Abstract
BackgroundThe elephant trunk technique has been applied in various situations including distal aortic dissection, entire aortic replacement, proximal aortic aneurysm, proximal aortic dissection, and Marfan’s syndrome. The elephant trunk technique remains a challenge in cardiac surgery. Here we report a modification of this surgical approach.Case presentationThe “extroverted cuff” technique that we propose is a novel modification of the flanged technique for the elephant trunk construction. The technique consists in the graft extroversion which is than located inside the descending aorta. Then the distal anastomosis is constructed between the descending aorta and the circular free edge the external layer of the graft. Such a technique was successfully applied in a patient with type A aortic dissection undergoing modified elephant trunk technique, aortic arch replacement and Bentall operation.ConclusionSuch a modification seems suitable for aortic arch aneurysm with ragged descending thoracic aorta that minimizes bleeding from the distal anastomosis and potentially prevents distal embolization of atheromatous plaque.
Highlights
The elephant trunk technique has been applied in various situations including distal aortic dissection, entire aortic replacement, proximal aortic aneurysm, proximal aortic dissection, and Marfan’s syndrome
Such a modification seems suitable for aortic arch aneurysm with ragged descending thoracic aorta that minimizes bleeding from the distal anastomosis and potentially prevents distal embolization of atheromatous plaque
The elephant trunk has been applied in various situations including distal aortic dissection, entire aortic replacement, proximal aortic aneurysm, proximal aortic dissection, and Marfan's syndrome
Summary
The elephant trunk was introduced by Borst et al [1] for a staged approach in extensive aortic disease. The elephant trunk has been applied in various situations including distal aortic dissection, entire aortic replacement, proximal aortic aneurysm, proximal aortic dissection, and Marfan's syndrome. Modifications of the elephant trunk have been reported, the distal anastomosis, especially the posterior aspect, is very difficult to be exposed after been constructed, and bleeding remains an important surgical pitfall [2,3,4,5]. We present a novel modification of the elephant trunk indicated for aortic arch aneurysm with ragged descending thoracic aorta that minimizes bleeding from the distal anastomosis and potentially prevents distal embolization of atheromatous plaque. Cardiopulmonary bypass was instituted with right atrial drainage and femoral artery cannulation. The patient was cooled to a rectal temperature of 22 °C, and the circulatory arrest was instituted associated with retrograde cerebral perfusion. A 30 mm Hemashield (30 cm length) woven double velour, Meadox, USA) graft was selected, the distal part was extroverted as a “cuff” for about 4 cm of the graft which were carefully
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