Reinforced closure of the sternum with absorbable pins for high-risk patients.

We report our result of the reinforced sternal closure in 51 consecutive patients. We applied a new type of absorbable radiopaque pins (Super FIXSORB) composed of poly-lactide acid and hydroxyapatite, in addition to conventional stainless steel wires. The risk scores of our patients were calculated from the simplified risk scoring system for major infection based on the Society of Thoracic Surgeons National Cardiac Database. The expected probability of infection is significantly higher than the actual infection rate in our patients. Our procedure may contribute to minimizing the fatal sternal complication particularly in high-risk patients.

Repeated true lumen collapse after repair of descending thoracic aneurysm in chronic type B dissection.

The patient was 69-year-old man. Dilatation of the descending thoracic aorta in chronic type B dissection was revealed on computed tomography. During replacement of the descending thoracic aorta, distal anastomosis was performed in a double-barreled manner. On postoperative day (POD) 3, the patient complained of paralysis and dysesthesia of both legs, and he developed acute renal dysfunction. Based on the results of emergent aortography, we suspected true lumen collapse resulting from an expanded false lumen; therefore, we stabilized the intimal flap to the aortic wall. However, on POD 7 he complained of coldness in both legs. Emergent aortography revealed that occlusion of the abdominal aorta had recurred, and so right axillobifemoral bypass was performed. Preoperative conventional angiography may be mandatory to confirm reentry. There have been several reports of transcatheter fenestration in acute or chronic aortic dissection. The technique would also be effective for postoperative malperfusion.

Aortic valve-sparing operation and a total arch replacement by an elephant trunk method for Marfan's syndrome with aortic regurgitation and a DeBakey type IIIb dissection.

A 35 year-old male with Marfan's syndrome was referred with a fortuitous echographic finding of an abdominal aorta flap. Transthoracic echocardiography showed moderate aortic regurgitation and an aneurysm in the sinus of Valsalva. Computed tomography demonstrated an aneurysm in the sinus of Valsalva 60 mm in size and a DeBakey type IIIb dissection extending from the left subclavian artery to the right common iliac artery. An aortic valve-sparing operation (reimplantation), total aortic arch replacement and the elephant trunk method were used in this patient. An aortic valve-sparing operation is preferable because the patient is young, and has no need for anticoagulant therapy after surgery. The extent of the aortic reconstruction, including the intact aortic arch, was appropriate to prohibit future dilatation of the aortic arch and retrograde dissection from a DeBakey type IIIb dissection.

Surgical treatment of giant left atrium using a combined superior-transseptal approach.

We report on the usefulness of a combined superior-transseptal approach for the surgical treatment of giant left atrium. The posteroinferior wall and the roof of the left atrium were easily plicated and the mitral valve procedure was simple.

Surgical removal of an accufix pacing lead with a protruding J wire.

We report a patient with a fractured J wire protruding through the outer polyurethane sheath of an Accufix electrode in the subclavian vein and right atrium. The wire within the subclavian vein was removed transvenously, while the tip of the lead within the right atrium was removed surgically via a median sternotomy.