A pancreaticoduodenal artery arcade aneurysm (PDAA) is rare and often associated with celiac axis stenosis by the median arcuate ligament. Although rupture risk of the PDAA is not related to its size, treatment guidelines are absent. Here we describe a 59-year-old woman with multiple ruptured PDAAs associated with celiac axis stenosis who was successfully treated with coil embolization. As follow-up computed tomography revealed rapid expansion of residual PDAAs and new gastric artery dissection, median arcuate ligament resection was followed by aorta-common hepatic artery bypass, which resulted in aneurysmal regression. Blood flow modification might prevent secondary rupture of PDAA associated with celiac axis stenosis.

Endovascular repair is often difficult in the case of a huge abdominal aortic aneurysm for anatomic reasons. Here, we describe open repair of a huge infrarenal abdominal aortic aneurysm. Open repair was performed through laparotomy with the Cattell-Braasch maneuver, a technique for right-sided medial visceral rotation. Laparotomy with the Cattell-Braasch maneuver is simple and effective in open repair of a huge abdominal aortic aneurysm extending into the right common iliac artery, for which proximal clamping is difficult because of a tortuous proximal neck just below the hepatic region.

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Introduction: Cardiogenic shock (CS) is still most challenging clinical conditions in cardiovascular medicine. Recently, hemodynamic support using percutaneous ventricular assist device (pVAD) demonstrated feasible and safe for CS, however the use of p-LVAD in the perioperative management presenting refractory CS eligible for cardiovascular surgery (CVS) is still unclear. Hypothesis: We hypothesize that the perioperative use of pLVAD was safe and effective and allow LV unload that can be associated with the good cardiac recovery. Methods: This was a retrospective study including 17 patients admitted at our centers who presented CS and with indication to CSV (average STS score 32.4%), in which p-LVAD was used as a bridge for hemodynamic stabilization. The primary endpoint was the clinical and hemodynamic stabilization before CVS, and the secondary endpoint was cardiac recovery and 30-day mortality. Results: The significant increasing of cardiac power output (0.41 to 0.82 W, p<0.05) with titration the dose of inotropes (inotrope score 10.4 to 6.2, p<0.05) was observed. Serum lactate level was also decreased (5.8 to 1.6, p<0.01), which is indicator of tissue perfusion. The perioperative stabilization allowed the 15 patients (88.2 %) to be eligible for scheduled CVS after a median time of 2.0 days under pLVAD. Postoperatively, all patients could wean off p-PVAD with improvement of LVEF (38.6 to 47.4%, p<0.05). 30-day mortality was 17.6 % which was superior to STS score. Conclusions: The use of the pLVAD is safe and feasible in patients eligible for CVS presenting refractory CS. It is also effective for clinical and hemodynamic stabilization preoperatively and postoperative cardiac recovery and improvement of clinical outcomes.

Introduction: The surgical strategy for atrial fibrillation (AF) combined with mitral valve (MV) disease are still controversial whether biatrial or left atrial maze procedure should be performed concomitantly. Hypothesis: Our retrospective study aimed to evaluate the long-term results of two kinds of maze procedure combined with MV surgery and identify the factors involved in AF recurrence. Methods: We enrolled 88 patients from January 2010 to December 2020 who underwent MV surgery with maze procedure concomitantly. The patients were divided into two groups; biatrial maze, group F: n=42 and left atrial maze, group L: n=46). Primary endpoint was AF recurrence and we also evaluated early and late complication and preoperative and operative factors related to AF recurrence. The average follow-up term was 2.8 years. Results: Preoperative factors of long-standing AF and TR grade were significantly higher in group F than group L (P=0.004, 0.02, respecively). Consequently, tricuspid annuloplasty (TAP) was performed significantly frequent in group F than group L (P=0.002). We encountered 2 hospital deaths (4.4%) due to postoperative cerebral hemorrhage and AMI in group L. There was 1 case (2.2%) required pacemaker implantation (PMI) during hospitalization in group L and 3 cases (7.1%) requiring PMI in Group F in late-period. The AF recurrence rates at 1 and 5-year follow-ups between Group F and Group L were not significantly different (24.4% and 28.4% vs. 22.9% and 32.4%, P =0.79). However, the AF recurrence rate in group L with TAP is significant high than those of the other groups (group F 24.4% and 28.4%, group L with TAP 44.3% and 56.7%, and group L without TAP 7.7% and 14.3% at 1 and 5 years, respectively p =0.005). Subject with group L with TAP were associated with a high risk of AF recurrence, with an adjusted OR of 2.4 (95% CI: 1.31-4.45, P =0.005). Conclusions: Our study demonstrated that both concomitant maze procedure was effective for preventing AF recurrence. However, it is also revealed that left atrial maze with TAP significantly increased AF recurrence. It was suggested that preoperative right atrial load was involved in primary occurrence of AF and left atrial maze alone might not control AF recurrence in such situation.