ELEPHANT TRUNK PROCEDURE FOR SURGICAL-TREATMENT OF AORTIC DISSECTION

Background. in surgical intervention for aortic dissection, a highly r adical operation can be performed by distal anastomosis with a true lu men resulting in thrombotic closure of the dissecting lumen. Ln this a nastomosis, the elephant trunk procedure, in which a graft is inserted into the distal true lumen, prevents blood Bow leakage into the disse cting lumen at the anastomosis site and also strengthens this area. Me thods. We performed this procedure in 15 patients (8 men and 7 women). Acute aortic dissection was observed in 9 patients and chronic dissec tion in 6, Stanford type A dissection was diagnosed in 10 patients and type B in 5. Results. Graft replacement of the ascending aorta and to tal aortic arch was performed in 10 patients and descending aortic rep lacement in 5. A graft with a diameter of 16 to 24 mm was inserted int o the true lumen of the descending aorta, and the false lumen was clos ed, Subsequently, distal anastomosis was performed on the true lumen. There were two hospital deaths. Postoperative digital subtraction angi ography showed good results in living patients, and computed tomograph ic scanning showed thrombotic closure in the dissecting lumen of the d escending aorta. Conclusions. The elephant trunk procedure is useful f or closing the false lumen of the distal aorta. (Ann Thorac Surg 1998; 66:82-7) (C) 1998 by The Society of Thoracic Surgeons.