Coselli JS, Krause H, Green SY, et al. - In patients whose distal (ie, descending thoracic and thoracoabdominal) aorta is symptomatic or disproportionately large compared with their proximal aorta (ie, ascending aorta and transverse aortic arch), staged repair of extensive thoracic aortic aneurysm could be done with the reversed elephant trunk (RET) technique. In this study, researchers sought to report their 23-year experience with the RET approach. Between 1994 and 2017, stage-1 RET repair of the distal aorta was performed in 94 patients (median age 62 [46-69] years). Aortic dissection was performed in 53 patients (56%), and heritable thoracic aortic disease (HTAD) was reported in 31 (33%) patients. Eighty-eight (94%) operations were Crawford extent I or II thoracoabdominal aortic repairs. Outcomes suggest achievement of acceptable short-term outcomes in correlation with managing extensive aortic aneurysm using the 2-stage RET technique. They suggest the utility of this technique for patients who require distal aortic repair before proximal repair and its particular effectiveness in patients with HTAD. As there was a low number of patients returning for completion repair, rigorous surveillance is recommended.