Stent Graft Collapse after Zone 0 Landing Thoracic Endovascular Aortic Repair.

A zone 0 landing thoracic endovascular aortic repair was performed on a 69-year-old man with a saccular aortic arch aneurysm. Seven days after the surgery, the patient experienced diminished consciousness and lower limb paralysis. Stent graft collapse was seen on a computed tomography scan.

Brachial plexus injury and upper rib fracture after median sternotomy in cardiac surgery.

Objectives: Sternal retractors utilized during open-heart surgeries through median sternotomy can cause upper rib fractures which sometimes further leads to brachial plexus injury. We aimed to investigate the incidence of brachial plexus injury and upper rib fractures in open-heart surgeries and how these injuries are associated with each other.

Methods: We investigated 1050 cases during the past five years.

Radial artery vs saphenous vein grafts for sequential coronary bypass grafting as a second conduit for the left coronary territory.

Objective: Although the radial artery graft has an adaptive property to flow demand, its flow characteristics in aorto-coronary sequential bypass grafting are not well elucidated. We evaluated the differences between the vein and radial artery grafts in the patency and the transit time flow meter-derived parameters (flow and pulsatile index), according to the stenosis rate of terminal target vessels and the number of anastomoses, in sequential bypass grafting to the left coronary territories as a second conduit.

Methods: We analyzed 222 patients who underwent isolated on-pump beating coronary artery bypass grafting with an aorto-coronary bypass to the left coronary territory.

Clinical feasibility and safety of transoesophageal motor-evoked potential monitoring.

Objectives: Canine experiments have shown that transoesophageal motor-evoked potential monitoring is feasible, safe and stable, with a quicker response to ischaemia and a better prognostic value than transcranial motor-evoked potentials. We aimed to elucidate whether or not these findings were clinically reproducible.

Methods: A bipolar oesophageal electrode mounted on a large-diameter silicon tube and a train of 5 biphasic wave stimuli were used for transoesophageal stimulation.

Carotid stenosis with impaired brain flow reserve is associated with an increased risk of stroke in on-pump cardiovascular surgery.

Objectives: To prevent haemodynamic stroke during cardiovascular surgery in patients with carotid stenosis, we routinely evaluated magnetic resonance angiography and selectively evaluated brain perfusion single-photon emission computed tomography with acetazolamide challenge. Off-pump surgery was preferred when cerebral blood flow reserve was impaired. This strategy's usefulness was investigated.

[Feasibility of Super Bioabsorbable Plate Insertion into the Sternum Manubrium for Sternal Closure].

We evaluated the efficacy of our sternum closure technique. Out of the 101 patients who underwent cardiovascular surgery at our department, 36 patients underwent sternum closure using ultra-high molecular weight polyethylene tape (NT) with Super FIXSORB MX40 (SF40) insertion into the sternum manubrium (group A) and 19 patients used NT with Sterna Lock Blu (group B). None of the patients had sternum disruption.

Cardiac arrest at high elevation with a favorable outcome.

A 36-year-old man started to climb Mount Fuji (3776m above sea level: ASL), from the Gotemba new fifth station (2400m ASL). He had no significant medical history, and this was his first attempt to climb such a high mountain. He began feeling chest discomfort but continued to climb.

Transesophageal versus transcranial motor evoked potentials to monitor spinal cord ischemia.

Objectives: We have previously reported that transesophageal motor evoked potential is feasible and more stable than transcranial motor evoked potential. This study aimed to investigate the efficacy of transesophageal motor evoked potential to monitor spinal cord ischemia.

Methods: Transesophageal and transcranial motor evoked potentials were recorded in 13 anesthetized dogs at the bilateral forelimbs, anal sphincters, and hindlimbs.

Transoesophageal spinal cord stimulation for motor-evoked potentials monitoring: feasibility, safety and stability.

Objectives: Specificity of transcranial motor-evoked potentials (MEPs) is low because amplitude fluctuation is common, which seems due to several technical and fundamental reasons including difficulty in electrodes positioning and fixation for transcranial stimulation and susceptibility to anaesthesia. This study aimed to investigate the feasibility, safety and stability of our novel technique of transoesophageal spinal cord stimulation to improve the stability of MEPs.

Methods: Ten anaesthetized adult beagle dogs were used.

Vertebral artery variations in thoracic aortic patients.

Objectives: Arterial variation is common in the vertebral artery, and simple occlusion of the left subclavian artery may result in brain infarction, especially when it terminates in the posterior inferior cerebellar artery (PICA). We report the results of preoperative vertebral artery evaluation by magnetic resonance angiography (MRA) and its impact upon operative strategy.

Methods: Among the 214 patients who underwent thoracic aortic surgery from 2009 through 2012, 159 patients with preoperative MRA were retrospectively analysed.