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The Buffalo Trunk Technique for Aortic Arch Reconstruction.

Mohamed Eldeiry1, Muhammad Aftab1, Edward Bergeron1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.

The Annals of Thoracic Surgery
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The Buffalo Trunk technique simplifies aortic arch repair, reducing operative times without compromising patient outcomes. This innovative approach offers the benefits of hybrid grafts for frozen elephant trunk procedures.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • The frozen elephant trunk technique is used for aortic arch and proximal descending aorta pathologies.
  • Hybrid grafts can simplify the frozen elephant trunk procedure but are not widely available in the US.
  • The Buffalo Trunk technique was developed to simplify the frozen elephant trunk procedure without a hybrid graft.

Purpose of the Study:

  • To present the Buffalo Trunk technique for aortic arch reconstruction.
  • To compare the Buffalo Trunk technique with the traditional frozen elephant trunk procedure.
  • To evaluate operative times and perioperative outcomes of the Buffalo Trunk technique.

Main Methods:

  • The Buffalo Trunk technique utilizes a soft-branched graft and a stent graft for distal anastomosis in zone 2 arch reconstruction.
  • Patient data, operative times, and perioperative outcomes were analyzed.
  • A retrospective comparison was made between 37 patients who underwent the Buffalo Trunk procedure and 29 patients who had the traditional frozen elephant trunk procedure.

Main Results:

  • The Buffalo Trunk group had significantly shorter bypass (34 minutes) and circulatory arrest (18 minutes) times.
  • Fewer blood transfusions were required in the Buffalo Trunk group.
  • Stroke rate was 5%, with 2 (30-day) mortalities; no significant differences in end-organ dysfunction, morbidity, or mortality were observed between techniques.

Conclusions:

  • The Buffalo Trunk technique achieves the benefits of a hybrid approach without requiring complex, industry-available technology.
  • This evolved technique leads to shorter circulatory arrest and overall operative times.
  • The Buffalo Trunk procedure offers comparable outcomes to the traditional frozen elephant trunk technique.