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Ann Thorac Surg 2002;74:S1836-S1839
© 2002 The Society of Thoracic Surgeons

Session 3: Dissection

Total arch replacement with elephant trunk procedure for retrograde dissection

Yuji Hanafusa, MDa*, Hitoshi Ogino, MDa, Hiroaki Sasaki, MDa, Kenji Minatoya, MDa, Motomi Ando, MDa, Yutaka Okita, MDa, Soichiro Kitamura, MDa

a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan

* Address reprint requests to Dr Hanafusa, Department of Cardiovascular Surgery National Cardiovasular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
e-mail: nakai{at}hsp.ncvc.go.jp

Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.

Abstract

BACKGROUND: The surgical management of type A dissection with the intimal tear in the descending aorta—retrograde dissection—has some challenging aspects because the standard approach through a median sternotomy for ascending aortic dissection is difficult in these cases in which the intimal tear is located in the descending aorta.

METHODS: From January 1995 to December 2001, 12 (8.6%) consecutive patients aged 40 to 71 years underwent total arch replacement with an elephant trunk procedure through a median sternotomy for retrograde dissection of the ascending aorta (acute: 10, chronic: 2) among 139 patients with type A dissection. The intimal tear was located in the descending aorta in all patients. Dissection extended proximally to the aortic root in 7 patients and to the ascending aorta in 5, and extended distally to the abdominal aorta in 4 and to the common iliac artery in 8.

RESULTS: Hospital mortality occurred in 1 patient (8%) owing to multiple organ failure after malperfusion of the renal arteries. Postoperatively the false lumen in the descending aorta was closed in all patients who survived but the false lumen in the abdominal aorta was patent in 9. The thoracic and abdominal aorta had slight dilatation in 2 patients.

CONCLUSIONS: These data suggest that total arch replacement with an elephant trunk procedure through a median sternomy should be recommended in patients with type A dissection and the intimal tear in the descending aorta. This procedure induces thrombosis of the remaining false lumen in the distal aorta postoperatively.




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Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?
Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1007 - 1013.
[Abstract] [Full Text] [PDF]


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