Background: The study aimed to assess the influence of the calcification of the ascending aorta on surgical mortality, postoperative stroke, and completeness of coronary revascularization in patients undergoing off-pump coronary artery bypass grafting with graft strategy tailored to its calcification severity. Methods and results: We examined the clinical records of 726 patients who underwent off-pump coronary artery bypass grafting. The age at operation was 71 ± 8 years. Calcification of the ascending aorta was graded as none–mild (less than spotty) in 668 (92.0%), moderate (<1/4 of circumference) in 26 (3.6%), and severe (>1/4) in 32 (4.4%) by preoperative non-contrast computed tomography. There were no significant differences in the number of distal anastomoses per patient among the three groups (3.3 ± 1.1, 2.9 ± 1.0, and 3.0 ± 0.9, respectively; p = 0.85). Graft strategy was tailored for each patient. Proximal anastomosis with partial clamp was used in 43.8%, 7.7%, and 3.1%, respectively (p < 0.001), while anastomotic devices were used in 6.8%, 30.1%, and 28.1%, respectively (p < 0.001). Other patients had aortic no-touch technique. There were four hospital deaths in the none–mild group (0.6%, p = 0.85). Stroke occurred in 1 (0.1%) patient, an aortic no-touch technique patient with none–mild calcification. Complete revascularization was not possible in 1 (0.1%) patient in the severe calcification group. Patency of saphenous vein graft of distal anastomosis was not different among groups. Conclusion: Influence of the calcification of the ascending aorta was minimized by tailoring graft strategy to calcification severity. It can practically abolish postoperative stroke while maintaining coronary revascularization success rates.
Abstract Background The ruptured thoracoabdominal aortic aneurysm (rTAAA) represents a considerable challenge for surgeons. To date, endovascular procedures have not been ableto completely replace open repair when debranching is required. Case presentation We report the management of a ruptured Crawford type IV TAAA in a 73-year-old man admitted to our hospital after complaining of left lateral abdominal pain. We first resuscitated with emergency surgery to close the lacerated foramen. A graft replacement was performed at 1 month after the initial surgery after the patient stabilized. At 5 years postoperatively, neither occlusion nor anastomotic pseudoaneurysm was noted on computed tomography scan. Conclusions We provide an update on the perioperative management of patients undergoing open rTAAA repair. This procedure can be considered to ensure complete repair of an rTAAA.
Abstract Medical management is the standard treatment of chronic type B aortic dissection (CTBAD). However, the roles of open surgical repair (OSR) and thoracic endovascular repair (TEVAR) in patients with CTBAD remain controversial. Thus, this study aimed to assess and compare the mid- and long-term clinical outcomes of OSR via left thoracotomy with that of TEVAR for CTBAD. The data of 85 consecutive patients who underwent surgery for CTBAD from April 2007 to May 2021 were retrospectively reviewed. The patients were divided into two groups: Group G, which included patients who underwent OSR, and Group E, which included patients who underwent TEVAR. Groups G and E comprised 33 and 52 patients, respectively. Preoperative and postoperative computed tomography (CT) studies were retrospectively analyzed for the maximum diameter. The mean duration of the follow-up period was 5.8 years. Operative mortality did not occur. There was no difference in complications, such as stroke (G: 2 vs. E: 0, p = 0.30), paraplegia (G: 1 vs. E: 1, p = 0.66), and respiratory failure (G: 2, vs. E: 0, p = 0.30). The difference in preoperative factors was observed, including the intervals between onset and operation (G; 4.9 years vs. E; 1.9 years, p < 0.01), maximum diameter in preoperative CT (G; 59.0 mm vs. E; 50.5 mm, p < 0.001), and maximum false lumen diameter (G; 35.5 mm vs. E; 29.0 mm, p < 0.01). There was no significant difference in the mid- and long-term survival rates ( p = 0.49), aorta-related deaths ( p = 0.33), and thoracic re-intervention rates ( p = 0.34). Postoperative adverse events occurred in Group E: four cases of retrospective type A aortic dissection, two cases of aorto-bronchial fistula, and one case of aorto-esophagus fistula. Aorta-related death and re-intervention rates crossed over in both groups after seven years postoperatively. Although endovascular repair of CTBAD is less invasive, the rate of freedom from re-intervention was unsatisfactory. Some fatal complications were observed in the endovascular group, and the mid- and long-term outcomes were reversed compared with those in the OSR group. Although OSR is an invasive procedure, it could be performed safely without perioperative complications. OSR has more feasible mid- and long-term outcomes.
Two cases of trigeminal neuralgia associated with the primitive trigeminal artery are reported. From 1981, the authors have treated 131 trigeminal neuralgia patients with microvascular decompression. Among them, we encountered two rare cases of trigeminal neuralgia associated with the primitive trigeminal artery (PTA) and its variant (PTAV). Case 1 is a 74-year-old woman who was admitted to our hospital due to pain of maxilla and mandible. We diagnosed her pain as trigeminal neuralgia. Preoperative angiogram showed the primitive trigeminal artery arising from the cavernous portion of the right internal carotid artery (ICA). She underwent a microvascular decompression operation. We found that her right trigeminal nerve was compressed by the right superior cerebellar artery (SCA) and the right anterior inferior cerebellar artery (AICA). We transferred the offending arteries, and her pain disappeared. Case 2 is a 48-year-old man who was admitted to our hospital due to severe mandibular pain. We diagnosed his pain as trigeminal neuralgia, and he underwent a microvascular decompression operation. His left trigeminal nerve was found compressed by the left SCA and the AICA, and the AICA was arising from the direction of Meckel's cave. His severe pain disappeared completely after operation. Postoperative angiogram of his left ICA showed an aberrant artery arising from the cavernous portion of the ICA, to the region of the left AICA. This aberrant artery is a variant of PTA (PTAV). PTA and PTAV, the so called persistent congenital arteries, are said to accompany aneurysms and other vascular lesions, and affect hemodynamic stress.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract Background: Annular dilation by left atrial remodeling is considered the main cause of atrial function mitral regurgitation. Although acceptable outcomes have been obtained using mitral ring annuloplasty alone for atrial functional mitral regurgitation, data assessing outcomes of this procedure are limited. Therefore, we aimed to assess midterm outcomes of mitral valve repair in patients with atrial functional mitral regurgitation. Methods: We retrospectively studied 40 patients (mean age: 69 ± 9 years) who had atrial fibrillation that persisted for >1 year, preserved left ventricular ejection fraction of >40%, and mitral valve repair for atrial functional mitral regurgitation. The mean clinical follow-up duration was 42 ± 24 months. Results: Mitral ring annuloplasty was performed for all patients. Additional repair including anterior mitral leaflet neochordoplasty was performed for 22 patients. Concomitant procedures included maze procedure in 20 patients and tricuspid ring annuloplasty in 31 patients. Follow-up echocardiography showed significant decreases in left atrial dimensions and left ventricular end-diastolic dimensions. Recurrent mitral regurgitation due to ring detachment or leaflet tethering was observed in five patients and was seen more frequently among those with preoperative left ventricular dilatation. Three patients without tricuspid ring annuloplasty or sinus rhythm recovery by maze procedure developed significant tricuspid regurgitation. Five patients who underwent the maze procedure showed sinus rhythm recovery. Rates of freedom from re-admission for heart failure at 1 and 5 years after surgery were 95% and 86%, respectively. Conclusions: Mitral valve repair is not sufficient to prevent recurrent atrial functional mitral regurgitation in patients with preoperative left ventricular dilatation. Tricuspid ring annuloplasty may be required for long-term prevention of significant tricuspid regurgitation.
