A novel modification of elephant trunk technique using a single four-branched arch graft for extensive thoracic aortic aneurysm.

Surgical repair for the extensive thoracic aortic aneurysm remains unsatisfactory, especially in elderly patients. We developed a total arch replacement with modified elephant trunk technique under moderately hypothermic cardiopulmonary bypass and selective brain perfusion, in which a 4-branched arch graft with a sewing 'collar' enabled the distal anastomosis just proximal to the innominate artery with open distal method and a long 'elephant trunk' was inserted into the descending aorta by the forceps catheter via the femoral artery. This modification is easy and less invasive, and reduces the risk of postoperative complications.