title: Surgical treatment of acute type B aortic dissection using an endoprosthesis (elephant trunk).
abstract: BACKGROUND
  The surgical treatment of acute complicated type B aortic dissection continues to be a challenge and is still associated with high morbidity and mortality rates.
  
  
  METHODS
  Seventy consecutive patients with an acute type B aortic dissection underwent an elephant trunk procedure through a median sternotomy during deep hypothermic circulatory arrest. An endoprosthesis that was 22 to 24 mm in diameter was inserted through an incision in the arch and held in place with only proximal sutures.
  
  
  RESULTS
  The mean arrest time was 31.4 +/- 8.7 minutes, and it was possible to adequately position the endoluminal graft in every patient. The procedure was done in association with other procedures in 13 patients. There were six in-hospital deaths not related to the endoprosthesis, and four late deaths. Late reoperation was necessary in 6 patients to manage leakage at the proximal suture line.
  
  
  CONCLUSIONS
  The insertion of an endoprosthesis through the arch for the management of a complicated acute type B dissection has several advantages over the conventional thoracotomy approach. The hospital mortality rate in this series of 70 patients was 20%, and the actuarial 5-year survival rate was 62.5%. We consider the elephant trunk procedure the treatment of choice in patients with type B acute dissections, regardless of whether the dissection is complicated or not.
authors.affiliation: Division of Cardiovascular Surgery, Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: J H
authors.initials: JH
authors.lastname: Palma
authors.forename: D R
authors.initials: DR
authors.lastname: Almeida
authors.forename: A C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: J C
authors.initials: JC
authors.lastname: Andrade
authors.forename: E
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design