loading page

Surgical “Elephant Trunk” Arch Replacement with a Branched Arch Prosthesis: Two Alternative Operative Techniques
  • +4
  • Carlo Bassano,
  • DARIO BUIONI,
  • Paolo Nardi,
  • Antonio Scafuri,
  • Calogera Pisano,
  • Fabio Bertoldo,
  • Giovanni Ruvolo
Carlo Bassano
University of Rome Tor Vergata Faculty of Medicine and Surgery

Corresponding Author:[email protected]

Author Profile
DARIO BUIONI
Università degli Studi di Roma Tor Vergata Facoltà di Medicina e Chirurgia
Author Profile
Paolo Nardi
Cardiac Surgery Unit, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy
Author Profile
Antonio Scafuri
University of Rome Tor Vergata Faculty of Medicine and Surgery
Author Profile
Calogera Pisano
University of Rome Tor Vergata Faculty of Medicine and Surgery
Author Profile
Fabio Bertoldo
University of Rome Tor Vergata Faculty of Medicine and Surgery
Author Profile
Giovanni Ruvolo
University of Rome Tor Vergata Faculty of Medicine and Surgery
Author Profile

Abstract

Background: Elephant trunk repair of the aortic arch cannot be performed with a branched prosthesis. We conceived two different modifications of the original technique to perform an arch replacement with a branched graft, while arranging an adequate landing zone for a subsequent TEVAR, without the need of dedicated material. Methods: Eight consecutive patients underwent arch replacement with one of our techniques. Five were emergency patients with acute aortic dissection, and 3 suffered chronic expansive disease. The “modified elephant trunk” includes a separate anastomosis of an endo-luminal prosthetic segment in the descending aorta. Subsequently, the branched arch prosthesis is anastomosed to the distal aortic stump with the attached trunk. In the “prophylactic debranching”, a tail is left on the distal end of the arch prosthesis, so that the branches for the supra-aortic vessels will remain displaced proximally, allowing a “zone 1” available for landing. Results: Three patients experienced transient cerebral deficits (1 TIA and post-operative delirium in 2 cases), 1 required re-operation for bleeding and 2 needed prolonged intubation. One died for multi-organ failure. Conclusion: Both techniques proved to be easily reproducible, and allow an adequate landing zone for a subsequent endovascular procedure, while keeping the advantages of using a tetra-furcated prosthesis. They are a viable alternative in case a hybrid prosthesis cannot be implanted.