We present a simplified elephant trunk procedure to treat type I acute aortic dissections. This technique transfers the anastomotic site of a modified elephant trunk prosthesis from zone 3 to zone 0 (before anonymous trunk).
From November 2015 to April 2018, 38 patients underwent an ascending aorta replacement for type I acute aortic dissection. In order to stabilize the arch and prepare a future landing zone, after the reconstruction of proximal and distal dissected aortic walls using inside and outside felt strips, we introduce into the aortic arch a Dacron prosthesis resected to create a “fenestration” under the supra-aortic branch vessels. The distal part of this prosthesis is left free floating into the descending aorta. The concave arch was also anchored to the prosthesis and through a catheter placed distally into the tube graft we perfused the thoracic aorta. Having the prosthesis a final shape of a canoe, we named the procedure “the Salerno Canoe Technique”.
Five patients died (13.2%). We observed a 5% reduction compared to our previous mortality. In one patient severe abdominal hypoperfusion due to secondary hypertensive false lumen was successful treated by an endovascular thoracic prosthesis landed proximally into the “canoe prosthesis”.
Compared to conventional elephant trunk technique this procedure is simpler and less circulatory arrest time-consuming (only mean 12 min increase respect to ascending aorta replacement alone). It allows an extensive arch stabilization, a safe perfusion of the descending thoracic aorta and a landing zone for future endovascular procedures.
1Cardiochirurgia d’Urgenza, Dipartimento Cardio-Vascolare Salerno