A Case of Replacement of the Ascending Aorta, Transverse Aortic Arch, Descending Aorta, and Upper Abdominal Aorta Using the "Elephant Trunk" Operation / 日本心臓血管外科学会雑誌

ABSTRACT

The“elephant trunk”operation, first described by Borst and associates, is a multistage operation for diffuse aneurysmal disease. We report a 59-year-old man complaining of hoarseness, who had a diffuse aneurysm extending from the ascending aorta to the upper abdominal aorta with occlusive disease in the neck branches. His aorta was replaced in two stages using the“elephant trunk”operation. The first stage operation, replacement of the ascending aorta and transverse aortic arch, was performed through a median sternotomy under selective cerebral perfusion. The second stage operation, replacement of the descending thoracic and upper abdominal aorta, was performed under F-F bypass. He had occlusive disease on bilateral carotid arteries with a history of brain infarction, had lost his left lower limb because of arteriosclerosis, and had undergone replacement of the infrarenal abdominal aorta because of an aneurysm. Despite a complicated preoperative general condition, the postoperative course was uneventful. The“elephant trunk” operation facilitates staged operation for diffuse aneurysmal disease as presented here, and thereby improves opeative result by reducing surgical stress.