Modified elephant trunk technique in distal anastomosis with the aid of antegrade selective cerebral perfusion for total arch replacement.
BACKGROUND
Secure distal anastomosis and reliable brain protection are indispensable for successful total arch replacement (TAR). In 2002, we introduced a modified elephant trunk technique, a novel approach to distal anastomosis, and employed antegrade selective cerebral perfusion. We retrospectively analyzed 107 consecutive patients to evaluate the efficacy of this technique for TAR with antegrade selective cerebral perfusion.


METHODS
Since 2002 we have employed moderate hypothermic circulatory arrest, selective antegrade cerebral perfusion, and open distal anastomosis with a modified elephant trunk technique in TAR. Between February 2002 and September 2011, 107 TARs were performed in 88 males and 19 females (age, 33 to 88 years; mean, 70.9±9.5 years). Etiologies of cases were as follows: 89 true aneurysm due to atherosclerosis; 5 infectious aneurysm; 1 aortic dilation with bicuspid aortic valve; 12 aortic dissection, including 1 of acute aortic dissection case; and 2 Marfan syndrome. Concomitant procedures included 19 coronary artery bypass grafting (CABG) cases, 2 aortic valve replacement cases, 1 mitral valve plasty case, 1 Bentall procedure case, and 1 case of Bentall with CABG.


RESULTS
The operative mortality within 30 days was 0.9% (1 of 107), and overall hospital mortality was 1.9% (2 of 107). Temporary and permanent neurologic dysfunction occurred in 5 patients each (4.7%). The Kaplan-Meier survival analysis revealed a 5-year survival rate of 91.8%.


CONCLUSIONS
The modified elephant trunk technique using selective antegrade cerebral perfusion provided secure distal anastomosis and demonstrated excellent results, with low operative mortality and few neurologic complications.
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan. Electronic address: yuji_1350@ybb.ne.jp.
Yuji
Y
Kaku
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
Masato
M
Nakajima
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
Yuki
Y
Ichihara
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
Kei
K
Iizuka
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
Koji
K
Tsuchiya
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001018:Aortic Diseases / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods