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OBJECTIVES: The aim of this study was to seek a new predictor of mid-term survival of surgical total aortic arch replacement (SAR) by evaluating indices relevant to frailty. METHODS: Between October 2012 and March 2017, 113 consecutive patients underwent elective surgical total aortic arch replacement with antegrade cerebral perfusion under circulatory arrest at a single cardiovascular institute. In addition to common parameters, Katz index of activities of daily living, nutritional status, skeletal muscle mass volume, swallowing and motor functions were used to evaluate patients' frailty. RESULTS: The associated variables with mid-term all-cause death include the following: age >_79 years was assigned 4 points; 68 years <_age <79 years, 1 point; age <68 years, 0 point; Canadian Study of Health and Aging (CSHA) scale >_4, 1 point; serum albumin level <3.7 g/dl, 2 points; 3.7 g/dl <_ serum albumin level <4.25 g/dl, 1 point; serum albumin level >_4.25 g/dl, 0 point or Katz index of activities of daily living index <6, 2 points each, according to the hazard ratio. The total score was reclassified into the low-risk (0--5) (n = 96) and high-risk (6-9) (n = 17) groups. Percentage of complicated patients was as follows: aided walking (11.5% and 47.1%; P = 0.001), dysphagia (13.5% and 41.2%; P = 0.012) and no discharge to home (13.5% and 47.1%; P = 0.003) in the low- and high-risk groups, respectively. The Kaplan-Meier curve revealed a significant decrease of 3-year survival according to the risk grades (96.2% and 33.9%; P < 0.001). CONCLUSIONS: Risk stratification for mid-term mortality of elective surgical total aortic arch replacement was achieved by simple score relevant to frailty. The risk classification was correlated with postoperative waning of physical functions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Graft flow in coronary artery bypass grafting (CABG) may be determined by the anatomical and pathological characteristics of the coronary artery and target myocardium. Our goal was to explore the relationships between graft flow and the cardiac/coronary parameters in CABG. METHODS: We enrolled 63 patients who underwent isolated CABG and were examined by cardiac computed tomography. We statistically analysed the correlation between the intraoperative graft flow, such as the mean graft flow (MGF) or the pulsatile index (PI), and the computed tomography scan-based anatomy of the coronary artery tree and the left ventricle in 104 individually bypassed grafts. RESULTS: The MGF displayed a significantly positive correlation with the perfused left ventricle mass volume (r = 0.3583, P = 0.0002), and the percentage of stenosis and the diameter of the coronary artery (r = 0.2396, P = 0.0148 and r = 0.2972, P = 0.0022). The PI displayed a negative correlation with the percentage of stenosis and the diameter of the coronary artery (r = -0.2826, P = 0.0038 and r = -0.2796, P = 0.0040). Abnormal graft flow (PI >5.0, and MGF<20 ml/min in arterial graft and MGF <40 ml/min in vein graft) was found in 9 grafts. The internal diameter of the coronary artery at the distal anastomosis site was significantly smaller [1.35 (1.15-1.64)mm vs 1.71 (1.5-2.1) mm, P = 0.0065], and the distal calcium score of the target coronary artery was significantly higher [40 (4-61) vs 0.4 (0-10), P = 0.014] in the abnormal grafts. CONCLUSIONS: Intraoperatively measured MGF and PI in CABG were associated with cardiac anatomical parameters, such as the percentage of stenosis, internal diameter or calcium score of the target coronary artery or perfused left ventricle mass volume. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Re-expansion pulmonary oedema (RPO) sometimes occurs after minimally invasive cardiac surgery (MICS) with single-lung ventilation. However, it has not been widely recognized as a serious complication. The aim of this study is to evaluate the occurrence rate and risk factors of RPO. METHODS: A total of 381 consecutive patients who underwent MICS with right mini-thoracotomy from March 2005 to October 2013 were retrospectively reviewed. RESULTS: RPO was observed in 8 (2.1%) patients. In the preoperative data, greater percentages of preoperative use of steroid or immunosuppressant were found in patients with RPO (25% [2/8] vs 1% [4/373]; P = 0.0056). In the operative data, significantly longer operation, cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC) times as well as greater percentages of second CPB run were found in patients with RPO (388 ± 80 vs 272 ± 61 min; P < 0.0002, 253 ± 79 vs 158 ± 50 min; P = 0.0009, 162 ± 65 vs 108 ± 38 min; P = 0.020 and 38% [3/8] vs 1.3% [5/373]; P < 0.0003). The overall 30-day mortality rate was 0.8% (3/381) and the 30-day mortality rate of patients with RPO was 12.5% (1/8). Significantly prolonged initial ventilation time, intensive care unit and postoperative hospital stay were observed in patients with RPO (P = 0.0022, <0.0001 and 0.0003, respectively). Multivariate logistic analysis detected preoperative use of steroid or immunosuppressant and prolonged ACC time (≥156 min) as independent risk factors for RPO after MICS (odds ratio [OR]: 87.6 [95% confidence interval, CI: 4.1–2463.8]; P = 0.006 and OR: 36.0 [95% CI: 4.8–731.4]; P < 0.001). CONCLUSIONS: RPO should be recognized as one of the most serious complications after MICS with right mini-thoracotomy. More accurate risk factors of prolonged lung malperfusion and steroid use on RPO after MICS should be investigated. [ABSTRACT FROM AUTHOR]

We present two cases with late graft leakage of unknown aetiology after open total aortic arch repair (TAR). Case 1: a 73-year-old woman underwent TAR for arch aneurysm with 24-mm four-branch graft. She had a previous history of pacemaker implantation for sick sinus syndrome and warfarin therapy for atrial fibrillation. Follow-up computed tomography (CT) revealed increased low-density area around the graft 4 years after surgery and blood leakage was shown in delayed-phase CT. Thoracic endovascular aortic repair (TEVAR) was performed to cover the haematic leakage, and shrinkage of the lesion was achieved 1 month after TEVAR. Case 2: a 72-year-old man with diabetes mellitus, hypertension and hyperlipidaemia was admitted to our institute for treatment of aortic arch aneurysm. TAR was successfully performed; however, leakage from the prosthetic graft was noticed by expert radiologists in follow-up delayed-phase CT scan 6 years after surgery. The leakage was resolved 1 month after TEVAR. Although the cause of late leakage was not determined, the slowly expanding haematoma proved to be treatable by additional TEVAR. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Distal anastomotic new entry (DANE) is considered to be one of the causes of patent false lumen (PFL) after acute type I aortic dissection repair. However, there have been few articles with regard to this important issue. We assessed the influence of PFL caused by DANE on long-term outcomes. METHODS: One hundred twenty-two patients underwent emergency surgery for acute type I aortic dissection (2007-12). The in-hospital mortality was 8% (10 patients). Among the survivors, 93 patients (mean age 67 years) underwent enhanced computed tomography within 2 weeks after the operation. These patients were divided into 3 groups according to the status of the residual FL: those with a PFL with DANE (n = 19) or without DANE (n = 27) and those with a thrombosed FL (n = 47). Changes in descending aortic diameter were analysed between early and last follow-up images. RESULTS: Aortic growth rate in the PFL with DANE group was greater than that of the other 2 groups (P < 0.05). The PFL with DANE group demonstrated a lower rate of freedom from dissection-related event of distal aorta (66% at 5 years) and enlargement of distal aortic lesions (62% at 5 years). There were no significant differences in late survival among the groups. PFL with DANE was one of the significant risk factors for distal aortic events. CONCLUSIONS: PFL caused by DANE after acute type I aortic dissection repair showed greater aortic growth rate of the descending aorta and was one of the significant risk factors for distal aortic events. [ABSTRACT FROM AUTHOR]