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Kato, M., Ohnishi, K., Kaneko, M., Ueda, T., Kishi, D., Mizushima, T. and Matsuda, H. (1996) New Graft-Implanting Method for Thoracic Aortic Aneurysm or Dissection with a Stented Graft. Circulation, 94, 188-193.

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• TITLE: 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!

  AUTHORS: Marios Patronis, Jonathan Unsworth-White, James Kuo

  KEYWORDS: Aortic Dissection, Total Arch Replacement, Stenting of the Descending Thoracic Aorta, Frozen Elephant Trunk

  JOURNAL NAME: Open Journal of Thoracic Surgery, Vol.10 No.3, September 18, 2020

  ABSTRACT: 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.