A simple technique to facilitate antegrade thoracic endograft deployment using a hybrid elephant trunk procedure under hypothermic circulatory arrest.

PURPOSE To describe a technique to facilitate antegrade thoracic endograft deployment using a hybrid elephant trunk operation under hypothermic circulatory arrest. TECHNIQUE When using a nitinol-based endograft in a hybrid endovascular aortic arch repair performed in a hypothermic patient, the endograft does not expand fully when the body temperature is typically maintained below 20 degrees C. Immersing the nitinol-based thoracic endograft in a sterile hot saline bath (48 degrees C) for 1 to 2 minutes prior to deployment warms the stent-graft to a physiological temperature of 38 degrees C, which it maintains for several minutes while being deployed. CONCLUSION Although the described technique represents an off-label approach to the use of a TAG device, we believe warming a nitinol-based endograft may potentially improve the technical success of this hybrid operation when the patient is under hypothermic circulatory arrest.