Surgical elephant trunk repair (ETR) allows a two-step replacement of the arch and descending aorta in case of diffuse aortic disease.(1)
The so-called “frozen” ETR addresses the entire thoracic aorta in a single operation, by means of a hybrid prosthesis, designed to obtain surgical replacement of the aortic arch and contemporary exclusion of the residual disease of the descending thoracic aorta with a self-expanding endovascular prosthesis positioned in antegrade direction.(2) Although extremely appealing, the frozen ETR requires dedicated material and adequate expertise of the team.
On the other hand the classic ETR cannot be performed with the newest vascular prostheses, equipped with added branches for the supra-aortic vessels.
We therefore conceived two different operations that combine the advantages of original ETR coupled with the possibility of individual reimplantation of the supra-aortic vessels, without requiring any specific training or dedicated material other than a regular tri- or tetra-furcated arch prosthesis.
METHODS