Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients Koichi Toda, MD, Kazuhiro Taniguchi, MD, Takafumi Masai, MD, Toshiki.

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Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients Koichi Toda, MD, Kazuhiro Taniguchi, MD, Takafumi Masai, MD, Toshiki Takahashi, MD, Satoru Kuki, MD, Yoshiki Sawa, MD The Annals of Thoracic Surgery Volume 88, Issue 1, Pages 16-22 (July 2009) DOI: 10.1016/j.athoracsur.2009.03.092 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Total arch replacement with a long elephant trunk (LET) anastomosed at the base of the brachiocephalic artery. (A) A 4-branched arch graft is sutured into the sinotubular junction under cardioplegic arrest. (B) After systemic perfusion is switched to selective cerebral perfusion using the Dacron grafts anastomosed to the right and left axillary arteries, and a small cannula in the left common carotid artery, the distal ascending aorta is transected and the LET is placed into the aortic arch by pulling the LET with a catching catheter. (C) A distal anastomosis is performed between the 4-branched arch graft and LET tube graft incorporating the distal ascending aorta. (D) After antegrade distal perfusion is resumed from the side branch of the graft, the patient is rewarmed, and the arch vessels are reconstructed. The Annals of Thoracic Surgery 2009 88, 16-22DOI: (10.1016/j.athoracsur.2009.03.092) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Kaplan-Meier survival curves after total arch replacement with a long elephant trunk (LET) in patients with complete thromboexclusion of arch aneurysm by LET (solid line), with incomplete thromboexclusion who underwent the second-stage procedure (dotted line), and with incomplete thromboexclusion who could not accomplish the second-stage procedure (dashed line). The Annals of Thoracic Surgery 2009 88, 16-22DOI: (10.1016/j.athoracsur.2009.03.092) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions