Unexpected thrombus migration obstructing the right coronary ostium after thoracic aorta graft replacement.

Unexpected and reversible causes of ventricular dysfunction requiring a prompt second surgical procedure to restore the cardiac function should always be sought before the initiation of positive inotropic support. We report a case of obstruction of the right coronary ostium by an organized thrombus that had migrated retrogradely from the false lumen of a dissected aortic aneurysm. The resultant ventricular dysfunction hindered separation from cardiopulmonary bypass.

Selective coverage of the left subclavian artery without revascularization in patients with bilateral patent vertebrobasilar junctions during thoracic endovascular aortic repair.

Objective: The primary purpose of the current study was to evaluate the safety and effectiveness of selective coverage of the left subclavian artery (LSCA) without revascularization during thoracic endovascular aortic repair (TEVAR) in patients with bilateral patent vertebrobasilar junctions. The secondary purpose was to assess morphologic change of the vertebral artery (VA) after the procedure.

Methods: Among 126 patients who underwent TEVAR between 2006 and 2011, 29 patients requiring LSCA coverage without preemptive revascularization were retrospectively analyzed in this study.

Descending aortic aneurysmal changes following surgery for acute DeBakey type I aortic dissection.

Objective: The aim of the study was to determine the risk factors for descending aortic aneurysmal changes following surgery for acute DeBakey type I aortic dissection.

Methods: A total of 129 patients who underwent surgery for acute type I aortic dissection between 2000 and 2010 were evaluated by contrast-enhanced computed tomography (CT) at least 6 months later (median follow-up 29.5 months, interquartile range 16.

Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection.

Objective: In acute DeBakey type I aortic dissection, it is still controversial whether to perform extended aortic replacement to improve long-term outcome or to use a conservative strategy with ascending aortic and hemiarch replacement to palliate a life-threatening condition.

Methods: Between 1999 and 2009, 188 consecutive patients (93 women; mean age, 57.4±11.

Repair of ascending and transverse aortic arch.

Objectives: This is a report to update our experience with repairs of the ascending and transverse arch, with an emphasis on the protective measures, including retrograde cerebral perfusion and blood flow and neurologic monitoring.

Methods: Retrospective data were collected from January 1991 to February 2010, and analysis was conducted on 1193 patients who had aneurysms involving the ascending aorta and arch.

Results: The 30-day mortality rate was 9.

Mitral valve replacement with or without a concomitant Maze procedure in patients with atrial fibrillation.

Background: Although the Maze procedure is regarded as the most effective way to restore sinus rhythm in patients with chronic atrial fibrillation (AF), it remains unclear whether this procedure offers long-term clinical benefits in patients undergoing mechanical valve replacement.

Methods And Results: Between 1999 and 2007, 402 patients with AF-associated mitral valve (MV) disease underwent MV replacement with a mechanical prosthesis. Of these patients, 159 underwent valve replacement plus the Maze procedure, whereas 243 received valve replacement alone.

The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting.

Objective: To assess the influence of bypass grafting technique on the flow characteristics and mid-term patency of saphenous vein coronary bypass grafts.

Methods: In the present study, 309 patients who underwent either sequential (group A, N = 84 grafts) or individual (group B, N = 244 grafts) saphenous vein coronary bypass grafting between February 2002 and September 2007 were investigated. Individual bypassing only was performed in 212 patients, and sequential bypassing only was performed in 78 patients.

Outcomes of acute type a aortic dissection after previous cardiac surgery.

Background: Reports on outcomes of acute type A aortic dissection (ATAAD) repair after previous cardiac surgery (PCS) are few. Some suggest no difference in mortality while others note decreased risk of free rupture due to adhesions. We analyzed our experience of ATAAD after PCS.

Integrated cerebral perfusion for hypothermic circulatory arrest during transverse aortic arch repairs.

Objectives: Antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) for ascending/transverse arch repair is used for cerebral protection. This study evaluates ACP in combination with retrograde cerebral perfusion (RCP) during extended HCA and compares it to RCP-only.

Methods: Between January 2005 and April 2007, we performed 64 consecutive arch repairs requiring extended HCA (>40 min).

Outcomes of patients with acute type a aortic intramural hematoma.

Background: The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications.

Methods And Results: Among 357 consecutive patients with type A acute aortic syndrome, 101 (28.

Acute type A intramural hematoma: analysis of current management strategy.

Background: Management of acute type A intramural hematoma (IMH) remains controversial, varying from immediate surgery to medical management only. Conversion to typical dissection remains a concern. We analyzed our experience managing acute type A IMH.

Cerebrospinal fluid drainage during thoracic aortic repair: safety and current management.

Background: The benefit of cerebrospinal fluid (CSF) drainage during thoracic aortic repair has been established. Few studies, however, report management and safety of CSF drainage.

Methods: Between September 1992 and August 2007, 1,353 repairs of the thoracic aorta were performed, with 82% using CSF drainage.

Repair of retrograde type a aortic dissection after thoracic endovascular aortic aneurysm repair using the modified elephant trunk technique.

We present a case of retrograde type A aortic dissection after thoracic endovascular stenting for acute type B aortic dissection. We describe the specifics of our surgical technique and provide a brief review of the literature.

Ascending and transverse aortic arch repair: the impact of retrograde cerebral perfusion.

Background: The benefit of retrograde cerebral perfusion (RCP) with profound hypothermic circulatory arrest has been subject to much debate. We examined our experience with ascending and transverse arch repairs to determine the impact of retrograde cerebral perfusion on stroke and mortality.

Methods And Results: Between August 1991 and June 2007, we performed 1107 repairs of the ascending and transverse aortic arch.

Analysis of ascending and transverse aortic arch repair in octogenarians.

Background: Increasing numbers of older patients are requiring complex thoracic aortic surgery. This retrospective study analyzed early and late outcomes after ascending and transverse arch surgery using hypothermic circulatory arrest (HCA).

Methods: Between January 1991 and December 2006, 779 patients requiring HCA were treated.

Total sternal reconstruction using a titanium plate-supported methyl methacrylate sandwich.

We report a case of total sternal reconstruction using a methyl methacrylate polypropylene sandwich secured by using titanium plates. After previously failed attempts to wean the patient from the ventilator, this reconstruction allowed successful separation from ventilatory support in 6 days.

Proximal reoperations after repaired acute type A aortic dissection.

Background: Concerned with the associated risks of proximal reoperation, some have proposed an aggressive approach of aortic root replacement during emergent repair of acute type A aortic dissection. Because few data exist regarding late reoperations, we report outcomes of proximal reoperation after repaired type A aortic dissection.

Methods: Between January 1991 and March 2006, 63 patients underwent reoperation after previous repair for acute type A aortic dissection.