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July 19, 2013European Journal of Cardio-Thoracic Surgery

Total aortic arch replacement with the elephant trunk technique: single-centre 30-year results

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Authors

MSMalakh ShresthaCardiac SurgeryAMAndreas MartensCarl von Ossietzky Universität OldenburgHKH. KrügerPfizer (Germany)

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Implication

Retrospective cohort study reveals outcomes of two-stage elephant trunk repair in complex aortic disease, indicating a persistent clinical role despite newer endovascular options.

Key Points

  • Evaluate 30-year single-centre surgical outcomes and safety of total aortic arch replacement using the two-stage elephant trunk technique for extensive thoracic aortic pathology.
  • Retrospective review of 179 patients (mean age 56.4±12.6 years; 112 males) undergoing an elephant trunk procedure between March 1982 and March 2012 for aortic aneurysms (n=91) or dissections (n=88, 47 acute).
  • Patients received cerebral protection via deep hypothermic circulatory arrest prior to 1999 or moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion after 1999.
  • First-stage operations had a mean cardiopulmonary bypass time of 208.5±76.5 min, resulting in 1.7% (3/179) intraoperative mortality, 17.3% (31/179) 30-day mortality, 7.9% (14/176) stroke, 18.2% (32/176) recurrent nerve palsy, and 5.6% (10/176) paraplegia.
  • Fifty-seven patients underwent second-stage completion (50 surgical, 7 interventional), which showed 5.2% (3/57) intraoperative mortality, 7.0% (4/57) 30-day mortality, 7.0% (4/54) paraplegia, and 0% stroke or recurrent nerve palsy.

Cite This Study

Shrestha et al. (2013) studied this question.

synapsesocial.com/papers/6a97b322d72f642c28a665d8https://doi.org/10.1093/ejcts/ezt359
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Also Consider

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  1. 1Is Treatment of Acute Type A Aortic Dissection in Septuagenarians Justifiable?2008 · 27 citations
  2. 2Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results†2012 · 129 citations
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  4. 4The elephant trunk technique: operative results in 100 consecutive patients2002 · 137 citations