Aortic repair, if performed immediately from the onset of symptoms, showed satisfactory recovery of consciousness and neurological function in patients with AADA complicated by coma. In this patient population, immediate aortic repair is warranted.

Background— Cardiac tamponade is associated with fatal outcomes for patients with acute type A aortic dissection, and the presence of cardiac tamponade should prompt urgent aortic repair. However, treatment of the patient with critical cardiac tamponade who cannot survive until surgery remains unclear. We analyzed our experience of controlled pericardial drainage (CPD) managing critical cardiac tamponade. Methods and Results— Between September 2003 and May 2011, 175 patients with acute type A aortic dissection were treated surgically, including 43 (24.6%) who presented with cardiac tamponade on arrival. Eighteen patients, who did not respond to intravenous volume resuscitation, underwent CPD in the emergency department. An 8F pigtail drainage catheter was inserted percutaneously, and drainage volume was controlled by means of several cycles of intermittent drainage to maintain blood pressure at ≈90 mm Hg. After CPD, all of the patients were transferred to the operating room, and immediate aortic repair was performed. Systolic blood pressure before CPD was 64.3±8.2 mm Hg and elevated significantly in all of the cases after CPD. Systolic blood pressure after CPD was 94.8±10.5 mm Hg, and increase in systolic pressure was 30.5±11.7 mm Hg. Total volume of aspirated pericardial effusion was 40.1±30.6 mL, and 10 patients required only ≤30-mL aspiration volume. All of the patients underwent aortic repair successfully. In-hospital mortality was 16.7%; however, there was no complications or mortality related to CPD. Conclusions— Preoperative pericardial drainage with control of volume is a safe and effective procedure for acute type A aortic dissection complicated by critical cardiac tamponade. In our patient population, timely controlled pericardial drainage is warranted.

The early and long-term outcomes as a result of immediate aortic repair for acute type A aortic dissection complicated by coma were satisfactory.

Objectives-Autologous vein grafts are still widely used, but their long-term patency is suboptimal. The objective of the current study was to determine whether wrapping a vein graft in gelatin hydrogel sheet incorporating basic fibroblast growth factor improves their mechanical and physiological properties. Methods and Results-Autologous femoral vein was interposed into the abdominal aorta in rats. The rats were divided into 3 groups: nontreated grafts (group A), grafts wrapped in basic fibroblast growth factor-free gelatin hydrogel sheet (group B), and grafts wrapped in basic fibroblast growth factor-impregnated gelatin hydrogel sheet (group C). On day 1, endothelial desquamation was observed in group A, and the media in groups A and B were disrupted, staining positive in the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay. In contrast, the media in group C remained intact and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling-negative, associated with activation of MAPK. Graft dilation was significantly inhibited in groups B and C compared with group A, with those in group C showing the smallest degree of neointimal proliferation. At 8 weeks grafts in group C developed neointima with homogeneous elastic laminae, presence of rigid neoadventitia that displayed neovascularity, and the highest blood flow velocity. Conclusions-Wrapping vein grafts in basic fibroblast growth factor-impregnated gelatin hydrogel sheet improved their structural and physiological properties, and might therefore also improve long-term patency. Key Words: basic fibroblast growth factor Ⅲ gelatin hydrogel Ⅲ vein graft R ecently, coronary arterial bypass grafting is often performed using arterial conduits such as internal mammary artery or radial artery rather than saphenous vein grafts, because of the superior long-term patency of arterial grafts. 1 However, arterial grafts are susceptible to arteriosclerosis, 2 and the available number of arteries for grafting is limited. Moreover, alternatives such as small-caliber synthetic vascular prostheses are still undergoing development for practical use in coronary arterial bypass grafting because of thrombogenicity. Improvement of vein graft patency would therefore be highly beneficial in improving the quality of coronary arterial bypass grafting, as well as surgery for peripheral arterial disease.Vein graft occlusion is attributable to the neointimal hyperplasia caused by vascular smooth muscle cell (SMC) proliferation. 3 Disruption of endothelium and media of the vein graft by mechanical forces associated with pulsatile blood flow is considered to be one of the causes of such neointimal hyperplasia. 4 In the literature, mechanical perivenous support such as that provided by polytetrafluoroethylene or polyethylene graft stents may protect the endothelium and media of vein grafts from mechanical destruction. 5,6 We selected gelatin hydrogel sheet (GS) as a substitute for polytetrafluoroethylene or polyethylene because the former is a biodegradable a...