INTRODUCTION
Mega-aorta syndrome is a relatively rare disease, with aneurysmal
dilatation afflicting the ascending aorta, the aortic arch, the
descending aorta and variable portions of the abdominal aorta[1].
This condition usually requires extensive surgical intervention, with
poor prognosis if left untreated (39% five-year survival in patients
with untreated aneurysms) [2]. Traditionally, open surgical
treatment has been the standard treatment of this syndrome, although
adjuvant endovascular therapy is increasingly being applied.
Thirty-seven years have passed since Dr. Borst and colleagues first
operated on their patients with mega-aorta syndrome using the Elephant
Trunk (ET) technique [3]. This brilliant technique negated the need
for proximal cross clamping of the descending aorta, facilitated the
second procedure, shortened clamp time, and significantly decreased
bleeding [4]. Thereafter, the technique was modified by pioneer
surgeons to facilitate the distal anastomosis by inverting the graft
within itself in the descending aorta [2], introducing a hybrid
procedure with a new collared graft [5] and converting the elephant
trunk into a “frozen” elephant trunk [6].
However, studies have raised concerns regarding the safety of the open
two-staged ET approach for extensive thoracic aortic aneurysm (TAA),
specifically in regard to inter-stage mortality[7].
The purpose of this study is to evaluate the safety of the two-stage ET
approach for management of extensive TAA.