Reverse elephant trunk technique: a novel approach to pseudoaneurysm repair

Traditional surgical access to the upper descending aorta is via a left thoracotomy. For postcoarctation pseudoaneurysm repair, this approach is difficult because of the risk of rupture while dissecting the aorta for proximal and distal control. Access from a median sternotomy may be safer, but is difficult because of the depth of the wound and because of the angle of approach to the distal aspect of the repair site. We describe a novel approach via a median sternotomy incision, using circulatory arrest and "elephant trunk" principles to achieve tube graft replacement of the aneurysmal section of aorta.