952-23 Use of the Elephant Trunk Technique in the Marfan Patient

Abstract

Patients afflicted with aortic manifestations of the Marfan syndrome often require staged aortic replacement. To facilitate anastomosing of the aorta further downstream, the “elephant trunk technique”, which leaves surplus intravascular graft length, was applied. Between 1982 and 1994, 18 elephant trunks were implanted in 14 patients with the Marfan syndrome (age range 20–50 years) suffering from chronic aortic dissection: type A = 9 (7 s/p emergency repair in the acute stage). type B = 5. In 5 patients, the primary elephant trunk was placed “proximally”, meaning the extension of a total aortic arch replacement into the proximal descending thoracic aorta. It was left “distally”, extending from a grafted descending aorta into the thoraco-abdominal portion, in 9 patients. Subsequent downstream replacement was performed after a mean interval of 9 months: descending thoracic aortic replacement, again utilizing an elephant trunk, in 4 cases, thoraco-abdominal replacement in 5. Two patients undervvent additional abdominal grafting. Thus, a total of 32 aortic operations, involving 18 elephant trunks, was performed in 14 patients. There was no mortality associated with the elephant trunk technique. Over time, technical modifications were introduced to ease the unfolding of the trunk. Ample membrane resection avoids its entrapment in the false lumen of a dissected vessel. In patients with the Marfan syndrome, who often need multiple aortic operations, the “elephant trunk technique” greatly disencumbers these troublesome procedures.