Clinical Outcome of the Type A Acute Aortic Dissection Repair Using the "Tailored Stand-Up Collar" Technique.

PURPOSE: Achieving a secure anastomosis and complete hemostasis is essential for surgically treating type A acute aortic dissection (TAAAD). This study assessed the clinical feasibility of "tailored stand-up collar (TSC)" technique for constructing the distal stump. METHODS: We enrolled 68 patients who underwent ascending aortic repair for TAAAD. Patients were categorized according to the technique for distal stump construction: conventional (C) group using only a felt strip (32 cases); post-aortotomy (P) group, with a Hydrofit-felt strip attached after aortotomy (18 cases), and TSC group, where a Hydrofit-felt strip attached during cooling (18 cases). Pre-operative characteristics, procedural profiles, and post-operative outcomes were evaluated. RESULTS: The pre-operative characteristics were identical among the groups. The durations of cardiopulmonary bypass, hemostasis, and surgery were significantly shorter in the P and TSC groups. The duration of open distal in the TSC group (21 min) was significantly shorter than the other two groups. Post-operative additional procedures were not required for the TSC group and their post-operative hospital stay was significantly shorter (47.1% of patients were discharged within 2 weeks). CONCLUSION: The TSC technique would be practical because of its high reproducibility in terms of ease of use, shorter anastomotic time, and secure hemostasis.

First Experience With the Triolifter, a Novel Device for Organ Fixation Used as a Heart Positioner in Cardiac Surgery.

We describe our first experience with the Triolifter (Fuji Systems, Yokohama, Japan) in cardiac surgery. The Triolifter is a less expensive, novel organ fixation device developed as a fixation indenter mainly for traction of the lung under video-assisted surgery and is now available in Japan. An 84-year-old man diagnosed with unstable angina pectoris underwent emergency coronary artery bypass grafting (CABG) under cardiac arrest. Following the declamping of the aorta and the resumption of the beating heart, bleeding from the left anterior descending artery (LAD) anastomosis site was observed. The Triolifter was used as a heart positioner to expose the anastomosis site for hemostasis in the setting of an on-pump beating heart. Hemostasis of the posterior descending artery (PDA) anastomosis site could also be confirmed by traction of the right ventricular anterior wall using the Triolifter. It could be effectively and safely used with neither significant subepicardial hematoma nor epicardial injury. In Japan, the Triolifter might be used as one of the insurance-covered devices in off-pump CABG in the future, but globally, it could also be used in on-pump CABG without hesitation because it is so inexpensive.

Evaluation of the Factors Affecting Higher Hospitalization Cost of Lung Resection for Primary Lung Cancer: A Retrospective Cohort Study.

PURPOSE: This study aims to evaluate the factors associated with the higher hospitalization cost of lung resection for primary lung cancer to contribute to the reduction of healthcare spending. METHODS: A total of 435 consecutive primary lung cancer patients who underwent lung resection by a single surgeon at a single institution were enrolled. Baseline patient characteristics, operative procedures, postoperative complications, and postoperative courses were analyzed in relation to the hospitalization cost. Patients with higher costs (exceeding the third quartile [TQ]) were compared with patients with lower costs (less than TQ). RESULTS: Median and TQ medical costs for overall cases were 11177 US dollars (USD) and 12292 USD, respectively. Smoking history, history of coronary artery disease, previous thoracotomy, multiple sealant material use, transfusion, tumor factor T3 or higher, squamous cell carcinoma, postoperative complications, and longer postoperative hospital stay (>10 POD) were significant risk factors for increased hospitalization cost in multivariate analysis. The 5-year survival rate was significantly lower in the higher hospitalization cost group. CONCLUSION: In addition to postoperative complications and prolonged hospitalization, patient background, histological types, and intraoperative factors were also considered as the risk factors for higher medical costs.

Sonoporation with doxorubicin enhances suppression of intimal hyperplasia in a vein graft model.

BACKGROUND: The purpose of the present study is to examine whether sonoporation with doxorubicin enhances suppression of intimal hyperplasia (IH) in a vein graft model. MATERIALS AND METHODS: After the administration of 1.5 mg/kg doxorubicin intravenously, the right external jugular vein of six rabbits was exposed at 2 W/cm2 and 1 MHz of ultrasound for 2 min (Sonoporation group). Tissue doxorubicin concentration was measured. In 48 rabbits, the right common carotid artery was ligated after performing a vein graft bypass. The animals were divided into the following four groups: the C0 group (surgical procedure only); the C0S (sonoporation without doxorubicin); the C1 (doxorubicin administration only); the C1S (sonoporation with doxorubicin). Twenty-four grafts were subjected to Elastic van Gieson staining for morphometric analysis 4 weeks after the operation; others were subjected to TdT-mediated X-dUTP nick end-labeling for detection of apoptic cells and to staining with a monoclonal antibody against the proliferating cell nuclear antigen for assessment of cell proliferation 1 week after. RESULTS: The tissue doxorubicin concentration was significantly higher in the Sonoporation group than in the Control group. Compared with the C0 group, IH was not suppressed in the C1 group but was significantly suppressed in the C1S group. Sonoporation with doxorubicin administration suppressed IH significantly (C1 group versusC1S group: P < 0.05). Cell apoptosis was induced and cell proliferation was suppressed significantly in the C1S group. CONCLUSIONS: Sonoporation with doxorubicin suppressed IH of the vein graft. Sonoporation may be effective in coronary or peripheral revascularization using vein grafts.

Intrathrombotic pressure of a thrombosed abdominal aortic aneurysm.

In a case of thrombosed abdominal aortic aneurysm, intraluminal and intrathrombotic pressures were simultaneously measured 3 cm distal to the left renal vein level (#1), at the inferior mesenteric artery level (#2) (3 cm distal to #1), 3 cm distal to #2 (#3), and at the aortic bifurcation level (#4) (3 cm distal to #3). The intraluminal pressure (at #1) was 154/72 (101) mmHg, and the intrathrombotic pressures at #2, #3, and #4 were 138/77 (100), 137/74 (97), and 135/68 (96) mmHg, respectively. The percentages of the systolic and mean intrathrombotic pressures to the intraluminal pressure were 90% and 99% at #2, 89% and 96% at #3, and 88% and 95% at #4, respectively. The mural thrombus of an aneurysm does not significantly decrease the pressure on the aneurysmal wall, even in a thrombosed aneurysm.