| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:109-116
© 2004 The Society of Thoracic Surgeons
a Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorders Clinic and Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Department of Cardiothoracic Surgery, Lahey Clinic, Burlington, Massachusetts, USA
Accepted for publication February 18, 2004.
* Address reprint requests to Dr Svensson, The Cleveland Clinic Foundation, 9500 Euclid Ave/Desk F 25, Cleveland, OH 44195, USA
e-mail: svenssl{at}ccf.org
Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.
BACKGROUND: The elephant trunk procedure is used for extensive aortic aneurysms. We evaluated its safety, newer indications, and influence of second-stage completion on survival.
METHODS: Records were reviewed for 94 consecutive patients (age 67 ± 11 years, 47% men) who underwent the procedure between November 1990 and February 2003. The trunk was implanted as an extension of the ascending aorta and arch graft in 83 of 94 (88.3%) patients, distal arch graft in 8 of 94 (8.5%) patients, and in 3 distal to the left subclavian artery (3 of 94 patients [3.2%]). Aortic dissection was present in 37 (39.4%) patients and Marfan syndrome was present in 7 (7.4%). Twenty-three were reoperations (24.5%). In 9 patients, the trunk procedure was adjunctive in preparation for the second operation. In 15 patients, the anastomosis was completed between the left subclavian and common carotid arteries. Coronary artery bypass was performed in 36 (38.4%) and aortic valve operation in 55 (58.5%; 20 root sparing repairs, 16 composite grafts and 19 replacements) patients.
RESULTS: There were two early 30-day in-hospital deaths (2.1%) and 5 permanent strokes (5.3%). Eleven died before the second-stage procedure. Forty-seven (57%) underwent second-stage procedures; 40 by thoracotomy and 7 by stent graft insertion, including 2 thoracoabdominal aneurysm repairs with visceral bypasses before stent grafting with 4 early deaths (8.5%). Five-year survival was 34% without a second-stage procedure versus 75% 3-year survival with it.
CONCLUSIONS: With a current total of 142 elephant trunk procedures, we found it is safe and should be used more with initial cardiac surgery before descending or thoracoabdominal aorta repair.
This article has been cited by other articles:
|
|
 |
|
  C.-H. Park, C.-H. Choi, Y.-B. Jeon, J.-I. Lee, S.-Y. Hyun, and K.-Y. Park Staged repair of a chronic dissecting aneurysm with the two elephant trunks technique. Ann. Thorac. Surg., December 1, 2009; 88(6): e69 - e71. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. C. Hughes, M. A. Daneshmand, K. R. Balsara, H. A. Achneck, B. Sileshi, S. M. Lee, and R. L. McCann "Hybrid" repair of aneurysms of the transverse aortic arch: midterm results. Ann. Thorac. Surg., December 1, 2009; 88(6): 1882 - 1888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Toda, K. Taniguchi, T. Masai, T. Takahashi, S. Kuki, Y. Sawa, and Osaka Cardiac Surgery Research (OSCAR) Group Arch aneurysm repair with long elephant trunk: a 10-year experience in 111 patients. Ann. Thorac. Surg., July 1, 2009; 88(1): 16 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kim, T. D. Martin, W. A. Lee, P. J. Hess Jr., C. T. Klodell, C. G. Tribble, R. J. Feezor, and T. M. Beaver Evolution in the management of the total thoracic aorta. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 627 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. T. Kouchoukos, P. Masetti, M. C. Mauney, M. C. Murphy, and C. F. Castner One-Stage Repair of Extensive Chronic Aortic Dissection Using the Arch-First Technique and Bilateral Anterior Thoracotomy Ann. Thorac. Surg., November 1, 2008; 86(5): 1502 - 1509. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Pichlmaier, O. E. Teebken, N. Khaladj, J. Weidemann, M. Galanski, and A. Haverich Distal aortic surgery following arch replacement with a frozen elephant trunk Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 600 - 604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Etz, K. A. Plestis, F. A. Kari, M. Luehr, C. A. Bodian, D. Spielvogel, and R. B. Griepp Staged repair of thoracic and thoracoabdominal aortic aneurysms using the elephant trunk technique: a consecutive series of 215 first stage and 120 complete repairs Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 605 - 615. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Greenberg, Q. Lu, E. E. Roselli, L. G. Svensson, M. C. Moon, A. V. Hernandez, J. Dowdall, M. Cury, C. Francis, K. Pfaff, et al. Contemporary Analysis of Descending Thoracic and Thoracoabdominal Aneurysm Repair: A Comparison of Endovascular and Open Techniques Circulation, August 19, 2008; 118(8): 808 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Karck and H. Kamiya 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]
|
|
|
|
|
|
K. Shimamura, T. Kuratani, G. Matsumiya, M. Kato, Y. Shirakawa, H. Takano, N. Ohta, and Y. Sawa Long-term results of the open stent-grafting technique for extended aortic arch disease. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1261 - 1269. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Schwartz, M. Bakhos, A. Patel, S. Botkin, and S. Neragi-Miandoab Repair of aortic arch and the impact of cross-clamping time, New York Heart Association stage, circulatory arrest time, and age on operative outcome Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 425 - 429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kutty, R. K. Greenberg, S. Fletcher, L. G. Svensson, and L. A. Latson Endovascular Stent Grafts for Large Thoracic Aneurysms After Coarctation Repair Ann. Thorac. Surg., April 1, 2008; 85(4): 1332 - 1338. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. LeMaire and J. S. Coselli Reply Ann. Thorac. Surg., February 1, 2008; 85(2): 691 - 692. [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Coselli and S. A. LeMaire Descending and Thoracoabdominal Aortic Aneurysms Card. Surg. Adult, January 1, 2008; 3(2008): 1277 - 1298. [Full Text]
|
|
|
|
 |
|
 F. Wallet, S. Perbet, M.-H. Fleron, V. De Castro, G. Godet, M. Bertrand, E. Kieffer, P. Coriat, and J.-P. Goarin Elephant Trunk Prosthesis Kinking: Transesophageal Echocardiography Diagnosis Anesth. Analg., January 1, 2008; 106(1): 67 - 69. [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson, N. T. Kouchoukos, D. C. Miller, J. E. Bavaria, J. S. Coselli, M. A. Curi, H. Eggebrecht, J. A. Elefteriades, R. Erbel, T. G. Gleason, et al. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts Ann. Thorac. Surg., January 1, 2008; 85(1_Supplement): S1 - S41. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Pichlmaier, O. E. Teebken, H. Baraki, and A. Haverich The frozen elephant trunk technique MMCTS, March 29, 2007; 2007(0329): 1990. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson, E. H. Blackstone, J. Feng, D. de Oliveira, A. M. Gillinov, M. Thamilarasan, R. A. Grimm, B. Griffin, D. Hammer, T. Williams, et al. Are Marfan Syndrome and Marfanoid Patients Distinguishable on Long-Term Follow-Up? Ann. Thorac. Surg., March 1, 2007; 83(3): 1067 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Baraki, C. Hagl, N. Khaladj, K. Kallenbach, J. Weidemann, A. Haverich, and M. Karck The Frozen Elephant Trunk Technique for Treatment of Thoracic Aortic Aneurysms Ann. Thorac. Surg., February 1, 2007; 83(2): S819 - S823. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Coselli, J. Bozinovski, and S. A. LeMaire Open Surgical Repair of 2286 Thoracoabdominal Aortic Aneurysms Ann. Thorac. Surg., February 1, 2007; 83(2): S862 - S864. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A.A.M. Schepens Aortic arch replacement: the conventional 'elephant trunk' technique MMCTS, January 2, 2007; 2007(0102): 2006. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Svensson Invited commentary Ann. Thorac. Surg., August 1, 2006; 82(2): 546 - 547. [Full Text] [PDF]
|
|
|
|
|
|
S. A. LeMaire, S. A. Carter, and J. S. Coselli The Elephant Trunk Technique for Staged Repair of Complex Aneurysms of the Entire Thoracic Aorta. Ann. Thorac. Surg., May 1, 2006; 81(5): 1561 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Flores, T. Kunihara, N. Shiiya, K. Yoshimoto, K. Matsuzaki, and K. Yasuda Extensive deployment of the stented elephant trunk is associated with an increased risk of spinal cord injury J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 336 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Greenberg, F. Haddad, L. Svensson, S. O'Neill, E. Walker, S. P. Lyden, D. Clair, and B. Lytle Hybrid Approaches to Thoracic Aortic Aneurysms: The Role of Endovascular Elephant Trunk Completion Circulation, October 25, 2005; 112(17): 2619 - 2626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson and E. R. Rodriguez Aortic Organ Disease Epidemic, and Why Do Balloons Pop? Circulation, August 23, 2005; 112(8): 1082 - 1084. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
