Kinetic Elephant Trunk Technique, Early Results in Chronic Symptomatic Aortic Dissection Management.

OBJECTIVE: The aim was to expand our understanding of the dynamic evolution of the aorta throughout the dissection time course. We investigated how the disease process can be modulated to equalise lumen pressure, enhance perfusion, and stabilise the aorta along its entire length using the kinetic elephant trunk (kET) technique.

TECHNIQUE: We performed the kET on nine patients with chronic symptomatic aortic dissection (CSAD) as a primary or secondary intervention regardless of the chronicity of the dissection. Endovascular scissoring of the intraluminal septum is performed in the infra-diaphragmatic dissected aorta to equalise pressure between true and false lumens, and allow all branched vessels to be supplied from one lumen. The Streamliner Multilayer Flow Modulator (SMFM), an uncovered cobalt-alloy aortic device, is deployed from the aortic sinus, covering the supra-aortic branches, distally into the distal aorta (primary intervention). In the case of a previous ascending aorta Dacron graft, the SMFM is deployed (secondary intervention) at the level of the Dacron graft so that it is overlapped with the graft, and landed in the distal aorta.

RESULTS: In the initial study period, all-cause and aortic-related survival were 100%, respectively, all great vessels and visceral branches were patent, and freedom of stroke, end-organ ischaemia, paraplegia and renal failure were 100%.

CONCLUSION: The kET is a treatment process for managing CSAD. Its simplicity, consistency and reproducibility in high-risk patients with low morbidity and mortality adds to the armamentarium of the cardiovascular specialist. Further assessment of the medium- and long-term outcomes is needed to fully establish benefits of kET.