The Association Between Ascending Aortic and Left Ventricular Dimensions in Patients After Aortic Valve Replacement

ABSTRACT Introduction: Aortic valve replacement (AVR) is often recommended for patients with severe aortic stenosis or chronic aortic regurgitation. These conditions result in remodeling of the left ventricle, including increased interstitial fibrosis that may persist even after AVR. These structural changes impact left ventricular (LV) mechanics, causing compromised LV diameter to occur earlier than reduced LV ejection fraction (LVEF). The aim of this study was to examine the effect of left ventricular end-diastolic diameter (LVEDD) and its role in aortic expansion one year after AVR. Methods: Sixty-three patients who underwent AVR were evaluated. All patients underwent standard transthoracic echocardiography, which included measurements of the ascending aorta, aortic root, LVEF, and LVEDD before the surgery and one year postoperatively. Correlations between these variables were calculated. Results: All patients underwent AVR with either a mechanical or biological prosthetic aortic valve. Following AVR, there was a significant decrease in the dimensions of the ascending aorta and aortic root (both P=0.001). However, no significant changes were observed in LVEDD and LVEF. Correlations were found between the preoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.419, P=0.001 and r=0.320, P=0.314, respectively). Additionally, there was a correlation between the postoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.320, P=0.003 and r=0.136, P=0.335, respectively). Conclusion: The study findings demonstrate a significant correlation between the size of the aortic root and ascending aorta, before and after AVR. Additionally, a notable correlation was observed between postoperative LVEDD and the size of the aortic root.

A Rare Catastrophe: Three Cases of Aortic Root Dehiscence after Surgery

Abstract Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut's modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.

In Situ Replacement for a Mycotic Aneurysm on the Porcelain Aorta Using the Superficial Femoral Artery as a Vascular Graft / 日本心臓血管外科学会雑誌

Infected thoracic aortic aneurysms are rare. Standard treatment methods have not yet been established for medical treatment, timing of surgery, or surgical techniques. In this study, we report a case in which an ascending aortic reconstruction using an autologous superficial femoral artery was successfully performed for an infected pseudoaneurysm of the thoracic aorta without the use of artificial materials. The patient was a 78-year-old man with bacteremia caused by Staphylococcus aureus and an infected pseudoaneurysm of the thoracic aorta. The patient underwent replacement of the ascending aorta and coronary artery bypass grafting. The patient was discharged from the hospital with no recurrence of infection and no abnormality of the reconstructed aorta.

Successful Use of a Stent-Graft for Treating a Pseudoaneurysm Located at the Anastomosis of the Ascending Aorta and the Great Saphenous Vein / 日本心臓血管外科学会雑誌

Takayasu Arteritis causes annuloaortic ectasia and coronary ostial stenosis, which may necessitate open heart surgery. However, pseudoaneurysms are sometimes observed postoperatively, making subsequent treatment difficult. We report thoracic endovascular aortic repair of a pseudoaneurysm of the ascending aorta with an anastomosis of the great saphenous vein in a 61-year-old female with a history of multiple open-heart procedures. Thirty years earlier, she underwent aortic valve replacement and coronary artery bypass surgery for aortic regurgitation, and right coronary ostial stenosis. Eleven years after surgery, an ascending aortic aneurysm was found and Bentall's surgery was performed. Multiple open thoracotomies were subsequently performed. Postoperatively, a pseudoaneurysm was found at the anastomosis between the ascending aorta and the great saphenous vein. The patient was transferred to the emergency room owing to hemoptysis and was diagnosed with a ruptured pseudoaneurysm at the anastomosis of the ascending aorta and the great saphenous vein. By inserting a stent graft into the ascending aorta, we avoided further complications and her prognosis was good. She was discharged on postoperative day 18 and did not experience any end leak for a year. Thoracic endovascular aortic repair in the ascending aorta is a minimally invasive procedure that may be useful for high-risk patients.

Early efficacy of water sac blocking versus Heartstring for proximal anastomosis during off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective:To compare the early effect of water sac blocking and Heartstring for proximal anastomosis of the calcific ascending aorta.Methods:The data of 400 consecutive patients undergoing elective off-pump coronary artery bypass grafting(OPCABG) in Beijing Anzhen Hospital from January 2022 to June 2022 were retrospectively analyzed. 46 patients with calcific ascending aorta including 40 males and 6 females, with the age ranged from 53 to 73 years and an average of(65.2±5.1) years, who were revealed by preoperative chest CT scan and intraoperative palpation. According to the method of proximal anastomosis, the patients were divided into 2 groups: water sac blocking group(n=19) and Heartstring group(n=27). The effect of preventing postoperative stroke was compared by counting the incidence of postoperative stroke. The efficacy of the 2 methods was compared by detecting the flow and pulsatility fraction of the saphenous vein trunk during surgery, observing the dynamic changes of the electrocardiogram and cTnI level within 48h after the surgery, and reviewing the coronary CTA 3 months after discharge.Results:There was no perioperative death, and all the patients were discharged 4-13 days postoperatively. No adverse events such as stroke and malignant ventricular arrhythmia occurred during perioperative period. 1 patient in each group developed low cardiac output syndrome postoperatively, and both improved after IABP placement. 1 patient in Heartstring group developed acute inferior myocardial infarction, which was improved after IABP placement. Coronary CTA 3 months after operation showed that there was no proximal anastomotic stenosis in both groups.Conclusion:There is no significant difference between the 2 proximal anastomosis methods in preventing stroke after OPCABG in patients with ascending aortic calcification. Compared with Heartstring, water sac blocking does not increase the risk of proximal anastomotic stenosis. In addition, water sac blocking does not require expensive consumables, which is especially suitable for patients with limited funds and can be generalized.

Management of Iatrogenic Aortic Dissections During Percutaneous Right Coronary Artery Interventions

ABSTRACT Iatrogenic acute aortic dissections during percutaneous coronary interventions are an extremely rare but potentially life-threatening complication, occurring in less than 0.02% of transcatheter procedures. We report three patients with different characteristics suffering from iatrogenic aortic dissection during percutaneous coronary intervention successfully treated with an emergency open-heart surgery. A conservative strategy should be pursuit only in small, localized lesions.

Hallazgos posoperatorios esperables en cirugías de aorta torácica ascendente con angiotomografía computada multicorte: todo lo que un médico radiólogo debe conocer / Expected postoperative findings in ascending thoracic aortic surgeries with multislice angiotomography: Everything a radiologist should know

Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.

Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patient’s pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.

Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study / 中国胸心血管外科临床杂志

@#Objective    To assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. Conclusion    Mid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.

Changes of ascending aortic diameter after transcatheter aortic valve replacement / 中国胸心血管外科临床杂志

@#Objective    To evaluate the changes of ascending aortic (AA) diameter after transcatheter aortic valve replacement (TAVR), and evaluate the safety and efficacy of TAVR in patients with AA dilation. Methods    We retrospectively included 87 patients who underwent TAVR at our center from 2016 to 2019. These patients were divided into 2 groups based on the preoperative AA diameter. There were 17 patients in the AA diameter≥45 mm group (including 10 males, aged 74.4±5.6 years), and 70 patients in the AA diameter<45 mm group (including 39 males, aged 75.9±7.0 years). Results     The baseline variables were similar between two groups (P>0.05). The overall device success rate was 97.7% (85/87). The median computed tomography (CT) follow-up time was 24.2±11.8 months in patients with AA diameter≥45 mm and 23.0±10.7 months in patients with AA diameter<45 mm, and the median annual dilation rate of AA were 0.36 mm/year and 0.00 mm/year, respectively. No statistical significance was observed between two groups (P>0.05). No adverse aortic events occurred during the follow-up period. Conclusion    TAVR is safe and effective in patients with preoperative AA diameter≥45 mm, and the AA diameter remains stable after the procedure. Patients with preoperative AA diameter≥45 mm and AA diameter<45 mm have similar annual dilation rates.

Preoperative ascending aorta diameter and prognosis analysis of patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.

Patient with unicuspid aortic valve and ascending aorta aneurysm treated with ozaki procedure and ascending aorta replacement

Abstract Although aortic valve replacement remains the gold standard treatment for aortic valve diseases like stenosis (AS) or insufficiency, new surgical methods have been developed with a focus in the reconstruction of the aortic valve rather than replacing it. The Ozaki procedure involves a tailored replacement of each individual valvular leaflet with glutaraldehyde-treated autologous pericardium and aims to reproduce the normal anatomy of the aortic valve. Cases of patients with unicuspid aortic valve treated with the Ozaki procedure are uncommon in the litrature and become even more rare when it comes to concomitant diseases like AS and ascending aorta aneurysm. We present the case of a 21-year-old, fit and asymptomatic male, with unicuspid aortic valve with severe stenosis and ascending aorta dilatation, surgically treated with tricuspidization of the aortic valve with glutaraldehyde-treated autologous pericardium and replacement of the ascending aorta with a straight synthetic graft. Postoperative studies showed a fully functional, neo-tailored tricuspid aortic valve with trivial regurgitation. The patient had an uncomplicated recovery, stayed in the intensive care unit for 2 days and was discharged on the 7th postoperative day.

The short-term effect of aortic sinoplasty on repairing aortic roots of patients with acute type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility, effectiveness and durability of aortic sinoplasty in repairing aortic roots of patients with acute type A aortic dissection. Methods    From January 2014 to July 2017, 43 consecutive patients with acute type A aortic dissection underwent aortic sinoplasty to repair aortic root in our institution, including 34 males and 9 females, aged 32-65 (50.1±8.1) years. The perioperative and follow-up data were retrospectively analyzed, and statistical analysis on the preoperative, postoperative and follow-up ultrasound indicators was performed. Results    Thirty-day mortality was 4.7%. Preoperative aortic regurgitation was corrected and false lumen was eliminated immediately after operation in all patients. There was no late death, or aortic root or valve re-intervention and two patients were lost during a follow-up of 18-45 (27.9±6.7) months. There was no residual dissection found. No patients had significant dilation of aortic root. No statistically significant difference was found when comparing the maximum of root diameter and aortic regurgitation grade between at discharge and follow-up. Conclusion    Aortic sinoplasty for aortic root repair in acute type A aortic dissection is a simple and reliable technique and demonstrates excellent early outcomes.

Concomitant Replacement of Aortic Valve, Ascending Aorta and Pulmonary Valve 45 Years after Repair of Tetralogy of Fallot / 日本心臓血管外科学会雑誌

We present a 70-year-old woman who underwent a classic Blalock-Taussig shunt for tetralogy of Fallot (TOF), followed by intra-cardiac repair at the age of 25 years. She developed heart failure due to aortic regurgitation with aortic root dilatation and pulmonary regurgitation 45 years after the surgery. She was successfully treated with concomitant biventricular outflow tract reconstruction (aortic valve, ascending aorta, and pulmonary valve replacement). The treatment strategy for aortic regurgitation with aortic root dilatation after TOF repair is unclear. With a transient increase in the number of elderly patients who have undergone the classic Blalock-Taussig shunt as palliative surgery, the number of complex cases of both right and left ventricular outlet tract involvement will also increase. With patients' advanced age and situation of complex reoperation taken into consideration, aortic valve and ascending aorta replacement may be useful options for cases of aortic regurgitation and aortic root dilatation.

Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision: A single-center experience of 13 patients / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility, safety, and short-term effect of minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision. Methods    The clinical data of 13 patients who underwent minimally invasive ascending aorta surgery (including minimally invasive Bentall operation in 7 patients, minimally invasive Wheat operation in 2 patients, and minimally invasive ascending aorta replacement in 4 patients) through a right anterior thoracotomy via the second intercostal incision in our center from October, 2019 to September, 2020 were retrospectively analyzed. There were 12 males and 1 female at age of 19-69 (52.4±13.7) years. Results    The aortic cross-clamping time was 84.3±18.3 min. Three patients received blood transfusion, with the rate of 23.1%. The drainage volume in the first 24 hours after operation was 214.5±146.3 mL, with no redo for bleeding. The duration of mechanical ventilation was 19.0±11.3 hours and the length of intensive care unit stay was 1.8±1.3 days. The drainage tube was removed 2.5±1.0 days after operation. All the 13 patients recovered and discharged 6.4±2.0 days after operation, with no dead patients found. All patients survived with New York Heart Association (NYHA) functional classⅠandⅡduring a median follow-up of 8 months. Conclusion    Minimally invasive ascending aorta surgery through a right anterior thoracotomy via the second intercostal incision may be a safe and effective method with less injury and quick recovery.

Posterior Plication of the Ascending Aorta to Relieve Tracheal Compression after Aorto-Left Ventricular Tunnel Repair / 日本心臓血管外科学会雑誌

A nine-month-old boy with a prenatal diagnosis of aorto-left ventricular tunnel (ALVT) and aortic valve disease underwent an urgent ALVT patch closure approximately 2 h after birth. The patient subsequently developed airway compression due to the progressive dilatation of the ascending aorta postoperatively associated with aortic regurgitation and stenosis. After 9 months of prolonged respiratory symptoms following the ALVT repair, he underwent a posterior plication of the ascending aorta. After plication, the tracheal compression and respiratory symptoms improved. A computed tomography (CT) scan 1 month after surgery revealed significant free space between the aorta and the trachea, which relieved the aortic compression. Posterior plication of the ascending aorta is achieved by resecting the posterior aortic wall adjacent to the airway. It is the procedure of choice for longer and more effective relief of airway compression compared to other procedures such as anterior aortopexy, the lateral sliding technique, and side clamp plication.

Mural Thrombosis in the Ascending Aorta Revealed by Cerebral Infarction : a Case Report / 日本心臓血管外科学会雑誌

A fifty-seven-year-old male farmer with a history of cerebral infarctions twice in the past without any functional disability stopped prescribed antithrombotics and regular medical follow-up. He had sudden left hemiplegia after the work, and was taken to our hospital. A contrast-enhanced computed tomography (CT) scan showed infarction at the right basal ganglia, occlusion of the internal carotid artery and the left vertebral artery, and mural thrombus in the ascending aorta. Mural thrombus in the ascending aorta was suspected to be the causative thrombus of other infarctions. He was started on continuous heparin infusion on the day of presentation, and had ascending aortic replacement surgery on day 24. No perioperative complication was confirmed. He was extubated on postoperative day (POD) 1, and was transferred to another rehabilitation hospital with almost no functional disability. No thrombotic event was confirmed as of POD 180.

Endovascular treatment of the ascending aorta: is this the last frontier in aortic surgery?

Abstract Regardless the successful treatment of the descending aorta with endovascular prosthesis, for the ascending aorta segment, because of several anatomic and physiologic issues, this technique has been considered an alternative only for high-risk or inoperable patients. Despite restricted indications, hundreds of treatments have been performed worldwide, demonstrating its safety and reproducibility if it is done in high-quality centers. Therefore, understanding patients' selection criteria and technique limitations are critical to its application.

Falso aneurisma del sitio de canulación aórtico después de cirugía cardíaca: Informe de un caso y revisión de la literatura / False aneurysm of ascending aortic cannulation site after cardiac surgery. Case report and literature review

RESUMEN El pseudoaneurisma de aorta ascendente, como complicación en cirugía cardíaca, tiene una incidencia menor del 0,5%, pero una mortalidad que varía del 6,7 al 60%. La manipulación aórtica y la infección son los principales factores predisponentes. Su clínica puede ser variada y constituir un hallazgo casual en controles posteriores. Se presenta el caso de una paciente operada de cirugía valvular mitral que a los 11 meses del postoperatorio se le diagnostica un pseudoaneurisma de aorta ascendente, que requirió tratamiento quirúrgico de emergencia. La cirugía fue llevada a cabo con la utilización de canulación periférica extramediastínica, sin requerir parada circulatoria, ni hipotermia para su correcta disección. El caso muestra una variante técnica para enfrentar una enfermedad poco frecuente, pero altamente desafiante, por la necesidad de reintervención y una correcta estrategia quirúrgica.

ABSTRACT False ascending aortic aneurysm, as a complication in cardiac surgery, has an incidence of less than 0.5%, but a mortality that ranges from 6.7% to 60%. Aortic manipulation and infection are the main predisposing factors. Its clinical presentation is non-specific and may be found incidentally on subsequent check-ups. The case of a patient undergoing mitral valve surgery who was diagnosed with ascending aortic false aneurysm, eleven months after postoperative period, requiring emergency surgical treatment is presented. The surgery was performed using extra-mediastinal peripheral cannulation, without induced circulatory arrest or hypothermia for proper dissection. The case shows a technical version to face an uncommon but highly challenging disease as it needs re-interventions and successful surgical strategies.

Tratamiento y resultados quirúrgicos en pacientes operados de aneurismas de aorta ascendente / Surgical procedure and outcomes in patients undergoing surgical treatment for ascending aortic aneurysms

RESUMEN Introducción: Los aneurismas de aorta ascendente son lesiones que deben tratarse quirúrgicamente debido a sus complicaciones potencialmente mortales, como la ruptura y la disección. Objetivos: Revisar los resultados a corto y mediano plazo del tratamiento quirúrgico en pacientes con aneurisma de aorta ascendente. Método: Se revisaron retrospectivamente las historias clínicas de 78 pacientes que recibieron tratamiento quirúrgico debido a un aneurisma de aorta ascendente, entre agosto de 2006 y julio de 2018, en el hospital Erzurum Regional Training and Research Hospital. Resultados: La edad promedio de los pacientes fue de 51,7 ± 9,8 (rango 24-77 años). Hubo 54 (69,2%) hombres y 24 (30,8%) mujeres. Cincuenta y ocho pacientes (74,3%) tenían síndrome de Marfan. También se encontraron enfermedad coronaria (15,4%), estenosis mitral (3,8%), insuficiencia (11,5%), estenosis (8,9%) y coartación aórticas (2,6%). Se realizó tratamiento quirúrgico de emergencia en 41 pacientes (52,5%). Se reemplazó la aorta ascendente en 55 pacientes (70,5%). Se empleó la técnica de Bentall (17,9%) y sustitución valvular aórtica más reemplazo de aorta ascendente con injerto (11,5%). En 14 pacientes se utilizó paro anóxico (parada circulatoria total). La mortalidad operatoria fue de 3,8% (3 pacientes) con la técnica de Bentall y la mortalidad postoperatoria temprana fue de 1,3% (1 paciente con coartación aórtica). Conclusiones: Los pacientes con aneurisma de aorta ascendente deben tener un estrecho seguimiento para definir su momento quirúrgico, debido al riesgo de disección y rotura. Aunque se pueden aplicar varias técnicas quirúrgicas de acuerdo con el estado de la válvula aórtica, especialmente en pacientes con síndrome de Marfan, el procedimiento quirúrgico preferido debería ser el reemplazo de la raíz aórtica con injerto compuesto, con el uso de la técnica de Bentall modificada, con reimplantación de los ostium de las arterias coronarias en el injerto.

ABSTRACT Introduction: Ascending aortic aneurysms are lesions that should be surgically handled because of their life-threatening complications like rupture and dissection. Objectives: To examine the early and midterm outcomes of surgical treatment in patients with ascending aortic aneurysm. Method: We retrospectively examined the records of 78 patients who underwent surgical treatment due to ascending aortic aneurysm between August 2006 and July 2018 at Erzurum Regional Training and Research Hospital. Results: The patients' average age was 51.7 ± 9.8 (ranged 24-77 years). There were 54 (69.2%) men and 24 (30.8%) women. Fifty-eight (74.3%) patients had Marfan's Syndrome. They also presented coronary artery disease (15.4%), mitral stenosis (3.8%), aortic regurgitation (11.5%), aortic stenosis (8.9%), and aortic coarctation (2.6%). The emergency surgical treatment was required in 41 (52.5 %) patients. Only 55 (70.5 %) patients had performed ascending aortic replacement. Bentall procedure (17.9%) and aortic valve replacement + ascending aortic graft replacement (11.5%) were performed. In 14 patients totally circulatory arrest was used. The operative mortality occurred in 3 (3.8%) patients with Bentall procedure and the early postoperative mortality occurred in 1 (1.3%) patient with aortic coarctation. Conclusions: Patients with ascending aortic aneurysms should be closely monitored for the timing of surgery due to the risk of dissection and rupture. Although various surgical techniques can be applied according to the aortic valve status, especially in patients with Marfan's Syndrome, root replacement with composite graft, and Bentall modifications and button anastomosis of coronary arteries in composite graft applications should be the preferred surgical procedure.

Hybrid Repair of Concomitant Descending Thoracic and Abdominal Aortic Aneurysms Using Antegrade Visceral Debranching from the Ascending Aorta / 日本心臓血管外科学会雑誌

A 76-year-old man had increasing thoracic and abdominal aortic aneurysms. First, endovascular repair was performed on the thoracic descending aorta, but type Ib endoleak persisted due to severe aortic calcification. Additional treatment was planned since the maximum diameter of the thoracic and abdominal aortic aneurysms had increased to 75 and 70 mm, respectively. Due to the fact that aortic calcification was present from the aortic arch to the bilateral iliac arteries, which is sometimes referred to as porcelain aorta, conventional open thoracoabdominal aortic repair or hybrid repair using retrograde debranching seemed impossible. Therefore we performed antegrade visceral debranching from the ascending aorta followed by endovascular thoracoabdominal aortic repair successfully. For the thoracoabdominal aortic aneurysms which present difficulty in performing conventional open surgical repair or hybrid repair with retrograde debranching from the iliac artery. This technique can be an effective alternative strategy, but still needs further investigation, including its indications, due to the high surgical stress associated with the procedure.