Surgery of the Elephant Trunk in the era of hybrid Prostheses: Experience with the Thoraflex Hybrid Prosthesis

Abstract

of a proximal elephant trunk facilitating the repair of the downward thoracic aorta. The mortality of this second operative stage is 10% and 50% of the patients only have the first stage. The treatment of these aneurisms can be completed by an endovascular route. The purpose of the study was to evaluate the effectiveness of this second endovascular stage and the perioperative morbimortality. Materials and Methods: The study was retrospective and monocentric. All the patients having the exclusion of a proximal thoracic aneurysm with a stentgraft after the realization of an elephant trunk were studied. The extension of the aneurysmal lesions of the thoracic aorta and the length of endovascular covering were reported. The rates of success, of perioperative mortality, of paraplegia and endoleak were determined. Results: Five patients profited from the second stage of elephant trunk with a stentgraft over a five years period. The mean age was 77 years. The time between the 1st and the 2nd operative stages was between 4 and 167 months. The material used was in three cases a Valiant (Medtronic) stentgraft, in one case a Relay NBS+ (Bolton) and in one case a custommade Relay NBS + (Bolton). The average diameter of the thoracic aneurysms was 55 mm. The artery of Adamkiewicz had been located in all the cases and was never covered. In two cases an anterior and superior spinal artery was covered. The stentgrafts covered the thoracic aorta from D7 to L1.The rate of postoperative paraplegia was null. Postoperative mortality was null. The primary success rate was of 100%. The average length of the trunks for the proximal anchoring of the stentgraft was 18 cm. The median follow-up was of 22 ± 21 months. Only one early type II endoleak was observed during the follow-up. Only one patient died during the followup, of a non-aortic cause. Conclusion: The endovascular second stage of the replacements of the aortic arch with elephant trunk offers a good immediate success rate in particular with a satisfactory proximal sealing, provided that the length of the elephant trunk is sufficient. The morbidity of this procedure is low, with the advantage of treating with precision the distality of the aortic lesions in contrast to the techniques of ‘‘frozen elephant trunk’’.