Acute Type A Aortic Dissection—Replacement of Ascending Aorta, Aortic Arch and Antegrade Stenting of the Descending Thoracic Aorta Using the Thoraflex™Hybrid Plexus Device (Terumo Aortic)—“Frozen Elephant Trunk”: The Plymouth Way!

Objectives: To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. Materials: Thoraflex™ Hybrid Plexus Device (Terumo Aortic). Design: Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. Method/ Results: Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. Conclusions: We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.

Strategy of dealing with left subclavian artery in total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection

Objective To summarize the experiences of ligating left subclavian artery ( LSA ) in total arch peplacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA. Methods Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive

The clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey Ⅰ thoracic aortic dissection

Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25

Surgical treatment of De Bakey type Ⅰaortic dissection using the“elephant trunk technique”

Objectives To review the indications, operative methods and postoperative management of the “elephant trunk technique”, and to report two cases of DeBakey type Ⅰ aortic dissection treated with the “elephant trunk technique” Methods Two cases of DeBakey type Ⅰ aortic dissection were operated with selective cerebral perfusion via the right subclavian artery At the first stage, a tubular dangling aortic graft prosthesis (“elephant trunk”) was inserted into the distal aorta while replacing the ascending aorta and aortic arch The distal elephant trunk prosthesis was then used at the second stage involving the replacement of the sections of the distal aorta via a left sided thoracotomy Results The two operations were successful Ultrafast computed tomograph (UFCT) showed that the two patients were cured after the first stage operation, and the second stage procedure could have been avoided Conclusions The “elephant trunk technique” is a multiple stage approach in the treatment of extensive aneurysmal diseases of the aorta The procedure is indicated for patients who have combined diseases of both ascending aorta plus aortic arch segments and descending aortic aneurysm It can also be used for patients with DeBakey type Ⅰ aortic dissection Some patients can be cured after the first stage operation

Outcome of stented elephant trunk technique for extensive thoracic aortic aneurysms

Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending thoracic aorta. We systematically reviewed about literatures of stented elephant trunk operation （SET） identified through searches of the electronic databasesEMBASE and Medline, and aimed to summarize studies of patients undergoing SET for extensive aneurysms. Since 1996, Kato Mintroduced a hybrid technique by using stented graft implantation to the descending aorta for treatment of thoracic aortic aneurysm or dissection. It has been describe a good option for extensive thoracic aortic aneurysms and in a fashion similar to the elephant trunk technique.

Inverse Displacement Analysis of a Hyper-redundant Elephant＇s Trunk Robot

This paper deals with inverse displacement analysis of a Hyper-redundant Elephant＇s Trunk Robot （HRETR）. The HRETR is connected in series with n modules of 3UPS-PRU parallel mechanism where the underline P denotes an active prismatic joint. Based on the idea of differential geometry, backbone curve of the robot is formulated by using a parametric fimction consisting of sub-fimctions and control parameters. A general algorithm for generating a backbone curve and fitting the modules to the backbone curve is proposed. In this way, the inverse displacement analysis of the robot can be carried out by solving the inverse displacement problem of each parallel mechanism module and taking into account the length limits of the links. A HRETR with 6 modules is taken as an example to demonstrate the applicability of the algorithm.