What is the Optimal Proximal Landing Zone of the Stent Graft in Treatment of Aortic Type B Dissection?

Purpose: Retrograde type A aortic dissection (RTAD) represents a serious complication of endovascular treatment for type B aortic dissection (TBAD). To avoid RTAD, it is recommended to land the proximal end of the stent graft in a non-dissected aortic segment. In this study, we investigated whether landing in the dissection area increased the number of events at the proximal site.

Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation.

Background: A delayed and recurrent complete atrioventricular block (CAVB) is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Post-TAVR evaluation may be important in predicting delayed and recurrent CAVB requiring permanent pacemaker implantation (PPI). The impact of new-onset right bundle-branch block (RBBB) after TAVR on PPI remains unknown.

Coronary protection using a pressure wire during transcatheter aortic valve implantation.

Unlabelled: Coronary obstruction is a rare but life-threatening complication of transcatheter aortic valve implantation (TAVI). This article describes the case of a patient with severe aortic valve stenosis treated with TAVI, during which preventive coronary wiring using a pressure wire was performed for coronary protection. After the deployment of the transcatheter heart valve (THV), the values of the fractional flow reserve (FFR) and resting full-cycle ratio (RFR) remarkably decreased, although the findings of transesophageal echocardiography and coronary angiography did not suggest coronary obstruction.

Ratio of left ventricular outflow tract area to aortic annulus area and complete atrioventricular block after transcatheter aortic valve replacement for aortic stenosis.

Background: Mechanical compression of cardiac conduction system by transcatheter heart valves leads to complete atrioventricular block (CAVB) after transcatheter aortic valve replacement (TAVR). Bulging of ventricular septum in the left ventricular outflow tract (LVOT) may be associated with greater compression of conduction system, leading to irreversible CAVB.

Objective: This study aimed to investigate the association of ventricular septal bulging with TAVR-related CAVB and permanent pacemaker implantation (PPI).

A case of early reperfusion of celiac artery for type A acute aortic dissection with malperfusion.

Malperfusion of the celiac artery alone, with acute aortic dissection, rarely requires early intervention. A 57-year-old woman had thrombosed type A acute aortic dissection with celiac malperfusion, for which total arch replacement was performed after percutaneous balloon angioplasty of the celiac artery. The endovascular treatment minimized extensive hepatic infarction, which saved the patient's life.

Entry Site Is Associated With Aortic Enlargement After Pre-emptive Endovascular Repair for Uncomplicated Type B Aortic Dissection.

Objectives: We aimed to examine the mid-term results corresponding to the entry site in patients who underwent pre-emptive thoracic endovascular aortic aneurysm repair (TEVAR) for uncomplicated type B aortic dissection (TBAD).

Methods: We included 27 patients who underwent pre-emptive TEVAR for uncomplicated TBAD between September 2014 and December 2019. We divided the patients into 2 groups depending on the proximal landing zone (zone 2 group, zone ≥3 group) and retrospectively analyzed the risk of all-cause and aorta-related mortality, aortic events (rupture, open conversion, and secondary intervention), and aortic enlargement (≥5 mm).

Proposal of a new classification: "sealed type" postinfarction left ventricular free wall rupture.

Objective: Postinfarction left ventricular free wall rupture (FWR) has been classified into blow-out type and oozing type. However, considering past papers, oozing type included the cases in which the bleeding had spontaneously stopped or sealed, and the distinction between blow-out type and oozing type was not always clear. We classified FWR into the BO type (combination of blow-out type and oozing type) with continuous bleeding and sealed type and clarified the pathophysiology of the sealed type.

A massive postoperative stroke caused by a carotid thrombus that occurred during the surgical repair of an aortic dissection.

A 59-year-old man with no prior neurological deficits developed a massive stroke during the repair of a double-barreled acute type A aortic dissection with major entry in the ascending aorta and an occluded brachiocephalic artery. As right cerebral ischemia was alleviated by the circle of Willis, the patient was alert and conscious preoperatively. Nevertheless, the thrombus in the right carotid artery induced a severe postoperative right cerebral embolism.

Early coronary reperfusion using only guidewires for acute type A aortic dissection.

Coronary malperfusion with acute type A aortic dissection is a fatal complication. It is controversial whether to prioritize central repair or coronary reperfusion. Lifesaving becomes even more difficult if a patient has pericardial haemorrhage.

Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair.

Objective: Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity.

Methods: Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair.

Veno-arterio-pulmonary-arterial extracorporeal membrane oxygenation in descending aortic surgery.

Hypoxia during one-lung ventilation is a significant problem in descending aortic surgery via left thoracotomy. Veno-arterio-pulmonary-arterial extracorporeal membrane oxygenation (VAPa-ECMO), which consists of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an additional arterial branch to perfuse a pulmonary artery (Pa), is useful.

Results of ascending aortic and arch replacement for type A aortic dissection.

Objective: The outcomes of emergency surgery for type A acute aortic dissection have improved. However, ascending aortic replacement sometimes leads to dilatation of the distal aorta. The present study reviewed our outcomes of ascending aortic replacement and total arch replacement in patients with type A acute aortic dissection.

Tracheo-innominate artery fistula with continuous bleeding successfully treated through the suprasternal approach: a case report.

Background: Tracheo-innominate artery fistula (TIF) is a rare but fatal complication occurring after tracheotomy. Brachiocephalic trunk transection, one of the surgical treatments for TIF, is mostly associated with a full or partial median sternotomy. We describe a case of TIF with continuous bleeding, which was successfully treated with brachiocephalic trunk transection through a collar incision without the need for median sternotomy.

Coil embolization of intercostal arteries accessed by surgical exposure for type II endoleak after thoracic endovascular aortic repair.

Many patients with type II endoleak after thoracic endovascular aortic repair (TEVAR) are closely observed without secondary intervention. Herein, we report a new technique of coil embolization for type II endoleak from intercostal arteries after TEVAR for ruptured acute type B aortic dissection. A hybrid procedure of exposing intercostal arteries via subcostal incision in the prone position and transcatheter technique enables embolization of intercostal arteries at their origin from the aorta.

Treatment of coronary malperfusion in type A acute aortic dissection.

Coronary malperfusion is one of the most dreadful complications of acute aortic dissection because it causes catastrophic acute myocardial infarction in patients who are already severely ill. Our strategy was as follows. After the administration of heparin, emergency percutaneous coronary intervention (PCI) was urgently performed at the same time as starting to prepare the operating room.

Extended posterior approach for huge popliteal aneurysm extended to superficial femoral artery.

Objectives: Generally, popliteal artery aneurysms have been addressed surgically by a medial, posterior, or lateral approach. We have designed a new posterior approach that exposes the superficial femoral artery and entire popliteal artery without dividing any muscles in a just prone position.

Methods And Results: A 72-year old man with huge popliteal aneurysm extended to superficial femoral artery was admitted to our hospital.

Exophytic Atheroma Mimicking Papillary Fibroelastoma Adjacent to the Aortic Valve.

Follow-up echocardiography in a 69-year-old man with alcoholic cardiomyopathy showed a mass above the aortic valve near the left coronary ostium. Transesophageal echocardiography and computed tomography suggested a papillary fibroelastoma with a high risk of embolism. At operation we found an exophytic atheroma adjacent to the left coronary artery orifice.

Cuff leakage, not paravalvular leakage, in the Carpentier Edwards PERIMOUNT Magna Ease aortic bioprosthesis.

Though the Carpentier Edwards PERIMOUNT Magna Ease valve is a bioprosthesis with documented excellent haemodynamics and easy implantability, this valve has a gap between the cobalt-chromium-nickel alloy stent and silicone sewing ring. This gap, which is widest just below each of the three commissural struts, lacks silicone and leaves the two-layer polytetrafluoroethylene fabric unsupported and unprotected. If the needle of a valve suture is placed in this structurally weak area of the sewing ring, the resultant fabric tear may result in a true cuff leakage, not the usual paravalvular leakage.

An easy and useful exposure technique using a malleable u-shaped retractor for proximal anastomosis in abdominal aortic replacement.

During surgery for an abdominal aortic aneurysm, various problems can occur at the proximal anastomosis. Adequate exposure must be secured, and the proximal anastomosis must be sutured firmly. We have used a malleable U-shaped retractor to easily secure exposure of the proximal anastomosis.

[Tension hemothorax accompanying rupture of the descending aortic aneurysm].

Although, tension hemothorax appears along with thoracic injuries in many cases, the incidence is rare and the concept itself has not yet been established. Moreover, reports on tension hemothorax caused by the rupture of thoracic aortic aneurysms are very rare. Herein, we report a case in which thoracic endovascular aortic repair( TEVAR) was carried out following chest drainage in order to treat tension hemothorax accompanying rupture of the descending aortic aneurysm, thus leading to the survival of the patient.

Intramural haematoma should be referred to as thrombosed-type aortic dissection.

Objectives: Intramural haematoma is defined pathologically as aortic dissection without an intimal tear. We therefore believe that this term is inappropriate as an acute clinical diagnosis, and instead, use the term 'thrombosed-type acute aortic dissection'. We compared the features of thrombosed-type acute aortic dissection with those of classic dissection.