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New Technology

Invited commentary

Division of Cardiac Surgery, Catholic University, Largo A. Gemelli 8, Rome 00168, Italy

(Email: nicola.luciani{at}tiscali.it; amedeo.anselmi{at}alice.it).

Several innovations have developed in surgery of the aortic arch in the last 20 years. The ingenious technique proposed by Taniguchi and coworkers [1] reflects many innovations, as it combines an elephant trunk with arch debranching, and the use of peripheral cannulation with a loop-designed catheter to fix the elephant trunk into the desired position. The surgical experience, creativity, and perseverance of its inventors, as described in this article, deserve our appreciation.

Technically, the major advantage of Taniguchi and coworkers’ [1] technique in the proximal elephant trunk is the shorter duration of deep hypothermia and circulatory arrest. Is the price of a more complex procedure with more anastomoses and additional incisions really worth the benefit? This question becomes irrelevant if cerebral perfusion during arch surgery and during moderate hypothermia optimally protects the brain regardless of cerebral perfusion time [2, 3]. Thus, given the success and safety of cerebral perfusion, one should advocate a direct comparison of neurologic outcomes between Taniguchi and coworkers [1] and previously established techniques.

Furthermore, the exclusion or the removal of the entire aneurysm in elective procedures should not be neglected as one of the historical, strategic principles of aortic surgery. This concept is based on the fact that the aneurysmal aortic tissue is abnormal and prone to progression. Taniguchi and coworkers’ [1] proximal elephant trunk technique disregards this concept, as it primarily addresses arch aneurysm and diffuse aneurysmal disease involving the arch. The operation produces a condition comparable with chronic dissection in the descending thoracic aorta. Only close follow-up of patients who have undergone this operation along with careful analysis will provide the eventual outcome and determine whether the "fake" lumen between the elephant trunk and the aortic wall becomes thrombosed as claimed by the authors.

We congratulate Taniguchi and associates [1] for their admirable work, but we assert that the indications for their technique and its place in aortic surgery remain to be established.

	References

Top References

 

1. Taniguchi K, Toda K, Hata H, et al. Elephant trunk anastomosis proximal to origin of innominate artery in total arch replacement Ann Thorac Surg 2007;84:1729-1734.[Abstract/Free Full Text]
2. Pacini D, Di Marco L, Marsilli D, et al. Nine years experience of aortic arch repair with the aid of selective antegrade cerebral perfusion J Cardiovasc Surg 2006;47:691-698.[Medline]
3. Di Eusanio M, Schepens MA, Morshuis WJ, et al. Brain protection using selective antegrade cerebral perfusion: a multicenter study Ann Thorac Surg 2003;76:1188-1189.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nicola Luciani Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Luciani, N. Articles by Anselmi, A. Search for Related Content PubMed PubMed Citation Articles by Luciani, N. Articles by Anselmi, A. Related Collections Great vessels Related Article