Elephant trunk anastomosis proximal to origin of innominate artery in total arch replacement.
OBJECTIVE
The purpose of this study was to describe our current technique for aortic arch replacement using a four-branched arch graft and a long elephant trunk.


METHODS
Using our method, the ascending aorta is replaced with a four-branched Hemashield arch graft (Hemashield Platinum, Woven Double Velour [Boston Scientific Corp, Wayne, NJ]) while cooling the patient. When 25 degrees C is reached, selective cerebral perfusion is started and the elephant trunk is inserted under open distal conditions into the descending aorta using a catching catheter introduced through a femoral artery. A distal aortic anastomosis is then performed between the four-branched graft and distal aorta incorporating the elephant trunk at the base of the innominate artery. Arch vessels are reconstructed separately during rewarming.


RESULTS
Between October 1998 and December 2005, we performed the present technique in 52 patients with no operative deaths within 30 days after the procedure. The mean duration of hypothermic circulatory arrest was 24 +/- 5 minutes, whereas that of selective cerebral perfusion was 86 +/- 9 minutes.


CONCLUSIONS
The technique described herein requires a shorter circulatory arrest time and is uniformly applicable to patients with extensive thoracic aortic aneurysms.
Taniguchi
Kazuhiro
K
Department of Cardiovascular Surgery, Osaka Rosai Hospital, Sakai, Japan. kazuhiro@orh.go.jp
Toda
Koichi
K
Hata
Hiroki
H
Shudo
Yasuhiro
Y
Matsue
Hajime
H
Takahashi
Toshiki
T
Kuki
Satoru
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods* / Q000401:mortality; D001013:Aorta, Thoracic / Q000601:surgery*; D016122:Brachiocephalic Trunk / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology