), with 70% of these deaths attributed to rupture of the untreated aortic segment. Patients not returning for the second stage had a significantly higher mortality rate of 32.1% (18/56).

Conclusions:

• The elephant trunk technique is a viable option for extensive aortic aneurysm repair, demonstrating acceptable morbidity and mortality rates.
• Emphasizes the critical importance of timely completion of the second stage of repair to prevent interval deaths, primarily from aortic rupture.