OBJECTIVES This study was aimed to investigate the impact of preoperative renal malperfusion on early and late outcomes after surgery for acute type A aortic dissection (AAAD). METHODS Of 915 patients who underwent surgery for AAAD between September 2004 and September 2017, we enrolled 534 patients whose preoperative enhanced computed tomography images were retrospectively available in this study. Exclusion criteria were single kidney (n = 3) and dialysis-dependent preoperatively (n = 12). We compared early and late outcomes between patients who had preoperative renal malperfusion (n = 64) and those who did not have renal malperfusion (n = 470). RESULTS The incidence of postoperative acute kidney injury, defined using the Kidney Disease: Improving Global Outcomes criteria, was higher in the renal malperfusion group than in the no renal malperfusion group (76.6% vs 39.4%; P < 0.001). Similarly, operative death was more frequently seen in the renal malperfusion group (12.5% vs 3.8%; P = 0.003). Multivariate analyses showed that renal malperfusion was the independent predictor for postoperative acute kidney injury [odds ratio 4.32, 95% confidence interval (CI) 2.25–8.67; P < 0.001] and operative death (odds ratio 3.08, 95% CI 1.02–8.86; P = 0.046). The median follow-up period in the hospital survivors was 3.3 years (interquartile range 2.1–6.7 years). The cumulative survival rate at 8 years was similar between the groups (74.6% in the renal malperfusion group and 76.0% in the no renal malperfusion group; P = 0.349). CONCLUSIONS Preoperative renal malperfusion is an independent predictor for postoperative acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.

CE for a diffusely diseased LAD using the ITA provides satisfactory clinical outcomes with favorable rates of angiographic patency.

The diffusely diseased coronary artery is challenging for cardiac surgeons because diffuse atheromatous lesions frequently render it unsuitable for conventional distal grafting. Coronary endarterectomy was introduced in the 1950s as a treatment option for diffusely diseased coronary arteries. However, initial studies demonstrated high operative mortality and morbidity associated with coronary endarterectomy; therefore, many cardiac surgeons have been reluctant to perform this procedure. With percutaneous coronary interventions increasingly being applied to coronary artery disease, the incidence of complex and diffuse coronary artery disease in patients referred for coronary artery bypass surgery has been increasing, and recent advances in the surgical technique and perioperative management have improved the surgical outcomes of coronary endarterectomy. In this review article, we sought to discuss coronary endarterectomy for the diffusely diseased coronary artery.

V-composite grafting using the RITA and the A-C bypass graft provides excellent clinical outcomes with satisfactory early and 1-year patency rates.

To improve the cosmetic results of minimally invasive cardiac surgery (MICS) for aortic valve replacement (AVR), we use a small right infraaxillary incision. A disadvantage of AVR via right infraaxillary thoracotomy is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the "Stonehenge technique" (Figs. 1A and 1B) Surgical TechniqueWe successfully performed AVR through a small right infraaxillary thoracotomy with our Stonehenge technique in 10 patients between July 2015 and August 2016. The patients were six women and four men with a mean age of 69.3 years (range: 56-81 years). Patients with severe aortic calcification, peripheral arterial stenosis, or poor left ventricular function were not included. The preoperative diagnosis was aortic stenosis in nine patients and aortic regurgitation in one patient.Using general anesthesia with differential lung ventilation, the patients were placed in a 70° left lateral position with a pillow beneath the left chest. The right upper arm was abducted anteriorly and the elbow flexed to 90°. The forearm of the patients was set in front of the face and held by a padded positioner bar. An 8-cm skin incision along the edge of the pectoralis major muscle was made at the right anterior axillary line (Fig. 1E). After dissecting a space beneath the pectoralis major muscle anteriorly, a thoracotomy incision was made through the third or fourth intercostal space. Cardiopulmonary bypass was established through the right femoral artery and vein or right atrium. Although the right atrial Ann