The Buffalo Trunk Technique for Aortic Arch Reconstruction

Objectives

The frozen elephant trunk can facilitate the repair of arch and proximal descending aortic pathologies. Commercially available hybrid grafts may simplify this approach by allowing for a single suture line with the soft graft secured to the stent, potentially streamlining the distal anastomosis. However, this is a commodity not available at all institutions. The authors developed a system to streamline performance of the frozen elephant trunk that obviates the need for a hybrid graft and decreases operating times.

Methods

The authors’ technique utilizes a soft-branched graft along with stent graft to create a distal anastomosis that incorporates the aorta, stent graft, and soft graft. Most of the cases were zone 2 reconstructions, with reinstitution of distal flow prior to left common carotid reconstruction. Patient characteristics, operative times, and perioperative outcomes were analyzed.

Results

A total of 37 patients underwent the Buffalo Trunk procedure from January 2016 through March 2018. Bypass times averaged around 162 minutes and circulatory arrest times averaged 24 minutes, in some cases the latter were as low as 12 minutes. The stroke rate was about 5% and 30-day mortality occurred in two patients.

Conclusion

The benefits of a hybrid approach to the frozen elephant trunk can be attained without the complex technology as presented here by this technique, the Buffalo Trunk. Evolution of this approach has facilitated shorter circulatory arrest and subsequently overall decreased operative times without compromising outcomes.

Jay D. Pal has received a research grant from Medtronic, and Joseph C. Cleveland has received a research grant from Abbott.

This educational video was originally presented during the STSA 65th Annual Meeting. This content is published with the permission of the STSA. For more information on the STSA and its next Annual Meeting, please click here.