A modified "elephant trunk" procedure for aortic arch replacement.

OBJECTIVES: We have devised a modified "elephant trunk" technique for primary aortic arch replacement that strengthens the distal anastomosis by preventing access of the blood stream to the distal suture line. The technique entails suturing an elephant trunk graft to the inner surface of the arch graft circumferentially just distal to the fourth of its 4 limbs. The inner graft is then inserted into the distal aortic lumen while the edge of the arch graft orifice is anastomosed to the aortic stump. This clinical trial was conducted to clarify its usefulness. METHODS: This technique was used in 5 cases of total arch replacement to reinforce distal anastomoses. RESULTS: All patients tolerated surgery well without complications such as paraplegia or thromboembolism. CONCLUSIONS: The advantages of this modified technique include simplicity and reproducibility.