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Aortic arch replacement: the conventional 'elephant trunk' technique.

Marc A A M Schepens1

  • 1Department of Cardio-thoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|January 14, 2014
PubMed
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This two-stage surgical approach for aortic pathology uses an "elephant trunk" technique. This method repairs the ascending aorta and arch first, then the descending aorta, minimizing risks to surrounding structures.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Thoracic Surgery

Background:

  • Aortic pathologies often involve extensive segments, from the ascending aorta to the thoracoabdominal aorta, necessitating complex surgical interventions.
  • Traditional open repairs of extensive aortic disease can be associated with significant risks due to the need for extensive aortic dissection.

Purpose of the Study:

  • To describe a two-stage surgical strategy for managing extensive aortic pathology.
  • To highlight the benefits of the "elephant trunk" technique in facilitating subsequent repair of the descending aorta.

Main Methods:

  • The first stage involves median sternotomy for repair of the ascending aorta and aortic arch, potentially including aortic root or valve procedures.
  • A "elephant trunk" prosthesis is deployed into the proximal descending aorta during the first stage.

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  • The second stage utilizes left thoracotomy, thoracophrenolaparatomy, or endovascular repair to address the descending or thoracoabdominal aorta.

    • Main Results:

    • The "elephant trunk" technique simplifies the second-stage repair by avoiding dissection in the critical distal aortic arch region.
    • This approach mitigates the risk of injury to vital adjacent structures, including arterial, venous, nervous, and lymphatic tissues.
    • The two-stage method allows for staged management of complex aortic diseases.

    Conclusions:

    • The two-stage surgical repair with an "elephant trunk" is an effective strategy for extensive aortic disease.
    • This technique significantly reduces the operative risks associated with complex aortic reconstructions.
    • The "elephant trunk" facilitates safer and more manageable subsequent repairs of the descending aorta.