Carrel T, Berdat P, Kipfer B, Eckstein F, Schmidli J
Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
J Thorac Cardiovasc Surg. 2001 Sep;122(3):587-91. doi: 10.1067/mtc.2001.115924.
The elephant trunk technique with a free-floating vascular prosthesis was originally developed to facilitate a subsequent operation on the downstream aorta. We present here our experience with further developments of this technique, which we call the reversed elephant trunk and bidirectional elephant trunk.
Between January 1, 1995, and December 31, 2000, 505 adult and adolescent patients underwent operations of the thoracic aorta. A reversed elephant trunk procedure in 13 patients and a bidirectional elephant trunk procedure in 4 patients was performed to facilitate either subsequent proximal or proximal and distal aortic replacement. Nine patients underwent subsequent aortic arch replacement with the reversed prosthetic portion after a mean interval of 8 +/- 5.5 months, and 2 patients received distal extension by use of the distal portion of the free-floating graft.
There was no hospital mortality (30 days) in this small group of patients, and no patient had aortic rupture, malperfusion caused by the technique itself, or thromboembolic complications during the waiting interval between the first and the second operations. Five patients are still being observed until the contiguous aortic size is large enough to require an operation, and one 74-year-old patient declined a second-stage operation.
The reversed and bidirectional elephant trunk techniques are interesting options that may be suitable for patients having complex abnormalities of the thoracic aorta and thoracoabdominal aorta when the proximal portion of the descending aorta has to be replaced before the aortic arch with or without the ascending aorta or the distal descending aorta with or without the thoracoabdominal aorta.
带游离血管移植物的象鼻技术最初是为便于后续对降主动脉进行手术而研发的。在此，我们介绍我们在该技术进一步发展方面的经验，我们将其称为反向象鼻技术和双向象鼻技术。
在1995年1月1日至2000年12月31日期间，505例成年和青少年患者接受了胸主动脉手术。对13例患者实施了反向象鼻手术，对4例患者实施了双向象鼻手术，以便于后续进行近端或近端及远端主动脉置换。9例患者在平均间隔8±5.5个月后接受了用反向人工血管部分进行的主动脉弓置换，2例患者通过使用游离移植物的远端部分进行了远端延伸。
在这一小群患者中无住院死亡（30天内），且在首次和第二次手术之间的等待期间，没有患者发生主动脉破裂、该技术本身导致的灌注不良或血栓栓塞并发症。5例患者仍在观察中，直到相邻主动脉大小足够大需要进行手术，1例74岁患者拒绝接受二期手术。
反向和双向象鼻技术是有趣的选择，当降主动脉近端必须在主动脉弓之前（无论有无升主动脉）或在胸腹主动脉之前（无论有无降主动脉远端）进行置换时，可能适用于患有胸主动脉和胸腹主动脉复杂异常的患者。
