Document Detail

Total arch replacement with long elephant trunk anastomosed at the base of the innominate artery: a single-centre longitudinal experience.
MedLine Citation:
PMID:  22518042     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Total arch replacement, with a long elephant trunk (ET) anastomosed at the base of the innominate artery using an undersized graft, is performed for a variety of arch aneurysms. We investigated the long-term clinical outcomes of this procedure, as well as its long-term effectiveness for preventing retrograde flow into the aneurysm and further dilation of the descending aorta.
METHODS: We treated 127 consecutive patients with an arch aneurysm, who were divided into two groups according to the diameter of the descending aorta at the Th6-Th8 thoracic vertebral level: 35 mm or less (Single-ET, n = 94) and >35 mm (Staged-ET, n = 33). The graft diameter was undersized by 10-20% of the distal aortic diameter. ET length was determined by preoperative computed tomography (CT) to locate the distal end at Th6-Th8. Thrombosis around the ET and the descending aorta diameter around the distal end of the ET were evaluated using CT.
RESULTS: Two patients (1.6%) died within 30 days, while seven (5.5%) died in the hospital, three (2.4%) had a new stroke, three (2.4%) had permanent paraplegia and one (0.8%) had paraparesis. CT demonstrated complete thrombosis of the perigraft space around the ET in 81 patients (86%) in the Single-ET group and 11 (33%) in the Staged-ET group within 1 month after surgery, but not in the remaining 35 patients. Twenty-seven of the 35 patients without complete thrombosis underwent a subsequent second-stage operation. In those, the descending aorta showed no further dilation around the distal end of the ET, while new-onset perigraft perfusion occurred in two patients in the Single-ET group at 14 and 126 months, respectively. Overall survival was 89, 86, 78 and 74% at 1, 3, 5 and 7 years, respectively.
CONCLUSIONS: Our operative strategy for extensive thoracic aortic aneurysms using a long ET technique yielded satisfactory short- and long-term outcomes.
Haruhiko Kondoh; Kazuhiro Taniguchi; Toshihiro Funatsu; Koichi Toda; Takafumi Masai; Toshiki Takahashi; Satoru Kuki
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-04-19
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  42     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-22     Completed Date:  2013-04-18     Revised Date:  2013-09-05    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  840-8; discussion 848     Citation Subset:  IM    
Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization, Osaka Rosai Hospital, Osaka, Japan.
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MeSH Terms
Anastomosis, Surgical
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / mortality,  surgery*
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / instrumentation,  methods*,  mortality
Brachiocephalic Trunk / surgery*
Cohort Studies
Graft Occlusion, Vascular / epidemiology,  etiology,  radiography
Hospital Mortality
Kaplan-Meier Estimate
Logistic Models
Middle Aged
Postoperative Complications / epidemiology,  etiology,  radiography
Retrospective Studies
Risk Factors
Spinal Cord Injuries / epidemiology,  etiology,  radiography
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome
Comment In:
Eur J Cardiothorac Surg. 2013 Aug;44(2):401   [PMID:  23349325 ]
Eur J Cardiothorac Surg. 2013 Aug;44(2):400   [PMID:  23349324 ]
Eur J Cardiothorac Surg. 2012 Nov;42(5):849-50   [PMID:  22531272 ]

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