Innovative Surgical Left Atrial Appendage Closure Technique: Early Experience of Inverted Spiral Closure Technique.

Objective: Simultaneous closure of the left atrial appendage (LAA) during cardiac procedures has become a common preventive measure against cardiogenic embolic events associated with atrial fibrillation. However, this strategy encounters limitations during minimally invasive mitral valve surgery through a right minithoracotomy because access to the LAA is limited. The use of endocardial sutures for surgical exclusion of the LAA is also well established but has a notable rate of closure failure.

A prospective randomized controlled study to assess the effectiveness of super FIXSORB WAVE for sternal stabilization after sternotomy.

Background: We developed a new sternal fixation device, Super FIXSORB WAVE, a corrugated plate made of u-HA/PLLA, to improve sternal stability after sternotomy. This present study aimed to evaluate the new device clinically.

Methods: This prospective, single-blinded, multicenter trial randomized 69 patients to either wire cerclage only (group C, n = 30) or wire cerclage plus Super FIXSORB WAVE (group W, n = 39).

Ring annuloplasty, optionally combined with edge-to-edge leaflet plications, should be amended with subvalvular repair techniques to efficaciously treat tricuspid regurgitation with severe tethering.

Objectives: This study aimed to evaluate the outcomes of tricuspid annuloplasty with/without additional edge-to-edge plications in patients with functional tricuspid regurgitation (TR) and to clarify the impact of tethering on surgical outcomes.

Methods: This retrospective observational study included patients with moderate or greater functional TR who underwent initial tricuspid valve repair between January 2008 and December 2021. The patients were divided into 2 groups based on whether they had tethering (preoperative tethering area ≥0.

Efficacy of Thromboelastography-Guided Blood Transfusion Management in Thoracic Aortic Surgery.

Background: In thoracic aortic surgery, a large amount of blood transfusion is required because of preoperative coagulopathy and long cardiopulmonary bypass (CPB) time. This study aimed to investigate the efficacy of intraoperative thromboelastography (TEG)-guided blood transfusion management in thoracic aortic surgery.

Methods: Between 2015 and 2017 at our institution, 53 patients who underwent elective thoracic aortic surgery with hypothermic circulatory arrest through median sternotomy were divided into 2 groups: group C, conventional management (25 patients); and group T, TEG-guided management (28 patients).

Surgical extraction of cardiac implantable electronic device leads based on a heart team approach.

Background: As cardiac implantable electronic devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization therapies, have become more popular, device extraction has become more frequent. At our institution, individual treatment strategies are discussed at a heart team meeting. Transvenous lead extraction (TVLE) is a first-line treatment; however, surgical lead extraction (SLE) is sometimes selected as a primary choice to provide optimal treatment and maintain the medical safety policy.

Long-term outcomes of papillary muscle relocation anteriorly for functional mitral regurgitation.

Objectives: This study aimed to evaluate the outcomes of the patients who underwent restrictive annuloplasty (RA) plus papillary muscle relocation anteriorly (PMR-A) with the risk factors in mitral valve repair for functional mitral regurgitation (FMR).

Methods: Eighty-six patients underwent mitral valve repair with RA for FMR. Thirty-five of them received additional bilateral papillary muscle relocation for severe leaflet tethering.

The rotational position of the aortic valve: implications for valve-sparing aortic root replacement.

Objectives: There are few reports on the rotational position of the aortic valve relative to the base of the left ventricle, and its influence on valve-sparing aortic root replacement (VSRR) has not been reported. Based on our experience with complications such as right atrial perforation and tricuspid valve injury, we investigated the cause of these complications in terms of morphological variations in the aortic root and its surrounding structures.

Methods: The aortic valve rotation relative to the base of the left ventricle was assessed in 30 patients with tri-leaflet aortic valves who underwent VSRR.

Efficacy of singular and composite annular repositioning and subvalvular surgical techniques to treat functional tricuspid regurgitation due to leaflet tethering: Early results of a feasibility study.

Objectives: The goal of this study was to evaluate the outcomes of patients with subvalvular procedures for functional tricuspid regurgitation (TR) with severe leaflet tethering.

Methods: Of 175 patients who had tricuspid valve surgery between June 2016 and June 2021, a total of 17 patients with functional TR with a preoperative tethering height ≥8 mm underwent subvalvular procedures (annular repositioning [An-Rep]) to reduce septal leaflet tethering, papillary muscle relocation to reduce anterior leaflet tethering, and/or papillary muscle bundling [PMB] to reduce anterior and posterior leaflet tethering along with ring annuloplasty at our institution. A single subvalvular procedure was performed in 9 patients (An-Rep in 5 patients, PMB in 4 patients; group S), and a combination of subvalvular procedures was performed in 8 patients (An-Rep and papillary muscle relocation in 5 patients, An-Rep and PMB in 3 patients; group C).

One-Stage Hybrid Total Aortic Arch and Descending Thoracic Aortic Repair is a Safe and Secure Procedure With Less Postoperative Complications for Extended Aortic Arch Aneurysms.

Purpose: Hybrid aortic arch repair (HAR) has been implemented for extended aortic arch and descending thoracic aortic disease since 2012 in our institution. This study aimed to estimate the early and mid-term efficacy and safety of HAR.

Materials And Methods: From 2007 to 2019, 56 patients underwent HAR for extended aortic arch disease, and 75 patients underwent total arch replacement (TAR) for arch-limited disease.

Surgical strategy for inflammatory thoracic aortic aneurysms in the endovascular surgery era.

Objective: Inflammatory thoracic aortic aneurysms (TAAs) are very rare aortic conditions. Resection and replacement of the inflammatory aorta is the first-line treatment, and thoracic endovascular aortic repair (TEVAR) has recently been reported as a less invasive alternative even for this aortic cohort. In the present study, we reviewed our experience with inflammatory TAAs and assessed the preoperative management, surgical procedures, and outcomes.

[Surgical Management for Cardiac and Aortic Lesion Caused by Arteritis].

Arteritis is an inflammatory disease of the vessel walls, resulting in vascular damage and a wide variety of clinical symptoms and multisystem disorders. Because aneurysmal disease, coronary disease, and aortic insufficiency affect patient prognosis, surgical intervention plays an important role. Preoperatively, systemic vessels, cardiac function, and other major organs should be evaluated.

Development of a Novel Heart Positioner for Minimally Invasive Coronary Surgery.

Purpose: We developed a heart positioner, the Tentacles NEO, specifically designed for minimally invasive coronary artery bypass grafting (MICS-CABG).

Description: The device has 3 flexible suction tubes, with a suction cup at the tip of each tube. The suction tubes can be detached from the device body, allowing them to be manipulated in any direction through a small incision around the small thoracotomy.

Coronary Ostial Patch Angioplasty With Femoral Artery in Takayasu Arteritis.

Takayasu arteritis (TA) occasionally involves the coronary ostium leading to myocardial ischemia. Although surgical coronary ostial angioplasty is desirable for ostial stenosis, the patch materials and long-term results are controversial. We used femoral artery (FA) as a patch material for coronary ostial angioplasty in 3 TA patients.

Safe and Effective Ultrasound-guided Myectomy and Mitral Valve Repair for HCM.

Surgery for obstructive hypertrophic cardiomyopathy with mitral abnormality requires a combined procedure of myectomy and mitral leaflet plication for relieving mitral systolic anterior motion and left ventricular outflow tract obstruction. We report a combined procedure of myectomy using intracardiac high-resolution ultrasonography and mitral bileaflet shortening in obstructive hypertrophic cardiomyopathy. Stepwise real-time verification of residual ventricular mass using high-resolution ultrasonic probe would be a potent addition to our armamentarium.

Surgical Repair of an Arch and Descending Aortic Aneurysm in a Child.

Pediatric thoracic aortic aneurysms are very rare, and almost all patients with such aneurysms have inflammatory or connective tissue diseases. This report describes a case involving 10-year-old girl who had an aortic arch and descending thoracic aortic aneurysm. Preoperative fluorine-18-fluorodeoxyglucose positron emission tomography combined with computed tomography showed an inflammatory lesion corresponding to the aneurysm's location.

[Salvage from Extracorporeal Membrane Oxygenation due to Acute Deteriorated Heart Failure;Treatment Decision-tree Based on the Risk Factors].

Background: Salvage rates for patients requiring extracorporeal membrane oxygenation (ECMO)due to acute cardiogenic shock remain poor due to difficulties in decision making on optical timing of ECMO removal or conversion to ventricular assist devices( VAD).

Method: From 2005 to 2018, 37 patients supported with ECMO due to acute circulatory deterioration were referred to our department for implantation of VAD. Their outcomes were analyzed using multi-variate analysis to assess the risk factors of VAD implantation, and we adopted a new decision-tree to improve the outcomes.

[Redissection of the Aortic Root Three Months after Replacement of the Ascending Aorta for Acute Stanford Type A Dissection;Report of a Case].

We report a case of redissection of the aortic root after graft replacement for acute aortic dissection using BioGlue to approximate the false lumen. A 49-year-old man underwent graft replacement of the ascending aorta for acute aortic dissection. In this operation, BioGlue was applied to the false lumen of the aortic root.

Minimally Circulatory-Assisted On-Pump Beating Coronary Artery Bypass Grafting for Patients With Complex Conditions for Off-Pump Surgery.

Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mm Hg and a pulmonary arterial systolic pressure of <30 mm Hg, providing optimal pulsatile circulation for end-organ perfusion and prevention of heart congestion.

[Tricuspid Valve Regurgitation and Right Heart Failure due to Perioperative Right Ventricular Myocardial Infarction].

We herein experienced 2 cases of severe tricuspid valve regurgitation (TR) and right heart failure after mitral valve surgery. In these cases, echocardiography showed a marked right ventricular dilatation and severe TR, which ware suspected to result from a right ventricular myocardial infarction at the time of the 1st operation. We considered the cause of right ventricular infarction to be an air embolism of the right coronary artery or inadequate cardioplegic perfusion to the right ventricle.