Uncomplicated postoperative course after transfusion of 176 units of blood products during a single cardiovascular surgery.

A patient with massive perioperative bleeding after repeat aortic surgery for proximal aortic redissection, anastomotic disruption, and prosthetic infection after recent surgery for acute type A aortic dissection was managed with, in total, 176 units of blood products during a 25-hour operating room session. The postoperative course was completely uneventful. Enduring and continuous hemostasis with mediastinal gauze packing, volume replacement, and timely blood product substitution may overcome temporary coagulopathy in desperate surgical circumstances.

[Intraoperative high frequency current ablation as therapy of atrial fibrillation. The Berlin modification].

Background: The Cox-maze procedure combined with an operation for organic heart disease is highly successful in the elimination of chronic atrial fibrillation. However, it prolongs significantly the aortic cross-clamp and operating time. In this study, a simplified left atrial maze procedure, a short procedure performed using a surgical radiofrequency ablation probe, is added to elective open-heart procedures in patients with atrial fibrillation.

Delayed retrograde aortic dissection after endovascular stenting of the descending thoracic aorta.

A 66-year-old patient underwent emergency endovascular repair of a descending thoracic aneurysm because of suspected aortic rupture. Two weeks later, a small saccular aneurysm of the aortic arch was treated with open surgery. An unexpected intraoperative finding was retrograde dissection of the aortic arch and of the ascending aorta that was not seen on the postprocedural computed tomographic scans after endografting.