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Ann Thorac Surg 2009;88:16-22. doi:10.1016/j.athoracsur.2009.03.092
© 2009 The Society of Thoracic Surgeons
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Koichi Toda
Kazuhiro Taniguchi
Takafumi Masai
Toshiki Takahashi
Yoshiki Sawa
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Original Articles: Adult Cardiac

Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients

Koichi Toda, MDa,*, Kazuhiro Taniguchi, MDa, Takafumi Masai, MDb, Toshiki Takahashi, MDc, Satoru Kuki, MDd, Yoshiki Sawa, MDe Osaka Cardiac Surgery Research (OSCAR) Group

a Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization Osaka Rosai Hospital, Sakai, Japan
b Department of Cardiovascular Surgery, Rinku General Medical Center, Izumisano, Japan
c Department of Cardiovascular Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
d Department of Cardiovascular Surgery, Takarazuka City Hospital, Takarazuka, Japan
e Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan

Accepted for publication March 31, 2009.

* Address correspondence to Dr Toda, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 565-0871, Japan (Email: ktoda2002{at}yahoo.co.jp).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: We studied the long-term outcome of arch aneurysm repair with a long elephant trunk (LET) anastomosed at the base of brachiocephalic artery.

Methods: Between 1998 and 2008, 111 patients underwent arch aneurysm repair with LET. A 4-branched graft was sutured to the sinotubular junction, the distal ascending aorta transected, and a LET inserted into the aortic arch while selective cerebral perfusion was maintained. The graft distal end was anastomosed to the LET, incorporating the distal ascending aorta, and arch vessels were anastomosed to graft branches.

Results: Concomitantly, 33 patients (30%) underwent other cardiac procedures, including 11 aortic root replacements. Two patients died (1.8%) within 30 days and 7 died (6.3%) after 30 days. Perioperative morbidity included 2 (1.8%) with stroke, 3 (2.7%) with paraplegia, and 1 (0.9%) with paraparesis. Postoperative computed tomography scans revealed complete aneurysmal thrombosis around the LET in 88 patients (79%), who were monitored without a second-stage procedure. Among 23 patients with incomplete thrombosis, 19 underwent a second-stage procedure to complete distal fixation of the LET. Overall survival was 88%, 83%, and 75%, at 1, 3, and 5 years after aneurysm repair with the LET. No aneurysm rupture or reexpansion occurred in patients with complete thrombosis. Four patients with incomplete thrombosis died of rupture before the second-stage procedure.

Conclusions: Our results demonstrated safety and good durability of the LET technique and suggest that this technique is a simple and safe procedure that is applicable to a variety of arch aneurysms.


Related Article

Invited Commentary
Anthony J. Rousou
Ann. Thorac. Surg. 2009 88: 22. [Extract] [Full Text] [PDF]



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A. J. Rousou
Invited commentary.
Ann. Thorac. Surg., July 1, 2009; 88(1): 22 - 22.
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