Elephant Trunk: Argument for All Arches.

Background Since Borst and colleagues first applied the elephant trunk technique more than 30 years ago, it has become a standard method in approach for staged repair of an extensive thoracic aneurysm. While the original technique was cumbersome, a number of innovations have significantly improved the results over the past 3 decades. Conclusions Today, total arch replacement with elephant trunk provides simplified staged surgery but, nonetheless, remains a complex surgical procedure. Although many proximal aortic procedures may be addressed with ascending and partial transverse arch replacement, when total or complete transverse arch replacement is required, then the use of the elephant trunk technique, whether standard or frozen, should be considered.