Extended aortic replacement in acute dissection by the separated elephant trunk technique

Background. Extensive aortic replacement in acute dissection is currently n ot a widely accepted method of treatment. Methods. We developed a safe method for extended aortic repair including th e aortic arch in type A acute dissection, and describe here its application in 5 cases. This method was based on a modification of the elephant trunk method and several other strategies. Most of the procedures were carried ou t under simple hypothermic circulatory arrest. Results. All patients recovered within 2 days without recurrent nerve injur y. One patient suffered from unilateral upper arm palsy due to severe innom inate dissection. Patients were all discharged and early postoperative comp uted tomography (CT) showed thrombotic obliteration around the elephant tru nk. Follow-up CT after 4 to 18 months confirmed that thromboexclusion proce eded down to the distal end of the elephant graft in 1 patient and to the d iaphragmatic level in 3 patients. Total obliteration was observed in the re maining 1 patient. Conclusions. This technique enables extended aortic repair in acute dissect ion with no increase in morbidity, and effectively promotes thromboexclusio n of the dissected lumen to a wider extent than conventional methods. (C) 1 999 by The Society of Thoracic Surgeons.