Elephant Trunk Anastomosis Proximal to Origin of Innominate Artery in Total Arch Replacement

Purpose The purpose of this study was to describe our current technique for aortic arch replacement using a four-branched arch graft and a long elephant trunk. Description Using our method, the ascending aorta is replaced with a four-branched Hemashield arch graft (Hemashield Platinum, Woven Double Velour [Boston Scientific Corp, Wayne, NJ]) while cooling the patient. When 25°C is reached, selective cerebral perfusion is started and the elephant trunk is inserted under open distal conditions into the descending aorta using a catching catheter introduced through a femoral artery. A distal aortic anastomosis is then performed between the four-branched graft and distal aorta incorporating the elephant trunk at the base of the innominate artery. Arch vessels are reconstructed separately during rewarming. Evaluation Between October 1998 and December 2005, we performed the present technique in 52 patients with no operative deaths within 30 days after the procedure. The mean duration of hypothermic circulatory arrest was 24 ± 5 minutes, whereas that of selective cerebral perfusion was 86 ± 9 minutes. Conclusions The technique described herein requires a shorter circulatory arrest time and is uniformly applicable to patients with extensive thoracic aortic aneurysms.