Optimal graft diameter and location reduce postoperative complications after total arch replacement with long elephant trunk for arch aneurysm Haruhiko.

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Background (1) ・ In 1998, we developed a modified elephant trunk (ET) technique using a single four-branched arch graft with a sewing “collar” and “long.

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Presentation transcript:

Optimal graft diameter and location reduce postoperative complications after total arch replacement with long elephant trunk for arch aneurysm Haruhiko Kondoh, MD, Toshihiro Funatsu, MD, Koich Toda, MD, Satoshi Kainuma, MD, Satoru Kuki, MD, Kazuhiro Taniguchi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 2, Pages 319-325 (August 2011) DOI: 10.1016/j.jtcvs.2010.10.035 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Total arch replacement with a long ET anastomosed at the base of the innominate artery. A, Four-branched arch graft is sutured into the sinotubular junction under cardioplegic arrest. B, After systemic perfusion is switched to selective cerebral perfusion using the right and left axillary arteries, and a small cannula is placed in the left common carotid artery, the distal ascending aorta is transected, and the long ET is placed into the aortic arch by pulling the ET with a catching catheter. C, Distal anastomosis is performed between the 4-branched arch graft and the long ET 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. ΔL, Length from the origin of the descending aorta at the lesser curvature of the aortic arch to the distal end of the ET. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 319-325DOI: (10.1016/j.jtcvs.2010.10.035) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Relationship between complications (spinal cord injury and retrograde flow into the peri-graft space) and the location of the end of the ET (the Th level and ΔL). The size of each circle represents the number of patients. Solid red and blue represent complications, as indicated. Long grafts were associated with an increased risk of spinal cord injury, and short grafts were associated with retrograde flow. ΔL varied, even when the distal end of the graft was positioned at the same thoracic vertebral level. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 319-325DOI: (10.1016/j.jtcvs.2010.10.035) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions