The development of the Siena graft

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic arch surgery is technically demanding, with historical challenges predating cardiopulmonary bypass (CPB).
• Advancements in perfusion, cerebral protection, and prosthetic grafts have improved surgical capabilities.
• The elephant trunk technique revolutionized staged treatment for diffuse aortic aneurysms, reducing surgical risk.

Purpose of the Study:

• To describe the evolution of surgical techniques and prosthetic grafts for aortic arch replacement.
• To detail the design and application of the Siena graft for the elephant trunk technique.
• To review the technical approach, pitfalls, safeguards, and clinical experience with the Siena graft.

Main Methods:

• Historical review of aortic arch surgical techniques and graft development.
• Description of the Siena graft's design features and rationale.
• Analysis of clinical experience, including technical aspects, challenges, and outcomes.

Main Results:

• The elephant trunk technique, introduced in 1983, is now a standard for complex aortic arch disease.
• The Siena graft, developed in the early 2000s, integrates endovascular device potential and addresses technical challenges like distal anastomoses.
• The Siena graft's design, featuring multi-branched prostheses and an anastomotic collar, facilitates secure repairs in challenging anatomy.

Conclusions:

• The Siena graft represents a significant advancement in treating diffuse aortic aneurysms using the elephant trunk technique.
• Collaborative design with industry has ensured the reliability and widespread adoption of the Siena graft.
• The graft remains a crucial platform for managing complex aortic pathologies requiring staged surgical approaches.