title: Total arch replacement with long elephant trunk anastomosed at the base of the innominate artery: a single-centre longitudinal experience.
abstract: OBJECTIVE
  Total arch replacement, with a long elephant trunk (ET) anastomosed at the base of the innominate artery using an undersized graft, is performed for a variety of arch aneurysms. We investigated the long-term clinical outcomes of this procedure, as well as its long-term effectiveness for preventing retrograde flow into the aneurysm and further dilation of the descending aorta.
  
  
  METHODS
  We treated 127 consecutive patients with an arch aneurysm, who were divided into two groups according to the diameter of the descending aorta at the Th6-Th8 thoracic vertebral level: 35 mm or less (Single-ET, n = 94) and >35 mm (Staged-ET, n = 33). The graft diameter was undersized by 10-20% of the distal aortic diameter. ET length was determined by preoperative computed tomography (CT) to locate the distal end at Th6-Th8. Thrombosis around the ET and the descending aorta diameter around the distal end of the ET were evaluated using CT.
  
  
  RESULTS
  Two patients (1.6%) died within 30 days, while seven (5.5%) died in the hospital, three (2.4%) had a new stroke, three (2.4%) had permanent paraplegia and one (0.8%) had paraparesis. CT demonstrated complete thrombosis of the perigraft space around the ET in 81 patients (86%) in the Single-ET group and 11 (33%) in the Staged-ET group within 1 month after surgery, but not in the remaining 35 patients. Twenty-seven of the 35 patients without complete thrombosis underwent a subsequent second-stage operation. In those, the descending aorta showed no further dilation around the distal end of the ET, while new-onset perigraft perfusion occurred in two patients in the Single-ET group at 14 and 126 months, respectively. Overall survival was 89, 86, 78 and 74% at 1, 3, 5 and 7 years, respectively.
  
  
  CONCLUSIONS
  Our operative strategy for extensive thoracic aortic aneurysms using a long ET technique yielded satisfactory short- and long-term outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization, Osaka Rosai Hospital, Osaka, Japan. haruhk@wa3.so-net.ne.jp
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kondoh
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Funatsu
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Takafumi
authors.initials: T
authors.lastname: Masai
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Kuki
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016122:Brachiocephalic Trunk / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome