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The redox state of human serum albumin (HSA) is reported to be an oxidative stress biomarker; however, its clinical use in cardiac disease has not yet been examined. This study aimed to investigate the relation between the redox state of HSA and exercise capacity, which is a robust prognostic factor, in patients with cardiovascular disease. This cross-sectional study included outpatients with cardiac disease. Exercise capacity was assessed by peak oxygen consumption (peakVO2) measured using symptom-limited cardiopulmonary exercise testing. The high-performance liquid chromatography postcolumn bromocresol green method was used to part HSA into human nonmercaptalbumin (oxidized form) and human mercaptalbumin (HMA, reduced form). The fraction of human mercaptalbumin found in HSA (f[HMA]) was calculated as an indicator of the redox state of HSA. The association between peakVO2 and f(HMA) was examined using the Spearman correlation coefficient and multivariate linear regression analysis. A total of 70 patients were included (median age 76 years; 44 men; median peakVO2 15.5 ml/kg/min). The f(HMA) was positively correlated with peakVO2 (r = 0.38, p <0.01). Even after controlling for potential confounders, this association remained in the multivariate linear regression analysis (standardized beta = 0.24, p <0.05). We found a positive association between f(HMA) and peakVO2, independent of potential confounders in patients with cardiac disease, suggesting that f(HMA) may be a novel biomarker related to exercise capacity in cardiac disease. Longitudinal studies are required to further examine the prognostic capability of f(HMA), the responsiveness to clinical intervention, and the association between f(HMA) and cardiac disease.
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Tolerância ao Exercício , Cardiopatias , Masculino , Humanos , Idoso , Estudos Transversais , Albumina Sérica Humana/metabolismo , Oxirredução , BiomarcadoresRESUMO
Objective: Zone 0 thoracic endovascular aortic repair (TEVAR) is associated with a high incidence of cerebral infarction mostly due to the embolic shower of a plaque from the aortic arch when the stent graft brushes against the aortic wall. Thus, it is important to develop a method for protecting the brain from such embolism. We report the outcomes of Zone 0 TEVAR with a novel brain protection method using selective cerebral perfusion under extracorporeal membrane oxygenation (ECMO). Materials and Methods: Two T-shaped grafts with ringed expanded polytetrafluoroethylene (ePTFE) were created using an 8-mm-ringed ePTFE anastomosed end-to-side with a 7-mm-ringed ePTFE. Carotid-carotid bypass and axillo-axillary bypass were established using these grafts. ECMO was connected to the grafts and the femoral vein. Bilateral carotid and axillary arteries were blocked, and cerebral perfusion was selectively maintained using ECMO. Total endovascular Zone 0 TEVAR was performed. The patency of brachiocephalic artery was maintained using the chimney or in situ fenestration technique. Results: Since August 2016, seven patients with aortic arch aneurysms underwent the procedure. The mortality rate was 0%. No neurological complications developed. Conclusion: This brain protection method using selective cerebral perfusion under ECMO is a safe method for Zone 0 TEVAR.
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We herein report a case of a 20-year-old man with aortic regurgitation (AR), coarctation of the aorta (CoA), and patent ductus arteriosus (PDA). The preoperative ankle-brachial pressure index was 0.56 in bilateral extremities. Enhanced computed tomography revealed CoA-postductal type. We decided to perform a two-stage surgery: thoracic endovascular aortic repair (TEVAR) for CoA and PDA and then open surgery for AR. TEVAR was successfully performed with deployment of the stent graft at a 31-mm diameter subsequent to balloon dilation. At 8 days after TEVAR, the patient underwent aortic valve replacement via median sternotomy and was discharged without a complication.
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BACKGROUND: In 2018, Japan became the first country to have robotic cardiac surgery covered under the national health insurance. The number of patients undergoing robotic mitral valve (MV) repair has been estimated to increase remarkably, but no reports in Japan have yet described the outcomes of robotic MV repair. This study aimed to analyze the early clinical outcomes of patients undergoing totally endoscopic robotic MV repair (TERMVR) as a landmark national study for this procedure.MethodsâandâResults:A total of 213 patients (152 men; mean age, 55±11 years) underwent TERMVR during May 2014 to December 2018. Preoperative demographics, operative profiles, and postoperative outcomes, including follow-up echocardiography, were analyzed. Successful TERMVR was achieved in all patients. Operation, cardiopulmonary bypass, and aortic cross-clamp times were 192±49.8, 127±23.8, and 70.1±16.2 min, respectively. Intraoperative transfusion was performed in 20 patients (10%). There were no in-hospital deaths. All patients were alive during the median follow-up period of 255 days (interquartile range, 32.5-208 days). Freedom from recurrence of MR >grade 2+ was 97.3%, 95.0%, and 90.7% at 6, 12, and 24 months, respectively. CONCLUSIONS: TERMVR is an effective and safe procedure with acceptable early postoperative outcomes.
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Endoscopia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Endoscopia/efeitos adversos , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/etiologia , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Recidiva , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores de Tempo , TóquioRESUMO
OBJECTIVE: The mitral valve plasty (MVP) technique for degenerative disease is typically leaflet resection and suturing. However, this technique is time consuming and unreproducible. To overcome this disadvantage, we developed a nonresectional folding technique, which is fast and reproducible. In this report, we examine our new folding technique in robotic MVP. METHODS: The new folding technique was performed in 10 patients (age 56 ± 15 years), and the conventional resection and suturing (RS) technique was performed in 22 patients (age 53 ± 8 years). In our new folding technique, we used two sutures to fold the prolapsed leaflet to the left ventricle side. The first folding suture line is a land mark, and the second line adjusts the height of the posterior leaflet to the anterior leaflet so that sufficient coaptation depth can be obtained. RESULTS: MVP was successful in all patients. In the folding technique group, the operation time, cardiopulmonary bypass time, and cross clamp time was faster than the conventional RS technique group (188 ± 31, 97 ± 32, and 55 ± 3 min, versus 242 ± 51, 137 ± 25, and 70 ± 15 min; P < .05). Hospital stays were significantly shorter in the folding technique group (13 ± 2 days versus 17 ± 7 days; P < .05). All patients were discharged without complications. The post-echocardiography revealed no mitral valve regurgitation in any patient. CONCLUSION: The new folding technique facilitated efficient MVP for posterior leaflet prolapse in mitral valve regurgitation, without the need for the resection of the leaflet.
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Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Técnicas de Sutura/instrumentação , Suturas , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
We successfully treated a case of mitral regurgitation due to chest trauma in Barlow's disease. A 71-year-old man was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. Preoperative examination revealed wide chordae tendineae rupture and myxomatous changes to the bileaflets. Neo-chordae reconstruction of the anterior mitral leaflet using loop technique, triangular resection of the posterior mitral leaflet, and ring annuloplasty was performed via surgical robot. Robotic mitral valve plasty for severe mitral regurgitation due to chest trauma in Barlow's disease was achieved safely with good clinical and excellent cosmetic results.
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Ecocardiografia Transesofagiana/métodos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ferimentos não Penetrantes/complicações , Idoso , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico , Medição de Risco , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Resultado do Tratamento , Ferimentos não Penetrantes/diagnósticoRESUMO
Radiofrequency ablation procedures for atrial fibrillation are occasionally associated with pulmonary vein stenosis (PVS). A common treatment for PVS is catheter intervention; however, because of the high restenosis rate, it is not suitable for young patients. The case presented herein is of a young male patient with severe bilateral PVS who underwent successful surgical pulmonary vein repair by sutureless technique. The stenotic lesions of the pulmonary veins were dissected and were covered using autologous pericardium. An enhanced computed tomographic scan revealed that all the pulmonary veins were widely patent after 6 months from the operation.
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Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Estenose de Veia Pulmonar/etiologia , Estenose de Veia Pulmonar/cirurgia , Adulto , Humanos , MasculinoRESUMO
OBJECTIVE: Ventricular septal rupture (VSR) is a severe complication of acute myocardial infarction, and the conventional technique for repair is associated with high operative mortality. A novel intraventricular stent graft (IVSG) device was tested as a less invasive treatment for VSR; it does not require cardiopulmonary bypass, cardiac arrest, or left ventricular incision. Its effectiveness was assessed using animal experiments. METHODS: Six pigs were placed on cardiopulmonary bypass. The VSR model was created by making a hole in the interventricular septum via the right ventricle. Animals were weaned off the bypass. The sheath encasing the device was advanced over the guidewire, and the IVSG was placed in the left ventricle. Before and after rupture creation and after device deployment, left ventriculography was performed, hemodynamic data were collected, and Qp/Qs values were measured. RESULTS: All procedures were completed safely. The left-to-right shunt seen after rupture creation disappeared after device deployment. The pulmonary-to-systemic blood flow ratio after rupture was 3.35 ± 1.00, decreasing significantly to 1.09 ± 0.10 after device deployment (P = 0.007). Hemodynamic instability after rupture creation improved dramatically after deployment. CONCLUSIONS: The use of our new IVSG in this VSR animal experiment model significantly decreased the left-to-right shunt. The new device was able to control the acute heart failure associated with VSR with a minimally invasive procedure during the hyperacute phase of heart failure. Potential improvements in VSR treatment outcomes are expected with its clinical application.
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Procedimentos Cirúrgicos Cardíacos/instrumentação , Infarto do Miocárdio/complicações , Procedimentos de Cirurgia Plástica/instrumentação , Stents , Ruptura do Septo Ventricular/cirurgia , Animais , Modelos Animais de Doenças , Suínos , Resultado do Tratamento , Ruptura do Septo Ventricular/etiologiaAssuntos
Terapia de Ressincronização Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/etiologia , Valva Mitral/cirurgia , Ecocardiografia Transesofagiana , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/fisiopatologiaRESUMO
This case report describes emergency thoracic endovascular aortic repair (TEVAR) of a ruptured Kommerell's diverticulum associated with a type B acute aortic dissection in a patient with a right aortic arch. A 64-year-old male was admitted with symptoms of sudden paraplegia and shock. The computed tomography imaging showed right aortic arch anomaly, with mirror image branching of the major arteries. The aorta was dissected from the origin of the right subclavian artery to the terminal aorta, with a thrombosed false lumen. Rupture was found in a 6.3 cm aneurysm located in the distal arch, which was diagnosed as Kommerell's diverticulum. We performed emergency TEVAR, and the aneurysm was successfully excluded using deployment of a Gore Tag stent-graft. At 3 months' follow-up, the patient was doing well and showed shrinkage of the aneurysm was confirmed. TEVAR is considered to be a suitable procedure for an emergency aortic catastrophe even in patients with aortic anomaly.
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Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Divertículo/cirurgia , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Divertículo/diagnóstico por imagem , Divertículo/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A 68-year old man with a cardiac tumour was admitted for robotic tumour resection using the da Vinci S Surgical System. While undergoing preoperative examination, he was found to have a persistent left superior vena cava. After general anaesthesia and single-lung ventilation, cardiopulmonary bypass was established, with venous drainage through bilateral internal jugular and right femoral veins and arterial return through the right femoral artery. Robotic tumour resection was performed by four ports in the right chest. There were no difficulties during the operation, and successful tumour resection was achieved with satisfactory margins. He was discharged without complications. Persistent left superior vena cava is very rare, but if diagnosed preoperatively and an appropriate operative plan is made, robotic cardiac surgery can be performed safely. With robotic surgery, cardiac tumour resection can be feasibly performed, with cosmetic benefits.
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Endoscopia , Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Procedimentos Cirúrgicos Robóticos , Veia Cava Superior/anormalidades , Idoso , Ponte Cardiopulmonar , Neoplasias Cardíacas/patologia , Humanos , Masculino , Mixoma/patologia , Ventilação MonopulmonarRESUMO
BACKGROUND: We successfully performed totally endoscopic atrial septal defect (ASD) repair via 2 ports, and we named this procedure two-port robotic cardiac surgery (TROCS).MethodsâandâResults:A 51-year-old woman with secundum ASD underwent robot-assisted ASD repair under ventricle fibrillation without aortic cross-clamping. Two ports were placed in the right side of the chest, and 1 port was for the robotic endoscope. Two robotic instruments were inserted through another port and crossed while preventing them from colliding. CONCLUSIONS: TROCS ASD repair using a cross-arm technique was achieved safely with good clinical results and excellent cosmetic results.
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Procedimentos Cirúrgicos Cardíacos , Comunicação Interatrial/cirurgia , Procedimentos Cirúrgicos Robóticos , Feminino , Comunicação Interatrial/patologia , Comunicação Interatrial/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: In surgical atrial septal defect (ASD) closure, there are no techniques or devices that can close the ASD accurately in a short time under a beating heart. We have developed a simple and automatic ASD closure technique using a circular stapler. This study assessed the feasibility and efficacy of a new circular stapler closure for ASD. DESCRIPTION: Under a continuous beating heart, hand-sewn patch plasty ASD closure was performed in 6 pigs (group A) and circular stapler ASD closure was performed in 6 pigs (group B). The time to close the ASD and the effectiveness of the closure were compared. EVALUATION: Closure was significantly faster in group B (10.5 ± 1.0 seconds) than in group A (664 ± 10 seconds; p < 0.05). There was no leakage at the closure site, and sufficient tolerance was confirmed. CONCLUSIONS: A circular stapler can be used to treat ASD faster than hand-sewn patch plasty, with sufficient pressure tolerance in a beating heart porcine model.
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Comunicação Interatrial/cirurgia , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/métodos , Animais , Procedimentos Cirúrgicos Cardíacos/métodos , Modelos Animais de Doenças , Desenho de Equipamento , Estudos de Viabilidade , Feminino , SuínosRESUMO
The presence of isolated accessory mitral valve tissue (AMVT) is extremely rare in adults. We successfully performed robot-assisted resection of dual AMVT that was attached to the papillary muscle and anterior mitral leaflet. Echocardiography was invaluable for identifying the most suitable approach. The short-axis view on echocardiography revealed the precise location where the AMVT was attached. The robotic operation enabled fine visualization; we clearly observed the AMVT and removed its entire extra structure. The patient recovered well and was discharged 3 days after the operation. To the best of our knowledge, this is the first report of successful robotic AMVT resection.
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Valva Mitral/anormalidades , Valva Mitral/cirurgia , Robótica , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , MasculinoRESUMO
Borderline resectable (BR) pancreatic head carcinoma (PhC) is an advanced disease, presenting with infiltration of major vessels. Major vascular resection (VR), particularly arterial resection, to achieve microscopic no residual tumor (R0) is a controversial approach, due to the potential complications. In this study, we aimed to clarify the benefit of en bloc R0 resection with VR for PhC by retrospectively evaluating 78 PhC patients who underwent pancreatoduodenectomy at our institute. The patients were divided into 4 groups as follows: R, resectable (n=20); BR-V, BR involving the superior mesenteric vein or portal vein (PV) (n=28); BR-SMA, BR involving the superior mesenteric artery (n=21); and BR-HA, BR involving the hepatic artery (n=9). In total, 65 patients underwent VR, with 63, 21 and 9 patients undergoing PV, SMA and HA resection, respectively. The R0 rates were as follows: R group, 85%; BR-V, 82%; BR-SMA, 71%; and BR-HA, 33%. The median survival time and 5-year survival rate for R0 resection were 31 months and 25% in the R group, 22 months and 28% in the BR-V group, 17 months and 27% in the BR-SMA group and 10 months and 0% in the BR-HA group, respectively. The prognosis was comparable among the BR-V, BR-SMA and R groups, but was significantly poorer in the BR-HA group. In total, 5 patients (6.4%) died perioperatively (4 from postoperative hemorrhage and 1 from suffocation due to failure of expectoration, without pneumonia or asthma). Of the 4 patients who succumbed to hemorrhage, 3 had undergone arterial resection. Therefore, en bloc resection with major VR for R0 may be suitable for BR-V and BR-SMA PhC patients.
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The free jejunum flap technique has been regarded as the optimal approach during circumferential pharyngolaryngectomy reconstruction. Although classical patency tests are available, an intraoperative guarantee of the patency of anastomoses and microcirculations is inevitable. Indocyanine green near-infrared angiography (ICGA) was intraoperatively performed in six patients after reconstruction using the free jejunum flap. An adequate arterial as well as venous phase was observed. In addition to classical patency tests and doppler, we have successfully monitored the flap after total pharyngolalyngectomy intraoperatively using the ICGA. Our preliminary results implicate that this novel technique offers secure intraoperative monitoring of a free jejunum graft. This technique will provide us with advantages over regular patency test in selected cases.
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Angiofluoresceinografia/instrumentação , Retalhos de Tecido Biológico/irrigação sanguínea , Neoplasias Hipofaríngeas/cirurgia , Verde de Indocianina , Jejuno/irrigação sanguínea , Jejuno/transplante , Laringectomia/métodos , Monitorização Intraoperatória/instrumentação , Faringe/cirurgia , Complicações Pós-Operatórias/diagnóstico , Anastomose Cirúrgica/métodos , Artérias/cirurgia , Humanos , Neoplasias Hipofaríngeas/patologia , Injeções Intravenosas , Esvaziamento Cervical , Grau de Desobstrução Vascular/fisiologia , Veias/cirurgiaRESUMO
OBJECTIVE: It is important for coronary active perfusion systems to avoid myocardial ischemia during off-pump coronary artery bypass grafting. We have developed a new concept for a perfusion system to pump blood based on changes in helium gas volume. This system uses a conventional intra-aortic balloon pump to activate the perfusion pump. Our study used basic and animal experiments to investigate the most suitable system for coronary perfusion using this new concept. METHODS: A conventional intra-aortic balloon pump was used to supply power. A device for perfusion was developed with a balloon placed inside a stiff syringe barrel. The device was connected to the helium gas line of the intra-aortic balloon pump. Changes in flow with changes in augmentation level were noted when volumes outside and within the balloon were changed. Six pigs with occlusion of the left anterior descending artery were used for system validation, with monitoring to identify changes in hemodynamics and cardiac enzyme levels. RESULTS: In the basic experiment, an 80-mL outside volume and 3.0-mL inner volume resulted in the greatest percentage change in flow rate with respect to changes in augmentation. In the animal experiment, the new coronary active perfusion system prevented myocardial ischemia during coronary occlusion. CONCLUSIONS: We clarified the most suitable method for our new coronary active perfusion system. Using this system, safe anastomosis was consistently performed in animal experiments. Clinically, off-pump coronary artery bypass may potentially be performed more safely and easily using this new system.
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Ponte de Artéria Coronária sem Circulação Extracorpórea/instrumentação , Circulação Coronária , Oclusão Coronária/cirurgia , Vasos Coronários/fisiopatologia , Balão Intra-Aórtico/instrumentação , Perfusão/instrumentação , Animais , Velocidade do Fluxo Sanguíneo , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/fisiopatologia , Modelos Animais de Doenças , Desenho de Equipamento , Frequência Cardíaca , Fluxo Sanguíneo Regional , Suínos , Fatores de TempoRESUMO
Thoracic reconstruction in patients with pectus excavatum with concomitant cardiac or aortic surgery poses a major clinical challenge. The report describes two cases of adult patients undergoing simultaneous surgical correction of cardiac disease and sternal deformity using one of two different techniques: a sterno-turnover method preserving the rectus muscle or a sternal elevation method with A-O plates.
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Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Tórax em Funil/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Valva Mitral/cirurgia , Procedimentos Ortopédicos , Adulto , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Tórax em Funil/complicações , Tórax em Funil/diagnóstico , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: A new method was developed to harvest bilateral internal thoracic artery grafts using a subxiphoid approach and robotic assistance. The present study compared the potential utility of the subxiphoid method with that of the lateral thoracic approach. METHODS: The first part of the study examined the optimal placement of the instrument ports to maximize the robotic arms' range of motion. The second part of the study examined the 2 approaches for harvesting bilateral internal thoracic arteries from pig carcasses. The obtained graft lengths and time needed to conduct each procedure were compared using the Mann-Whitney U test. RESULTS: The preliminary study suggested that optimal positioning of the instrument ports was achieved by placing the right and left instrument ports far apart and linearly arranging all the ports. Using this configuration, the subxiphoid approach yielded a left internal thoracic artery that was 11.7 ± 1.90 cm long compared with 9.17 ± 0.74 cm using the conventional approach (P = .0131). The right internal thoracic arteries (11.8 ± 1.69 cm) obtained using the subxiphoid approach were significantly longer than those obtained using the conventional approach (8.88 ± 0.58 cm). The time needed to harvest the right internal thoracic arteries (34.7 ± 8.14 minutes) was significantly shorter using the subxiphoid approach than using the conventional approach (52.3 ± 8.21 minutes). CONCLUSIONS: Because of the maximized lengths of the grafts and the duration of the procedure, the robot-assisted subxiphoid approach could be an effective method for performing minimally invasive myocardial revascularization in patients with multivessel disease.
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Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna/transplante , Robótica , Cirurgia Assistida por Computador , Procedimentos Cirúrgicos Torácicos , Coleta de Tecidos e Órgãos/métodos , Animais , Modelos Animais , Suínos , Fatores de TempoRESUMO
Double aortic aneurysm (DAA) falls under the category of multiple aortic aneurysms. Repair is generally done through staged surgery due to low invasiveness. In this approach, one aneurysm is cured per operation. Therefore, two operations are required for DAA. However, post-first-surgery rupture cases have been reported. Although the problems involved with managing staged surgery have been discussed for more than 30 years, investigation from a hemodynamic perspective has not been attempted. Hence, this is the first computational fluid dynamics approach to the DAA problem. Three idealized geometries were prepared: presurgery, thoracic aortic aneurysm (TAA) cured, and abdominal aortic aneurysm (AAA) cured. By applying identical boundary conditions for flow rate and pressure, the Navier-Stokes equation and continuity equations were solved under the Newtonian fluid assumption. Average pressure in TAA was increased by AAA repair. On the other hand, average pressure in AAA was decreased after TAA repair. Average wall shear stress was decreased at the peak in post-first-surgery models. However, the wave profile of TAA average wall shear stress was changed in the late systole phase after AAA repair. Since the average wall shear stress in the post-first-surgery models decreased and pressure at TAA after AAA repair increased, the TAA might be treated first to prevent rupture.