ABSTRACT
We experienced a hybrid repair for Kommerell diverticulum and right aortic arch. A 62-year-old man with dyspnea and dysphagia was referred to our hospital. He underwent atrium septum defect closure when he was 15 years old and was found to have ventricular septal defect and severe aortic regurgitation at the referring hospital. Preoperative computed tomography incidentally showed right aortic arch and Kommerell diverticulum with aberrant left subclavian artery. First, we performed ventricular septal defect closure and aortic valve replacement. Three months later, we performed one-stage hybrid repair of Kommerell diverticulum that included left common carotid-subclavian artery bypass, left subclavian artery plug occlusion and descending aortic replacement via a right thoracotomy. This hybrid strategy did not require in-situ reconstruction of the aberrant subclavian artery and minimized the risk of bleeding, injuries of esophagus and recurrent laryngeal nerve. The postoperative course was uneventful. This hybrid repair is a safe and effective procedure for Kommerell diverticulum with aberrant subclavian artery.
ABSTRACT
In this study, we report early and mid-term outcomes of endoscopic saphenous vein (SV) harvesting (EVH) for coronary artery bypass grafting. EVH is expected to have superior cosmetic results and fewer wound complications than conventional open techniques. EVH was performed in 262 patients from April 2008 to December 2010. From September 2010, we have administered heparin before EVH to prevent intraluminal SV clot formation. The mean age of the patients was 70±7.3 years, and 178 (67.9%) patients were men. The success rate of EVH was 97.3%. Hospital mortality was 1.2%. Postoperative wound complications occurred in only 7 (2.8%) patients. The early and mid-term patency was 95.8% (276/288) and 74.2% (187/252), respectively, as evaluated by postoperative angiography or computed tomography. Comparing the mid-term patency rate between the groups with or without systemic heparinization before EVH, statistical significance was not observed, but the mid-term patency was good in the group with systemic heparinization (82.5% vs. 73.6%, <i>p</i>=0.16). Actuarial 1-year and 3-year survival were 93.9% and 79%. Actuarial 1-year and 3-year major adverse cardiac event-free rates were 92.2% and 77.5%. In 10 patients who had SV graft occlusion during the observation period, percutaneous coronary intervention was required for the native coronary artery. EVH has great cosmetic advantages and has a good early patency. However, the mid-term patency is not satisfactory. Thus, systemic heparinization before EVH, improvement of the device and further clinical experience and techniques are required to improve the mid-term and late patency.
ABSTRACT
Since 1998, as a method of operating on descending thoracic aortic disease, especially distal aortic disease, a simple circulatory support technique, which uses the axillary artery or the ascending aorta as the aortic inflow, and the inferior vena cava for total body retrograde perfusion of cold oxygenated blood during circulatory arrest for open proximal anastomosis has been applied. This technique has been used in 25 consecutive cases over 10 years. In this report, we evaluate the efficacy of this support technique. From our experience, an atherosclerotic lesion in the ascending aorta required selection of the femoral artery as an aortic inflow site in 7 patients. Prolonged ventilatory support was unnecessary postoperatively unless neurological sequelae supervened, and no heart or visceral organ complications were occurred recognized. The hospital mortality rate was 16%. These results suggest our technique will continue to play an important role in operations on descending thoracic aortic diseases.