SURGICAL-TREATMENT OF ACUTE TYPE-B AORTIC DISSECTION USING AN ENDOPROSTHESIS (ELEPHANT TRUNK)

Background. The surgical treatment of acute complicated type B aortic dissection continues to be a challenge and is still associated with hi gh morbidity and mortality rates. Methods. Seventy consecutive patient s with an acute type B aortic dissection underwent an elephant trunk p rocedure through a median sternotomy during deep hypothermic circulato ry arrest. An endoprosthesis that was 22 to 24 mm in diameter was inse rted through an incision in the arch and held in place with only proxi mal sutures. Results. The mean arrest time was 31.4 +/- 8.7 minutes, a nd it was possible to adequately position the endoluminal graft in eve ry patient. The procedure was done in association with other procedure s in 13 patients. There were six in-hospital deaths not related to the endoprosthesis, and four late deaths. Late reoperation was necessary in 6 patients to manage leakage at the proximal suture line. Conclusio ns. The insertion of an endoprosthesis through the arch for the manage ment of a complicated acute type B dissection has several advantages o ver the conventional thoracotomy approach. The hospital mortality rate in this series of 70 patients was 20%, and the actuarial 5-year survi val rate was 62.5%. We consider the elephant trunk procedure the treat ment of choice in patients with type B acute dissections, regardless o f whether the dissection is complicated or not. (C) 1997 by The Societ y of Thoracic Surgeons.