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Elephant trunk procedure: newer indications and uses.
Lars G Svensson1, Kyung-Hwan Kim, Eugene H Blackstone
1Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorders Clinic and Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. svenssl@ccf.org
The Annals of Thoracic Surgery
|June 30, 2004
Summary
The elephant trunk procedure is safe for extensive aortic aneurysms. Completing a second-stage repair significantly improves survival rates in patients undergoing this aortic surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Aneurysm Repair
Background:
- The elephant trunk procedure is a critical intervention for extensive aortic aneurysms.
- Evaluating its safety, indications, and impact on survival is essential.
Purpose of the Study:
- To assess the safety and efficacy of the elephant trunk procedure.
- To explore newer indications for its use.
- To determine the influence of second-stage completion on patient survival.
Main Methods:
- Retrospective review of 94 patients undergoing the elephant trunk procedure (November 1990 - February 2003).
- Analysis of trunk implantation sites, patient comorbidities (aortic dissection, Marfan syndrome), and concomitant procedures (coronary artery bypass, aortic valve operations).
- Evaluation of second-stage procedures, including thoracotomy and stent graft insertion.
Main Results:
- Low early mortality (2.1%) and stroke rate (5.3%) were observed.
- Survival rates were significantly higher with second-stage procedures (75% at 3 years) compared to no second stage (34% at 5 years).
- Second-stage procedures, including thoracoabdominal aneurysm repair, showed an 8.5% early mortality.
Conclusions:
- The elephant trunk procedure is a safe and effective treatment for extensive aortic aneurysms.
- It should be considered more frequently in conjunction with initial cardiac surgery.
- This approach facilitates subsequent repair of descending or thoracoabdominal aorta.