Cardiobacterium hominis endocarditis associated with cerebral, renal, and splenic infarctions: A case report and review of the literature.

Cardiobacterium hominis (C. hominis) is a fastidious, pleomorphic, gram-negative bacillus that causes infective endocarditis. Identification of C. hominis is difficult because it grows very slowly in culture media. C. hominis is also known to cause large friable vegetations in the heart valves, complicated by systemic embolism. Here, we report a case of C. hominis infective endocarditis associated with cerebral, renal, and splenic infarctions. A 58-year-old Japanese man with a medical history of diabetes mellitus presented with acute right-sided back pain. Enhanced abdominal computed tomography scan showed a right renal infarction and splenic embolism, and cerebral magnetic resonance imaging revealed multiple infarctions. Transesophageal echocardiography revealed the presence of a vegetation and severe aortic regurgitation. C. hominis was detected in the blood culture; thus, a diagnosis of C. hominis infective endocarditis was made. The patient received antibiotic therapy and surgical aortic valve replacement, and he was doing well without major complications. We also reviewed the cases of systemic emboli caused by C. hominis infective endocarditis.

Surgical outcomes in acute type A aortic dissection based on surgeon experience.

OBJECTIVES: The aim of this study is to evaluate our surgical strategy for acute aortic dissection Stanford A and determine whether it is safe regardless of the experience of the primary surgeon. METHODS: Between April 2015 and September 2020, a total of 160 patients who underwent open surgery for type A aortic dissection at Shonan Kamakura General Hospital were reviewed. Data were collected from reviews of computerized medical records. From this study cohort, we retrospectively reviewed the cases of trainee (group T) and experienced primary surgeons (group E). We evaluated rates of 30 day and in-hospital mortality, stroke, aortic reintervention, and mid-term survival for both groups. RESULTS: The rates of 30 day and in-hospital mortalities in group T were 5.1 and 7.7%, respectively, whereas those in group E were 4.7 and 4.7%, respectively. One and 3 year survival rates in group T were 88.4 and 87.1% and in group E were 95.3 and 95.3%, respectively (log-rank test, p = 0.11). The 1 year and 3 year rates of freedom from reintervention were 90.9 and 72.8% in group T and 96.8 and 92.7% in group E, respectively (log-rank test, p = 0.29). The permanent neurological dysfunction rate was 8.1% overall, 8.5% in group T, and 7.0% in group E, with no significant difference. CONCLUSIONS: Our surgical strategy for acute type A aortic dissection is safe and appropriate regardless of the experience of the primary surgeon.

Acute type A aortic dissection in non-agenarians: to cut or not.

OBJECTIVES: Surgery for acute type A aortic dissection (type AAD) in non-agenarians is usually contraindicated due to advanced age. The aim of this study was to assess and compare outcomes after surgical or conservative treatment for acute type AAD in non-agenarians by evaluating frailty. METHODS: Between October 2012 and September 2018, 273 patients underwent open repair for type AAD at the Shonan Kamakura General Hospital and the Shonan Fujisawa Tokushukai Hospital, and here, we retrospectively reviewed the case reports of 10 surgically treated non-agenarians and 15 conservatively treated non-agenarians. Exclusion criteria for surgery were the patient's refusal of surgery, severe dementia and coma. In patients considered to be at a high risk, our judgements were based on the results of comprehensive evaluation. RESULTS: Both in-hospital mortality and 30-day mortality in the surgical group were zero, while in-hospital mortality in conservatively treated non-agenarians was 73.3%. Importantly, 1-year survival in the surgical group and conservative group was 90% and 25%, respectively. The 5-year survival in the surgical group and conservative group was 49.2% and 25%, respectively (log-rank test, P = 0.0105). Four of 6 patients with preoperative clinical frailty scores not higher than 4 were still alive at 1 year with the same level of preoperative frailty. CONCLUSIONS: Surgery for acute type AAD in non-agenarians can be performed with acceptable outcomes in carefully selected patients, particularly in those with preoperative clinical frailty scores not higher than 4.

Descending aortic banding for re-rupture of retrograde aortic dissection after emergency thoracic endovascular aortic repair.

Conversion to open repair after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection is rare, but inevitable. We present a case of an 86-year-old man with ruptured type B aortic dissection after TEVAR. He received a successful stent-graft implantation of the descending aorta without any type of endoleak. After the patient was transferred to the intensive care unit, he went into a shock state. Contrast-enhanced CT revealed a re-rupture of acute retrograde type B aortic dissection. The false lumen was patent and perforated to the left thorax. Left thoracotomy and descending aortic banding was performed. Descending aorta was encircled with a woven Dacron graft at the distal part of the rupture site to compress the patent false lumen. The bleeding was stopped, and the follow-up CT showed false lumen thrombosis. Descending aortic banding is one of the quick and effective open conversion techniques.