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[Aortic arch replacement and elephant trunk method for thoracic aneurysm]

A Yanagiya1, Y Okada

  • 1Department of Cardiovascular Surgery, Nikko Memorial Hospital, Muroran, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|December 5, 1998
PubMed
Summary

This study details a successful aortic arch replacement using the elephant trunk technique in a patient with extensive thoracic aortic aneurysm. The innovative surgical approach ensured a good recovery without neurological complications.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Aneurysm Repair
  • Minimally Invasive Cardiac Surgery Techniques

Background:

  • A 73-year-old female patient presented with ischemic heart disease and a complex thoracic aortic aneurysm involving the ascending and descending aorta.
  • The case required a sophisticated surgical strategy to address both coronary artery disease and extensive aortic pathology.

Observation:

  • The surgical team performed a combined coronary artery bypass and aortic arch replacement utilizing the elephant trunk method.
  • Extracorporeal circulation and selective cerebral perfusion were employed to maintain organ viability during the procedure.
  • A unique inverted four-branched graft was used for the aortic arch reconstruction, with the elephant trunk component inserted into the descending aorta.

Findings:

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  • The left internal thoracic artery to the left anterior descending artery anastomosis was successfully completed.
  • The elephant trunk graft was deployed into the descending aorta, and the inverted end was secured beyond the left subclavian artery origin.
  • Postoperative aortogram confirmed successful proximal aortic replacement with the graft segment extending into the distal aneurysm, surrounded by thrombus.
  • The patient experienced an uneventful recovery, with no cerebral complications observed.

    • Implications:

    • This case demonstrates the feasibility and safety of the inverted elephant trunk technique for complex aortic arch and descending aorta aneurysms.
    • The successful outcome highlights the importance of meticulous surgical planning and execution in managing extensive aortic disease.
    • This approach may offer a viable option for patients requiring simultaneous management of coronary artery disease and thoracoabdominal aortic aneurysms.