How I would want my Elephant Trunk Procedure to be done.

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Presentation transcript:

How I would want my Elephant Trunk Procedure to be done. Prof Dr med. Malakh Shrestha Chief Staff Surgeon and Director of Aortic Surgery Cardio-thoracic, Transplantation and Vascular Surgery Hannover Medical School

Disclosures Consultant work not relevant for this presentation. Consultant Vascutek Terumo Edwards Lifesciences Medtronic Sorin Biomedica Consultant work not relevant for this presentation.

“Elephant Trunk Technique“ Stage 1 1. Aneurysm:15th March 1982 2. CADA: 28th October 1983 3. AADA: 22nd May 1989 Modifications in Classical Elephant Trunk Borst HG et al. Extensive aortic replacement using the ‚elephant trunk prosthesis‘ Thorac Cardiovasc Surg 1983; 31 (1): 37-40

The second stage completion is inevitable! METHODS: From March 1982 to March 2012, 179 patients (112 males, age 56.4 ± 12.6 years) received an ET procedure (91 aneurysms, 88 dissections (47 acute)). The cerebral protection was done either by deep (till 1999) or moderate hypothermic circulatory arrest and selective antegrade cerebral perfusion (SACP, after 1999). RESULTS: Among AADA Patients, the 30-day mortality during the first-stage operation was 32% (15/47) Peri-operative stroke was 17% (n = 8/47). Postoperative recurrent nerve palsy was present in 13% (8/47). The second stage completion is inevitable!

Hannover Medical School: ET (1982-2015) n=191; FET (2001-2015), n=224.

Aortic arch surgery doesn‘t always result in death ! Aortic Rupture Ischaemia/ Malperfusion: -Myocardial -Cerebral: stroke -Visceral Intra-operative Bleeding Myocardial failure (?Long X-clamp time) Multi-organ failure

Good judgment comes from experience and experience comes from bad judgment.

Hannover Concept Core temperature: 25°C Bilateral cold selective antegrade cerebral perfusion (22-24°C) ‘Beating Heart‘ arch Surgery Branched graft for aortic arch Minimize Lower Body ischaemia CSF Drainage CO2 Sufflation FET

Selective Antegrade Cerebrale Perfusion Bachet J, Guilmet D, Goudot B, Dreyfus GD, Delentdecker P, Brodaty D, Dubois C Antegrade cerebral perfusion with cold blood: a 13-year experience. Ann Thorac Surg. 1999 Jun;67(6):1874-8; discussion 1891-4.

Is BGT better than en-block technique for total aortic arch replacement? Ann Thorac Surg. 2004 Jun;77(6):2021-8. Separate grafts or en bloc anastomosis for arch vessels reimplantation to the aortic arch. Di Eusanio M, Schepens MA, Morshuis WJ, Dossche KM, Kazui T, Ohkura K, Washiyama N, Di Bartolomeo R, Pacini D, Pierangeli A. Spielvogel 2005

Conclusion Olympics Motto Aortic arch repair Citius, Altis, Fortius! (Higher, Faster, Further) Safer, Simpler, Reproducible!

Nepal Earthquake: Please Help!