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Backgrounds Permanent pacemaker implantation (PPMI) is one of the greatest disadvantages of transcatheter aortic valve implantation (TAVI). To seek the predictors and clinical impacts of PPMI and investigate the recovery rate from conduction disorders.Methods We retrospectively analysed data from 745 consecutive patients who underwent TAVI for severe aortic stenosis from November 2013 to July 2022. The ventricular pacing (VP) rate was recorded at 1 and 6 months after PPMI and the recovery from conduction disorders was defined as the VP rate

Objective: In patients with ischemic cardiomyopathy, coronary artery bypass grafting ensures better survival than medical therapy. However, the long-term clinical impact of complete revascularization remains unclear. This observational study aimed to evaluate the effects of complete revascularization on long-term survival and left ventricular functional recovery in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting. Methods: We retrospectively reviewed outcomes of 498 patients with ischemic cardiomyopathy who underwent complete (n = 386) or incomplete (n = 112) myocardial revascularization between 1993 and 2015. The baseline characteristics were adjusted using inverse probability of treatment weighting to reduce the impact of treatment bias and potential confounding. The mean follow-up duration was 77.2 ± 42.8 months in survivors. Results: The overall 5-year survival rate (complete revascularization, 72.5% vs incomplete revascularization, 57.9%, P = .03) and freedom from all-cause death and/or readmission due to heart failure (54.5% vs 40.1%, P = .007) were significantly greater in patients with complete revascularization than those with incomplete revascularization. After adjustments using inverse probability of treatment weighting, the complete revascularization group demonstrated a lower risk of all-cause death (hazard ratio, 0.61; 95% confidence interval, 0.43-0.86; P = .005) and composite adverse events (hazard ratio, 0.59; 95% confidence interval, 0.44-0.79; P

Objective: We investigated whether or not a history of multiple percutaneous coronary interventions (PCIs) is associated with clinical outcomes after surgery for ischemic mitral regurgitation. Methods: A total of 309 patients with chronic ischemic mitral regurgitation and left ventricular ejection fraction ≤40% who underwent restrictive mitral annuloplasty were classified as follows: patients with no or 1 previous PCI (nonmultiple PCI group [n = 211]) and patients with 2 or more previous PCIs (multiple PCIs group [n = 98]). Mean follow-up duration was 53 ± 40 months. Results: Before surgery, there were no intergroup differences in patient demographic characteristics except for lower estimated glomerular filtration rate in patients with multiple PCIs. These patients underwent concomitant coronary artery bypass grafting less frequently with a lower number of distal anastomoses (P

Anomalous systemic arterial supply to the left basal lung is a rare congenital lung malformation, and its optimal treatment strategy is not well defined. We present a case of a 61-year-old man who underwent thoracic endovascular aortic repair (TEVAR) for anomalous systemic arterial supply to the left basal lung complicated with aneurysmal dilatation of the aberrant feeding artery. Computed tomography angiography after TEVAR revealed significant shrinkage of the aneurysmal portion as well as complete occlusion of the aberrant feeding artery. TEVAR proved to be a safe and efficient treatment for this rare arterial abnormality.

Abstract Aims In patients with ischaemic mitral regurgitation (MR), the impact of mitral valve surgery with concomitant coronary artery bypass grafting (CABG) on post‐operative survival and left ventricular (LV) reverse remodelling remains unknown. Therefore, we investigated these outcomes following restrictive mitral annuloplasty (RMA) with and without CABG in those patients. Methods and results This study included 309 patients with chronic MR and ischaemic cardiomyopathy for whom concomitant CABG was indicated (n = 225) or not indicated (n = 84) with RMA. The primary endpoint was all cause mortality during the follow‐up, and the secondary endpoint was defined as the composite of mortality and re‐admission for heart failure. Linear mixed model was used to analyse serial echocardiographic changes in LV function. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent RMA with and those who underwent it without CABG, we established weighted Cox proportional‐hazards regression models with inverse‐probability‐of‐treatment weighting. Pre‐operatively, there were no intergroup differences in age (RMA with CABG, 67 ± 9 vs. RMA without CABG, 68 ± 11, P = 0.409) and logistic EuroSCORE II (16 ± 14 vs. 15 ± 15%, P = 0.496). The 30‐day mortalities were 2.7% and 3.6%, respectively (P = 0.67). During follow‐up with a mean duration of 72 ± 37 months (range, 5.6–179), there were 157 deaths and 105 re‐admissions for heart failure. Overall 1‐year and 5‐year survival rates were 83 ± 2% and 58 ± 3%, respectively. Patients who did not receive CABG with RMA had a significantly lower 5‐year survival rate (45% vs. 63%, P = 0.049) and freedom from adverse events defined as mortality and/or admission for heart failure (19% vs. 43%, P

Background The aim of this study was to compare the predictive accuracy of acute kidney injury (AKI) after cardiac surgery using cardiopulmonary bypass for the largest area under the curve (AUC) below the oxygen delivery (DO2) threshold and the cumulative AUC below the DO2 threshold. Methods and Results From March 2017 to October 2019, 202 patients who had undergone cardiac surgery with cardiopulmonary bypass were enrolled. The perfusion parameters were recorded every 20 seconds, and the DO2 (10×pump flow index [L/min per m2]×[hemoglobin (g/dL)×1.36×arterial oxygen saturation (%)+partial pressure of arterial oxygen (mm Hg)×0.003]) threshold of 300 mL/min per m2 was considered to define sufficient DO2. The nadir DO2, the cumulative AUC below the [Graphic: see text], and the largest AUC below the [Graphic: see text] were used to predict the incidence of AKI. Postoperative AKI was observed in 12.4% of patients (25/202). By multivariable analysis, the largest AUC below the [Graphic: see text] ≥880 (odds ratio [OR], 4.9; 95% CI, 1.2–21.5 [P=0.022]), preoperative hemoglobin concentration ≤11.6 g/dL (OR, 7.6; 95% CI, 2.0–32.3 [P=0.004]), and red blood cell transfusions during cardiopulmonary bypass ≥2 U (OR, 3.3; 95% CI, 1.0–11.1 [P=0.041]) were detected as independent risk factors for AKI. Receiver operating curve analysis revealed that the largest AUC below the [Graphic: see text] was more accurate to predict postoperative AKI compared with the nadir DO2 and the cumulative AUC below the [Graphic: see text] (differences between areas, 0.0691 [P=0.006] and 0.0395 [P=0.001]). Conclusions These data suggest that a high AUC below the [Graphic: see text] is an important independent risk factor for AKI after cardiopulmonary bypass, which could be considered for risk prediction models of AKI.

Objective: The aim of this study is to evaluate mitral valve hemodynamics after mitral valve repair for degenerative disease, and seek the impact of type/size of annuloplasty prosthesis on resting cardiac hemodynamics. Methods: Between October 2012 and June 2019, 301 patients underwent isolated mitral valve repair for degenerative disease were enrolled. Correlation between postoperative mitral hemodynamics and type/size of annuloplasty prosthesis was evaluated. Results: There were significant correlations between annuloplasty size and peak velocity (r = −0.41, p

An aortic arch banding procedure was performed on an 82-year-old man for treatment of proximal type I endoleaks 2 days after he had undergone emergency thoracic endovascular aortic repair with the chimney technique for a ruptured aortic arch aneurysm. Contrast-enhanced computed tomography after the second procedure demonstrated significant shrinkage of the aneurysmal sac as well as a complete disappearance of the endoleaks. The basic concept of this technique is to treat the type IA endoleak, including possible gutter endoleaks, by creating a new proximal seal zone distal to the chimney graft using a banding technique.

BackgroundCarpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long‐term results reported. However, residual mitral regurgitation (MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a posterior mitral leaflet repair. Methods and ResultsWe retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3‐dimensional transesophageal echocardiography examination. Twelve had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual MR (odds ratio, 6.82; 95% confidence interval, 1.8–33.8; P=0.0049). Receiver operator characteristics curve analysis revealed a cut‐off value of 24.3° (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter (P

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: 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]

Purpose: To demonstrate feasibility and efficacy of preoperative coil embolization of side branches and postoperative tranexamic acid (TXA) therapy for management of type II endoleak and aneurysmal sac regression after endovascular aortic repair (EVAR).Materials and Methods: This study included 284 patients who underwent EVAR between 2007 and 2014. In 133 patients (group A), since March 2012, preoperative coil embolization of side branches and postoperative TXA therapy had been introduced as a modified strategy after EVAR, including combined coil embolization and TXA therapy (n = 41), coil embolization only (n = 17), and TXA therapy only (n = 75). The remaining 151 patients (group B) underwent EVAR with no coil embolization and TXA therapy. After propensity score matching, postoperative results were retrospectively compared between 92 matched pairs (group A vs group B).Results: Matched comparison revealed no significant difference in incidence rate of type II endoleak at 6 months after EVAR between group A and group B (19.6% [18/92] vs 29.4% [27/92]; P = .1172). A significantly greater shrinkage of sac size at 6 months after EVAR (-8.5% ± 11.6 vs -3.6% ± 8.4; P = .0011) and significantly more rapid pace of sac shrinkage (change of size per year; -4.2 mm/y ± 7.6 vs -1.9 mm/y ± 6.1; P = .0301) were observed in group A.Conclusions: Combined preoperative coil embolization of side branches and postoperative TXA therapy were associated with significantly more rapid aneurysmal sac regression after EVAR. [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]

Objective Right axillary artery (RAxA) perfusion was introduced for selective antegrade cerebral perfusion in total aortic arch repair to prevent cerebral embolism derived from arterial cannulation. However, the strategic benefits and long-term results regarding the cannulation site remain controversial. We retrospectively compared the outcomes between propensity score-matched patients with and without using RAxA cannulation. Methods Between 2006 and 2012, 260 consecutive patients underwent total arch repair with antegrade cerebral perfusion and moderate hypothermia at a single institution. RAxA cannulation was added in 142 patients (54.6%), and 70 propensity score-matched pairs were obtained. Results There were no significant differences in 30-day (2.9% [2 of 70] vs 5.7% [4 of 70]; P = .415 and in-hospital death (5.7% [4 of 70] vs 5.7% [4 of 70]; P = 1.000) between matched pairs. Although there was no significant difference in the occurrence of postoperative stroke (8.6% [6 of 70] vs 8.6% [6 of 70]; P = 1.000), the new rate of new occurrence of postoperative paraparesis was lower in patients with RAxA perfusion (0% [0 of 70] vs 4.3% [3 of 70]; P = .067). With a mean follow-up period of 1057 ± 686 days, the overall 5-year survival was 90.6% and was 89.6% for patients with RAxA perfusion. Thee difference in survival between patients with and without RAxA perfusion was not significant. Conclusions RAxA perfusion is a useful option for total aortic arch repair, and the midterm outcomes were satisfactory. However, RAxA perfusion did not completely prevent stroke in patients with an atherothrombotic aorta. [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]