title: [Surgical Procedure Using the Elephant Trunk Technique at All Anastomotic Sites for Acute Type A Aortic Dissection].
abstract: OBJECTIVE
  We report the use of the elephant trunk technique at all anastomotic sites in acute type A aortic dissection surgery.
  
  
  METHODS
  Artificial graft carrying a 2-mm short elephant trunk were prepared for both distal and proximal anastomotic sites. Subjects were 82 patients with acute type A aortic dissection who underwent surgery using this procedure between March 2009 and August 2015. The mean age was 69.6 ±10.7 years( range, 43~89 years). Seventeen patients( 20.7%) had cardiac tamponade or shock, while 8 cases( 9.8%) had organ ischemia due to malperfusion.
  
  
  RESULTS
  Total aortic arch replacement was performed in 22 patients (26.8%), while replacement of the ascending aorta was performed in 60( 73.2%). The mean durations of surgery, extracorporeal circulation, and cardiac ischemia were 352 ± 64, 199 ± 37, and 123 ± 26 min, respectively. Five in-hospital deaths( 6.1%) occurred. With respect to early complications, 5 patients( 6.1%) had permanent encephalopathy. Nine (11.0%) had respiratory failure, and 4 (4.9%) required tracheotomy. None of the patients had bleeding requiring additional thoracotomy for hemostasis and none had complications attributed to preparation of the artificial vessels.
  
  
  CONCLUSIONS
  Artificial graft were prepared using the elephant trunk technique for use at all anastomotic sites in acute type A aortic dissection surgery. This procedure, involving stepwise proximal anastomosis, is highly effective for hemostasis and safe.
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki Harbor Medical Center, City Hospital, Nagasaki, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hashizume
authors.forename: Mizuki
authors.initials: M
authors.lastname: Sumi
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tanigawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.forename: Seiji
authors.initials: S
authors.lastname: Matsukuma
authors.forename: Ichiro
authors.initials: I
authors.lastname: Matsumaru
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged