title: Results of "elephant trunk" total aortic arch replacement using a multi-branched, collared graft prosthesis.
abstract: We report on our experience with a simplified elephant trunk (ET) procedure with a multi-branched prosthesis (Vascutek(®) Siena™ Collared Graft). It consists of a proximal portion (20 cm) with prefabricated side branches, a collar and a distal portion (30 cm). The collar, which can be trimmed into any desired diameter, constitutes the suture portion to the descending aorta. Radiopaque markers in the distal portion indicate the landing zone. Between January 2011 and June 2013, 20 consecutive patients (10 women; mean age, 66 ± 9.3 years) underwent ET procedure, including 6 re-do cases. Underlying aortic diseases were acute dissection (n = 6), chronic dissection (n = 4), aneurysm (n = 8) and PAU (n = 2). Mean preoperative diameter of the descending aorta was 49.1 ± 12.9 mm (range 74.7-29.7 mm). Concomitant procedures included ascending aortic replacement in 16 patients; root replacement in 2; AVR in 2, CABG in 3 and mitral repair in 1 patient. CPB time was 263 ± 94 min; mean duration of ACP was 65 ± 14 min. Two patients died on POD 8 and 78, respectively. Major adverse events included stroke (n = 1), resternotomy for bleeding (n = 2), renal failure requiring temporary dialysis (n = 1) and recurrent nerve paresis (n = 2). After a mean follow-up of 10 ± 8 months, all discharged patients were alive. Seven patients underwent stent-graft implantation of the descending aorta and one patient underwent open descending aortic replacement. The last generation of multi-branched arch prosthesis and especially the Vascutek(®) Siena™ Collared Graft make ET procedure a reasonable treatment option even in patients with acute aortic dissection.
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. stefan.schneider@ukmuenster.de.
authors.forename: Stefan R B
authors.initials: SR
authors.lastname: Schneider
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Angelo M
authors.initials: AM
authors.lastname: Dell'Aquila
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Akil
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Schlarb
authors.affiliation: Department of Vascular and Endovascular Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Panuccio
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Martens
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rukosujew
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002908:Chronic Disease; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic arch replacement; Aortic dissection; Ascending aortic aneurysm; Elephant trunk procedure