Extended aortic replacement in acute dissection by the separated elephant trunk technique

Background. Extensive aortic replacement in acute dissection is currently not a widely accepted method of treatment. Methods. We developed a safe method for extended aortic repair including the aortic arch in type A acute dissection, and describe here its application in 5 cases. This method was based on a modification of the elephant trunk method and several other strategies. Most of the procedures were carried out under simple hypothermic circulatory arrest. Results. All patients recovered within 2 days without recurrent nerve injury. One patient suffered from unilateral upper arm palsy due to severe innominate dissection. Patients were all discharged and early postoperative computed tomography (CT) showed thrombotic obliteration around the elephant trunk. Follow-up CT after 4 to 18 months confirmed that thromboexclusion proceeded down to the distal end of the elephant graft in 1 patient and to the diaphragmatic level in 3 patients. Total obliteration was observed in the remaining 1 patient. Conclusions. This technique enables extended aortic repair in acute dissection with no increase in morbidity, and effectively promotes thromboexclusion of the dissected lumen to a wider extent than conventional methods.