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Ann Thorac Surg 2007;83:S890-S892
© 2007 The Society of Thoracic Surgeons

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Supplement

Panel Discussion: Session IV—Descending and Thoracoabdominal Aorta

Richard P. Cambria, MD, Joseph S. Coselli, MD, Randall B. Griepp, MD, Ali Khoynezhad, MD, PhD, R. Scott Mitchell, MD, Konstadinos A. Plestis, MD, Marc Schepens, MD, PhD, Geert Willem Schurink, MD, PhD, Lars G. Svensson, MD, PhD, Grayson H. Wheatley, III, MD

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

The first 300 words of the full text of this article appear below.

DR DAVID SPIELVOGEL (Valhalla, NY): I would like to ask all the speakers to please come up for the panel discussion. Do you have any questions for our distinguished panelists?

DR EDWARD L. WOODS (Danville, PA): Should every patient with an elephant trunk have clips and pacing wires for a possible endograft? How long do you make the trunk for this purpose?

DR LARS G. SVENSSON (Cleveland, OH): A good question. As far as the length of the elephant trunk, as you perhaps recall in a previous paper, we recommend that it be 10 to 15 cm. You want enough length so that if you are going to do a second stage, you can grab it without having to clamp the aortic arch. In other words, you do what we call a slash and grab: open the aorta, grab the graft, and clamp it. So that is what you want to have enough length for.

On the other hand, for a second stage elephant trunk stent with an endograft, you don’t want it too long, because, as I pointed out, if it is too long you have got much more risk of it being foreshortened or concertinaed. We actually put clips now and pacing wires on all our patients, even the chronic dissections. Most of our chronic dissections end up having an open second stage procedure, because we still don’t believe that endografting is a good option, but occasionally we will stent a chronic dissection elephant trunk, but generally not.

DR RANDALL B. GRIEPP (New York, NY): Let me just add something to that. Remember, when you put that elephant trunk in, it is in its flaccid state when it is hanging in the aorta. Once you connect it to your stent graft and pressurize it, it elongates because it . . . [Full Text of this Article]

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