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Author(s): Yuji Shiba (corresponding author) [1, 2]; Toshihito Gomibuchi [3]; Tatsuichiro Seto [3]; Yuko Wada [3]; Hajime Ichimura [3]; Yuki Tanaka [3]; Tatsuki Ogasawara [3]; Kenji Okada [3]; Naoko Shiba [...]

OBJECTIVES We aimed to identify predictors of postoperative permanent neurological deficits (PNDs) and evaluate the early management of cerebral perfusion in patients undergoing surgical repair of acute type A aortic dissection with cerebral malperfusion. METHODS Between October 2009 and September 2018, a total of 197 patients with acute type A aortic dissection underwent aortic replacement. Of these, 42 (21.3%) patients had an imaging cerebral malperfusion (ICM). ICM was assessed preoperatively, which also revealed whether dissected supra-aortic branch vessels were occluded or narrowed by a thrombosed false lumen. After September 2017, early reperfusion and extra-anatomic revascularization were performed in cases with ICM. RESULTS Hospital mortality rates for cases with ICM were 4.8% (2/42). Before September 2017, PND were observed in 6 patients (54.5%) with preoperative neurological symptoms (n  = 11), and 7 patients (33.3%) without neurological symptoms (n  = 21) in patients with ICM. Occlusion or severe stenosis of supra-aortic branch vessels (odds ratio, 7.66; P  <   0.001), regardless of preoperative clinical neurological symptoms, was a risk factor for PND. After September 2017, 7 of 10 patients with ICM underwent early reperfusion and extra-anatomic revascularization. PND did not occur in any of these 7 patients. CONCLUSIONS Occlusion or severe stenosis of supra-aortic branch vessels is a predictor of PND risk in patients undergoing surgery for acute type A aortic dissection. Early reperfusion and extra-anatomic revascularization may reduce the risk of neurological complications in patients with ICM, with or without neurological symptoms. [ABSTRACT FROM AUTHOR]

Mitral valve (MV) repair is indicated for patients with severe MR. We report a case of acute MR caused by patch detachment after posterior leaflet augmentation in MV repair. A 65-year-old male underwent MV repair with posterior leaflet augmentation and coronary artery bypass graft 1 month prior to this study. An inverted T-shaped incision was made on the posterior mitral leaflet (PML), and a piece of autologous fresh pericardium was sewn in the PML defect. Seven days after hospital discharge, he started feeling chest pain and presented with pulseless electrical activity. Ultrasonic cardiography showed severe mitral regurgitation (MR), which was suggestive of acute MR. We performed emergency reoperation. The edge of the autologous pericardial patch was detached from the anterior papillary muscle, and MV replacement was performed. He was discharged from the hospital 55 days after the reoperation and returned to his normal daily life. We conclude that avoidance of tension focalization during MV repair may be important. [ABSTRACT FROM AUTHOR]

Chronic kidney disease( CKD) is a challenge in cardiac surgery in elderly patients, making intraoperative and postoperative management critical. Although sodium glucose co-transporter 2( SGLT2) inhibitors have nephroprotective effects, it's important to discontinue them three days before surgery and resume them when food intake is possible. Nephroprotective perioperative management of CKD stage 3-4 patients requires different approaches at each stage, with blood pressure control and nutritional counseling being key. For patients with CKD stage 5, postoperative management includes circulatory management in the intensive care unit and assessment of the need for and timing of hemodialysis. Continuous renal replacement therapy( CRRT) is common, but recently the use of multiple dialysis modalities (multimodal approach) has increased. This multimodal approach, which aims to avoid CRRT trauma, may contribute to improved outcomes.