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J Thorac Cardiovasc Surg 2006;131:107-113
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection

Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academe of Medical Science and Peking Union Medical College, Beijing, China

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 29, 2005; revisions received August 24, 2005; accepted for publication September 9, 2005.

^_* Address for reprints: Li-Zhong Sun, MD, Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital Beijing, CAMS & PUMC, 100037, 167 Bei Li Shi Rd, Xi Cheng District, Beijing, Peoples Republic of China (Email: liuzgfwh{at}hotmail.com).

OBJECTIVES: To eliminate the residual false lumen in the descending thoracic aorta and improve long-term outcomes of surgical intervention for Stanford type A aortic dissection, we performed the skeletonized "elephant trunk" procedure in the ascending aorta and aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for both acute and chronic type A aortic dissection, and the short-term results were compared.

METHODS: Between April 2003 and November 2004, 60 consecutive patients (mean age, 53 ± 16.7; approximate range, 28-78 years) with acute (n = 36) or chronic (n = 24) type A aortic dissection underwent this procedure. Right axillary artery cannulation was used for cardiopulmonary bypass and selected cerebral perfusion. The stented graft, a 10-cm-long woven Dacron graft with a self-expandable stent, was implanted through the aortic arch during hypothermic circulatory arrest. Enhanced electric beam computed tomography was performed in each patient before discharge, 3 months after the operation, and once each year thereafter to evaluate the postoperative time course of the residual false lumen.

RESULTS: Cardiopulmonary bypass time was 166 ± 38 minutes, and average selective cerebral perfusion and lower body arrest time was 30 ± 15 minutes. The in-hospital mortality was 3.3% (2/60). Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 92% and 85% of the acute and chronic aortic dissections, respectively, 3 months postoperatively. There was no late death during follow-up.

CONCLUSIONS: The skeletonized elephant trunk procedure is an effective way of closing the residual false lumen of the descending aorta and might contribute to better long-term outcomes for both acute and chronic type A aortic dissection.

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