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Ann Thorac Surg 2007;84:1729-1734. doi:10.1016/j.athoracsur.2007.05.087
© 2007 The Society of Thoracic Surgeons
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New Technology

Elephant Trunk Anastomosis Proximal to Origin of Innominate Artery in Total Arch Replacement

Kazuhiro Taniguchi, MD, PhDa,*, Koichi Toda, MD, PhDa, Hiroki Hata, MD, PhDa, Yasuhiro Shudo, MDa, Hajime Matsue, MD, PhDb, Toshiki Takahashi, MD, PhDb, Satoru Kuki, MD, PhDb

a Department of Cardiovascular Surgery, Osaka Rosai Hospital, Sakai, Japan
b Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

Accepted for publication May 31, 2007.

* Address correspondence to Dr Taniguchi, Department of Cardiovascular Surgery, Japan Labour Health and Welfare Organization Osaka Rosai Hospital, Sakai, 591-8025, Japan (Email: kazuhiro{at}orh.go.jp).

Purpose: The purpose of this study was to describe our current technique for aortic arch replacement using a four-branched arch graft and a long elephant trunk.

Description: Using our method, the ascending aorta is replaced with a four-branched Hemashield arch graft (Hemashield Platinum, Woven Double Velour [Boston Scientific Corp, Wayne, NJ]) while cooling the patient. When 25°C is reached, selective cerebral perfusion is started and the elephant trunk is inserted under open distal conditions into the descending aorta using a catching catheter introduced through a femoral artery. A distal aortic anastomosis is then performed between the four-branched graft and distal aorta incorporating the elephant trunk at the base of the innominate artery. Arch vessels are reconstructed separately during rewarming.

Evaluation: Between October 1998 and December 2005, we performed the present technique in 52 patients with no operative deaths within 30 days after the procedure. The mean duration of hypothermic circulatory arrest was 24 ± 5 minutes, whereas that of selective cerebral perfusion was 86 ± 9 minutes.

Conclusions: The technique described herein requires a shorter circulatory arrest time and is uniformly applicable to patients with extensive thoracic aortic aneurysms.


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Invited commentary
Nicola Luciani and Amedeo Anselmi
Ann. Thorac. Surg. 2007 84: 1734. [Extract] [Full Text] [PDF]



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N. Luciani and A. Anselmi
Invited commentary
Ann. Thorac. Surg., November 1, 2007; 84(5): 1734 - 1734.
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