A simple technique to facilitate antegrade thoracic endograft deployment using a hybrid elephant trunk procedure under hypothermic circulatory arrest.
OBJECTIVE
To describe a technique to facilitate antegrade thoracic endograft deployment using a hybrid elephant trunk operation under hypothermic circulatory arrest.


METHODS
When using a nitinol-based endograft in a hybrid endovascular aortic arch repair performed in a hypothermic patient, the endograft does not expand fully when the body temperature is typically maintained below 20 degrees C. Immersing the nitinol-based thoracic endograft in a sterile hot saline bath (48 degrees C) for 1 to 2 minutes prior to deployment warms the stent-graft to a physiological temperature of 38 degrees C, which it maintains for several minutes while being deployed.


CONCLUSIONS
Although the described technique represents an off-label approach to the use of a TAG device, we believe warming a nitinol-based endograft may potentially improve the technical success of this hybrid operation when the patient is under hypothermic circulatory arrest.
Lin
Peter H
PH
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houstan, Texas 77030, USA. plin@bcm.edu
Dardik
Alan
A
Coselli
Joseph S
JS
D000497:Alloys; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D006358:Hot Temperature; D006801:Humans; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012965:Sodium Chloride; D015607:Stents
D000497:Alloys; C013616:nitinol; D012965:Sodium Chloride; D011138:Polytetrafluoroethylene