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Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis

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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.

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Abbreviations

ET:

Elephant trunk

ACP:

Antegrade cerebral perfusion

AVR:

Aortic valve replacement

CPB:

Cardiopulmonary bypass

CABG:

Coronary aortic bypass grafting

PAU:

Perforating aortic ulcer

NIRS:

Near infrared spectroscopy

POD:

Postoperative day

SLEDD:

Slow low effective daily dialysis

AVR:

Aortic valve replacement

HIT:

Heparin-induced thrombocytopenia

SD:

Standard deviation

GRF:

Gelatin–resorcinol–formaldehyde

ROTEM:

Rotational thromboelastometry

CTC:

Computed tomography of the cerebrum

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Conflict of interest

None declared.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany

    Stefan R.B. Schneider, Angelo M. Dell’Aquila, Ali Akil, Dominik Schlarb, Sven Martens & Andreas Rukosujew

  2. Department of Vascular and Endovascular Surgery, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany

    Guiseppe Panuccio

Authors
  1. Stefan R.B. Schneider
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  2. Angelo M. Dell’Aquila
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  3. Ali Akil
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  4. Dominik Schlarb
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  5. Guiseppe Panuccio
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  6. Sven Martens
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  7. Andreas Rukosujew
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Corresponding author

Correspondence to Stefan R.B. Schneider.

Additional information

S. R. B. Schneider and A. M. Dell’Aquila contributed equally.

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Schneider, S.R., Dell’Aquila, A.M., Akil, A. et al. Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis. Heart Vessels 31, 390–396 (2016). https://doi.org/10.1007/s00380-014-0612-6

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