[Efficacy of Distal Perfusion During Frozen Elephant Trunk Procedure:Continuous Perfusion Versus Intermittent Perfusion].

PURPOSE: To compare the effectiveness of continuous distal perfusion( CDP) with that of intermittent distal perfusion( IDP) during frozen elephant trunk( FET) procedures. METHODS: There were 54 patients in the CDP group and 15 patients in the IDP group. There were no significant differences in preoperative characteristics between the two groups, but dissection was more common in the IDP group than in the CDP group, and the maximum aneurysmal diameter was larger in the CDP group than in the IDP group. RESULTS: Emergency surgery was significantly more common in the IDP group than in the CDP group. Operating time, cardiopulmonary bypass time, lower body arrest time, and aortic cross-clamp time were significantly longer in the IDP group. Postoperative paraparesis occurred in one case in each group, and temporary paraparesis occurred in two cases in the CDP group, with no significant differences, including in mechanical ventilation time. There were two in-hospital deaths, one due to respiratory failure and one due to ischemic colitis, in the CDP group and one due to multiple organ failure in the IDP group. Postoperative liver and renal functions did not differ significantly between the two groups. CONCLUSION: IDP has proven to be almost as effective as CDP during FET for preventing spinal cord ischemia and maintaining respiratory, liver, and renal functions.

[The Examination of Spring Back Force in Frozen Elephant Trunk;Matsui-Kitamura Stent versus J Graft Open Stent Graft].

OBJECTIVES: We examined the spring back force (SBF) in the frozen elephant trunk technique between patients receiving a Matsui-Kitamura stent (M group) or a J Graft Open Stent Graft (J group). METHODS: There were 11 cases in the M group and 10 cases in the J group. For all cases, we performed computed tomography( CT) scan and measured distal arch angle( DAA) and stent graft angle (SGA). RESULTS: There was no difference between groups with regards to patient characteristics. The insertion graft length[155±19 mm (M group) versus 138±17 mm (J group)]was significantly longer in the M group( p<0.05). In the J group, the SGA at 1 and 2 years postoperatively( 105°±18.5° and 114°±19.1°, respectively) were significantly increased compared to that at 1 month postoperatively (99.9°± 18.7°). In addition, the SGA in the J group was significantly larger than that in the M group during the postoperative period. CONCLUSIONS: The SBF in the J group was thought to be significantly larger than that in the M group. SBF was thought to be associated with the stent frame characteristic.

[Constrictive Pericarditis with Intractable Ascites after Aortic Valve Replacement;Report of a Case].

We report a 68-year-old man, who developed refractory ascites of unknown cause after aortic valve replacement. He was diagnosed with constrictive pericarditis because of "dip-and-plateau" waveform findings via cardiac catheterization and operated with cardiopulmonary bypass. Following waffle procedure, we incised pericardium for decompression, so that pericardial mobility and diastolic dysfunction was improved. Postoperative computed tomography (CT) image also showed decrease of ascites fluid. We concluded that pericardiotomy is an established surgical procedure and is excellent indication to constrictive pericarditis.

[Marked Aneurysmal Expansion Caused by Type II Endoleaks Eight Years after Thoracic Endovascular Aortic Repair;Report of a Case].

We report a case of marked aneurysmal expansion by type II endoleaks 8 years after thoracic endovascular aortic repair. The preoperative chest computed tomography (CT) demonstrated the descending thoracic aorta of 95 mm with type II endoleak. We performed suture closure of 3 endoleaks and partial aneurysmorrhaphy via left thoracotomy under partial cardiopulmonary bypass. The postoperative CT showed no endoleak with shrinkage of the aneurysm. The patient was discharged on the 21th postoperative day uneventfully.

[Long-term results of open stent-grafting applied with a Matsui-Kitamura( MK) stent in treatment of arch aneurysm].

We report the initial and long-term results of open stent-grafting (OSG) applied with a Matsui-Kitamura (MK) stent in the treatment of thoracic aortic aneurysm (TAA). From August 2005 to March 2013, OSG for TAA was applied in 46 cases( male/female, 36/10, 54-86 years old, mean age 71). During deep hypothermic circulatory arrest with antegrade selective cerebral perfusion, stent graft was delivered through the transected proximal aortic arch, followed by arch replacement with a 4-branched prosthesis. Operative mortality within 30 days was 6.5%(respiratory failure in 1, multiple organ failure in 1and ischemic enteritis in 1) and there was 1 in hospital death due to brain stem infarction. Perioperative morbidity included 2( 4.3%) stroke, 5( 10.9%) spinal cord injuries( paraplegia in 1, paraparesis in 1 and transient paraparesis in 3). In long-term follow-up, survival was 86.8%, 77.2%, and 72.0% for 1, 3 and 5 years. Freedom from aortic event was 97.3%, 93.8% and 89.1% for 1, 3 and 5 years. Theseresults suggested the OSG method applied with a MK stent is a useful surgical procedure for the treatment of TAA.