ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
THE CLINICAL RESULTS OF ELEPHANT TRUNK TECHNIQUE IN THE TREATMENTS OF AORTIC DISSECTION
Kaan KIRALİ, Hasan ARDAL, Mustafa GÜLER, Suat Nail ÖMEROĞLU, Denyan MANSUROĞLU, Bahadır DAĞLAR, Esat AKINCI, Mehmet BALKANAY, Gökhan İPEK, Cevat YAKUT, * Füsun GÜZELMERİÇ, ** Turan BERKİ, *** Ali GÜRBÜZ, **** Ömer IŞIK
Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, İSTANBUL
*Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Koşuyolu Anesteziyoloji Kliniği, İSTANBUL
**Kocaeli Üniversitesi, Kalp Damar Cerrahisi Anabilim Dalı, İZMİT
*** Atatürk Devlet Hastanesi, Kalp Damar Cerrahisi Kliniği, İZMİR
**** Maltepe Üniversitesi, Kalp Damar Cerrahisi Anabilim Dalı, İSTANBUL
Background:

The elephant trunk technique, which is used for the surgical treatment of aortic dissections involving the arcus aorta by replacing the transverse aorta, is widespread popularized in the last decade. The purpose of this retrospective study is to assess the clinical results of elephant trunk technique performed in our clinic.

Methods:

Between 1993 and December 2000, elephant trunk technique was performed in 28 of all patients with aortic dissection in Koşuyolu Heart and Research Hospital. Twenty-seven patients (96.4%) were male and one patient (3.6%) was female. The mean age of the patients was 50.3 ± 9.3 years (range, 33 to 70 years). Acute aortic dissection developed in 14 patients (50%), while chronic dissection was observed in 14 patients (50%). The survivors were followed up for a mean of 3.3 ± 1 years (range, 1 to 7 years).

Results:

The hospital mortality was 32.1% with 9 patients. The reasons were low cardiac output, acute tubular necrosis, ARDS, multiorgan failure, massive hemorrhage and CVA. In the multivariante analysis of 18 possible determinants of the early mortality, chronic obstructive pulmonary disease (p < 0.001), associated aortic valve replacement (p = 0.0276) and perfusion time (p = 0.0008) were the only significant risk factors. Late mortality was 10.5% with two patients, and the causes were graft endocarditis and rupture of the aneurysm. The survival rate was 55.1% ±11.5% at 5 years. The most common morbidities were neurologic complications (21.4%), pulmonary complications (14.3%) and ryhthm disturbances (7.4%). Actuarial freedom from death showed no difference for type of dissection (p = 0.8), emergency pattern of the dissection (p = 0.9) or associated aortic aneurysm (p = 0.5).

Conclusions:

Anastomosis of the arch branches to the graft, which is used for the elephant trank procedure during replacement of the transverse aorta, is keeping up the cerebral blood flow, and it is an effective technique that facilitates the replacement of the descending aorta in a second stage.

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