Exposure of the proximal descending thoracic aorta in the first stage of the elephant trunk procedure.

My colleagues and I propose a simple and reproducible technique to achieve optimal exposure and mobilization of the distal aortic arch and proximal descending thoracic aorta in the first stage of the elephant trunk procedure. The technique uses division of the ligamentum arteriosum and a series of circumferential pledgeted traction stitches on the segment of aorta selected for the distal anastomosis.