[Anatomical Repair of Total Arch Replacement for Stanford Type B Subacute Aortic Dissection with Aberrant Right Subclavian Artery:Report of a Case].

A 45-year-old man complaining of chest and back pain due to acute aortic dissection was referred to our department. A contrast enhanced computed tomography( CT) scan showed Stanford type B aortic dissection with Kommerell diverticulum and aberrant right subclavian artery. The patient underwent antihypertensive treatment for one month. Despite the successful treatment, CT scan revealed a 5 mm false lumen dilatation in this period. We decided to close the primary entry. The operation was performed through median sternotomy;after establishing cardio-pulmonary bypass, the ostium of the aberrant right subclavian artery( ARSA) was sutured closed and anastomosed the ARSA and right common carotid artery. Total arch replacement was performed using frozen elephant trunk technique. His postoperative course was uneventful.

[Elective Mitral Valve Repair for Acute Mitral Regurgitation Due to Anterior Papillary Muscle Rupture:Report of a Case].

An 83-year-old woman with congestive heart failure due to severe mitral regurgitation was referred to our department. Because acute coronary syndrome was suspected, the patient underwent emergent coronary artery angiography, which showed 75% stenosis of segment 2 and 90% stenosis of segment 11. Subsequently, segment 11 was treated by percutaneous coronary intervention. Additionally, transesophageal echocardiography findings showed a prolapse of P2 due to papillary muscle rupture. After management of heart failure, a scheduled operation was performed under the diagnosis of acute mitral regurgitation due to papillary muscle rupture. Intraoperative findings demonstrated a rupture of the anterior papillary muscle, prolapse of P2, and no evidence of infection. The patient underwent mitral valve repair with artificial chordae through median sternotomy. Her postoperative course was uneventful.

Postoperative atrial fibrillation after thoracic aortic surgery.

BACKGROUND: Postoperative atrial fibrillation (POAF) increases considerably the chances of morbidity and mortality after cardiac surgery. The objective of this study was to identify the major risk factors responsible for POAF after thoracic aortic surgery in order to define preventive measures. METHODS: We analyzed 12,260 records (between January 1, 2004, and December 31, 2008) obtained from the Japan Adult Cardiovascular Surgery Database. Patients with history of AF were excluded. Data were collected for 12 preoperative and 10 operative risk factors that had been proven or believed to influence POAF. The relationship between the risk factors and outcome was assessed by the Fisher exact test, Student t test, and multiple logistic regression analysis. RESULTS: The patients' mean age (± standard deviation) was 67.5 ± 12.7 years, and 27% of the subjects were women. The incidence of POAF was 17.1%. The following risk factors were associated with increased POAF: age (p < 0.0001), history of smoking (p < = 0.020), hypertension (p = 0.020), congestive heart failure (p < 0.0001), urgent operation (p = 0.023), and concomitant with nonelective coronary artery bypass (p = 0.022). Postoperative mortality and postoperative stroke were significantly increased in patients with POAF (p < 0.0001 in both cases). The odds ratios for the POAF risk factors were as follows: replacement of the ascending aorta, 1.67; aortic arch, 1.62; aortic root, 1.42; concomitant with valve operation, 1.35; age, 1.27; and urgent operation, 1.22. CONCLUSIONS: Several risk factors contribute to the incidence of POAF after thoracic aortic surgery. We found that POAF significantly increased 30-day operative mortality (p < 0.0001). Our findings can be used to develop a risk stratification system for the prediction of POAF.

The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience†.

OBJECTIVES: We aimed to evaluate the long-term prognosis of prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD). METHODS: Between 1997 and 2012, 120 consecutive patients (mean age: 64.4 ± 10.9 years) underwent total arch replacement with FET for AAAD; 36 patients had an entry at the descending aorta, 68 patients were aged <70 years and 8 patients had Marfan's syndrome. With regard to preoperative morbidity, 23 patients had stroke, 10 had coronary ischaemia and 9 had visceral ischaemia. During intraoperative measurement, the required size and length of the stent graft were determined and inserted under transoesophageal echographic guidance. RESULTS: Seven patients (6%) died in the hospital. Four (3%) cases of stroke and 2 (2%) with spinal cord injuries were noted. Computed tomography prior to discharge indicated complete thrombosis of the false lumen by the stent graft in 113 patients, with a mean diameter of 26.0 ± 2.5 mm before discharge and 27.5 ± 2.5 mm at 1 year postoperatively compared with a mean stent graft diameter of 27.8 ± 1.7 mm. During the long-term follow-up (mean period: 104.6 ± 51.9 months), 12 patients died of non-aortic events and 5 distal aortic reoperations were required using endovascular stent grafting of the descending aorta, including 1 case with new tear formation. None of the patients had a patent false lumen on the stent graft at the final follow-up. The 10-year survival rate was 75% and the overall 10-year reoperation-free rate on the thoracic aorta was 93%. CONCLUSIONS: The FET technique results in excellent aortic remodelling of the downstream aorta and can improve the long-term outcomes for AAAD.