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Total arch replacement with elephant trunk procedure for retrograde dissection.

Yuji Hanafusa1, Hitoshi Ogino, Hiroaki Sasaki

  • 1Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. nakai@hsp.ncvc.go.jp

The Annals of Thoracic Surgery
|November 21, 2002
PubMed
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Total arch replacement with an elephant trunk procedure is a recommended surgical approach for type A aortic dissection when the intimal tear is in the descending aorta, promoting false lumen thrombosis.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Managing type A aortic dissection with intimal tears in the descending aorta presents surgical challenges.
  • Standard median sternotomy for ascending aortic dissection is difficult when the intimal tear is distal.

Purpose of the Study:

  • To evaluate the efficacy of total arch replacement with an elephant trunk procedure for type A aortic dissection with descending aortic intimal tears.

Main Methods:

  • A retrospective review of 12 patients (aged 40-71) who underwent total arch replacement with an elephant trunk procedure via median sternotomy between 1995 and 2001.
  • All patients had type A aortic dissection with the intimal tear located in the descending aorta.

Main Results:

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  • One hospital mortality (8%) occurred due to multiple organ failure.
  • Postoperative false lumen closure in the descending aorta was achieved in all survivors.
  • The false lumen remained patent in the abdominal aorta in 9 patients, with slight thoracic and abdominal aortic dilatation in 2.

Conclusions:

  • Total arch replacement with an elephant trunk procedure is a recommended surgical option for type A aortic dissection with intimal tears in the descending aorta.
  • This surgical approach promotes thrombosis of the distal false lumen.