OBJECTIVES We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection. METHODS We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain. Nine patients presented with malperfusion and 1 with cardiac arrest, preoperatively. A FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision. Single fenestration was made in the FET in 15 patients, 2 fenestrations in 5 patients and a total fenestrated technique in 2 patients. Concomitant procedures were performed in 5 patients. RESULTS The cardiopulmonary bypass, aortic cross-clamp and hypothermic circulatory arrest times were 181 ± 49, 106 ± 43 and 37 ± 7 min, respectively. In-hospital mortality, stroke, or recurrent nerve injury did not occur in any patient. One patient developed paraparesis, which completely recovered at discharge. During the follow-up period (mean 18 ± 7 months), 1 patient died of heart failure. Fenestration site occlusion did not occur. Follow-up computed tomography (mean 12 ± 6 months postoperatively) revealed that the maximal aortic diameter remained unchanged at the levels of the distal end of the FET, the 10th thoracic vertebra and the coeliac artery; however, the aortic diameter was significantly reduced at the level of the pulmonary artery bifurcation. CONCLUSIONS The fenestrated FET technique is a simple, safe and effective procedure for selected patients with acute type A aortic dissection.

Objective Postoperative atrial fibrillation (POAF) after open heart surgery is associated with a high risk of mortality and morbidity. Although oral β-blockers are usually recommended to prevent POAF, the efficacy of a transdermal β-blocker patch in preventing POAF is unclear. We compared the incidence of POAF between users of oral and transdermal bisoprolol. Methods We investigated 108 patients who underwent cardiac and/or thoracic aortic surgery between April 2016 and February 2018. We compared perioperative clinical and hemodynamic variables between 49 patients treated with a transdermal bisoprolol patch and 59 patients treated with an oral bisoprolol fumarate. Results POAF occurred in 24% of patients in the transdermal and in 46% of patients in the oral bisoprolol groups (p = 0.027). No intergroup difference was observed in in-hospital mortality, perioperative blood pressures and heart rates, and other morbidities. Multivariable logistic regression analysis revealed that the use of transdermal bisoprolol was independently associated with a lower rate of POAF (odds ratio 0.21, 95% confidence interval 0.05-0.84, p = 0.027). Conclusions A transdermal bisoprolol patch is an effective and safe β-blocker drug delivery system. The incidence of POAF in this group was lower than that in users of oral bisoprolol.

Video clip is available online. Acute type A aortic dissection frequently results in aortic rupture into the pericardial space. Herein, we describe a rare case of acute type A aortic dissection that ruptured into the right atrium resulting in the formation of an aorto-right atrial fistula. CLINICAL SUMMARY A 50-year-old man who presented with chest pain and dyspnea was transferred to our institution. On arrival, blood pressure was 120/50 mm Hg and percutaneous oxygen saturation was 98% at 6 L of oxygen. A chest radiograph revealed moderate pulmonary congestion. Contrastenhanced computed tomography revealed a type A aortic dissection from the aortic root down to the right femoral artery and, notably, the communication between the false lumen of the aortic root and the right atrium (Figure 1, A). Transthoracic echocardiography (TTE) revealed preserved left ventricular function without pericardial effusion and a shunt flow from the aorta to the right atrium (Figure 1, B). With the diagnosis of an acute type A aortic dissection complicated by an aorto-right atrial fistula (Figure 1, C), emergency surgery was performed. Intraoperative transesophageal echocardiography also confirmed the left-to-right shunt flow (Figure 1, D). Cardiopulmonary bypass (CPB) was initiated through cannulation of the ascending aorta, the superior and inferior vena cava, and a left ventricular vent. Hypothermic circulatory arrest was performed at a rectal temperature of 25 C. Retrograde and antegrade cold blood cardioplegia were intermittently administered. Antegrade selective cerebral perfusion was

Background: An aortic pseudoaneurysm after cardiovascular surgery can be fatal.Methods/Results: Here, we describe the staged successful treatments of three pseudoaneurysms in a 77-year-old female patient who underwent total arch replacement and coronary artery bypass grafting 5 years ago. Computed tomography revealed three pseudoaneurysms: in the distal anastomosis of the total arch replacement, in the anastomosis of the left common carotid artery, and in the proximal anastomosis of the saphenous vein graft. Endovascular treatment and surgical repair were performed to treat these three pseudoaneurysms.Discussion: An aortic pseudoaneurysm is a rare complication after cardiac or aortic surgery. Here, we present a case of combined endovascular and surgical repairs of three pseudoaneurysms in one patient. K E Y W O R D Saorta and great vessels

Papillary muscle rupture is a rare but life-threatening complication of myocardial infarction (MI). Here, we describe a case of papillary muscle rupture caused by a microscopic MI. A 76-year-old woman was referred to our institution, where she developed cardiac arrest upon admission. Severe mitral regurgitation was noted without significant coronary artery lesions. Emergency surgery was performed, and posteromedial papillary muscle rupture was observed. Postoperatively, cardiac magnetic resonance imaging revealed a microscopic MI of the posteromedial papillary muscle.