Stand-Alone Elephant Trunk Procedure

Abstract

In some patients, with a very proximal descending aortic aneurysm, there is not enough room for a secure proximal anastomosis to be done via the left chest (without DHCA).

Questions and Answers

• BAZ: Is this not “a long run for a short slide,” to use the baseball analogy? In other words, is this not a big operation to establish a proximal anastomosis?

• JAE: For a talented and experienced aortic surgeon, transecting and re-anastomising the aortic arch is a relatively small operation, which can be accomplished quickly and safely. Sewing tissue to tissue, with a graft edge being caught by each suture is quite straightforward. The aorta is of normal caliber at the site of the anastomosis; otherwise, a different procedure (arch replacement) would need to be performed. The operating time is probably not much longer than the alternative carotid to subclavian graft, which does carry a risk of graft closure and phrenic and recurrent laryngeal nerve injuries. Also, the proximal anastomosis provides a secure, durable proximal “landing zone” (to borrow the interventional terminology)—without any risk of early or late failure and no need for future “touch ups.”