Search

Objectives: A primary goal of thoracic endovascular aortic repair (TEVAR) for type B acute aortic dissection (BAAD) is exclusion of the primary entry tear with a suitable stent graft (SG) to reestablish true lumen flow and promote aortic remodeling. This study aimed to determine the safety and efficacy of a conformable thoracic SG in a Japanese population with complicated BAAD., Methods: Between 2016 and 2017, 43 patients with complicated BAAD were enrolled in this prospective, nonrandomized, multicenter post-market surveillance study at 27 sites in Japan. All patients underwent TEVAR using the Gore TAG Conformable Thoracic Endoprosthesis (CTAG) (W.L. Gore and Associates, Flagstaff, AZ)., Results: The most common TEVAR indication for complicated BAAD was malperfusion (41.9%; 24 out of 43) and aortic rupture was observed in 32.5% of patients (14 out of 43). All SG implants were successfully completed and there was no patient with surgical conversion. Thirty-day mortality was 7.0% (3 out of 43) and one patient (2.3%) experienced spinal cord ischemia during hospitalization. Entry tear exclusion was achieved in 91.3% of patients at 1 month, and 95.7% at 24 months. Through 24 months after TEVAR, no retrograde type A aortic dissection was observed and distal stent graft induced new entry was observed in two patients (4.7%)., Conclusion: TEVAR utilizing the CTAG device for complicated BAAD in Japan demonstrated a low incidence of perioperative mortality and complications. Complications directly attributed to the SG including RTAD and dSINE were uncommon and the midterm outcomes were deemed satisfactory., Competing Interests: Declarations. Conflict of interest: Yoshimasa Seike—None. Sophie Green – Employee of W.L. Gore & Associates. Keita Mori—Employee of W.L. Gore & Associates. Kimberly Reid—Employee of W.L. Gore & Associates. Hitoshi Matsuda—None., (© 2025. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

A simple method for determining elemental sulfur in environmental water was developed and applied to seawater samples collected immediately after the occurrence of blue tides in Tokyo Bay. To investigate the concentration and extraction methods, artificial elemental sulfur was quantitatively produced by oxidizing a sulfide solution with an iodine solution, then used as a standard reagent in the experiments. To concentrate the elemental sulfur in the water sample, glass filter paper (GF/F) was used to filter and collect the elemental sulfur. The elemental sulfur was then extracted using n-hexane, the main component of petroleum ether; however, the recovery of elemental sulfur from the wet glass filter paper was low, and remained so even when the glass filter paper was dried. We, therefore, used a mixture of n-hexane and an acetone solvent, which is a hydrophilic organic solvent, for extraction and succeeded in recovering more than 90% of the elemental sulfur from the wet glass filter paper. Using this solvent mixture, we extracted and quantified elemental sulfur from seawater samples collected after the occurrence of blue tide, and detected 0.36-0.38 mgS L -1 of elemental sulfur in the near-surface layer. We also found that the elemental sulfur concentrations were higher in the surface layer than in the bottom layer. Therefore, we demonstrated that the quantification of elemental sulfur is important to better understand the blue tide phenomenon., Competing Interests: Declarations. Conflict of interest: The authors declare no conflict of interest., (© 2025. The Author(s).)

Purpose: Owing to the time-sensitive nature of myocardial ischemia, challenging clinical scenarios should be considered in patients with type A acute aortic dissection (AAAD) complicated by coronary malperfusion. In clinical settings, the diagnosis and reperfusion strategies for coronary malperfusion often depend on institutional resources. This study evaluated early surgical outcomes in such patients, focusing on transportation type and clinical management., Methods: We retrospectively reviewed 70 patients who underwent emergency surgery for AAAD with coronary malperfusion, excluding those with cardiac tamponade on arrival, between 1997 and February 2024. Patients were divided into 2 groups based on transportation: direct transfer and referral., Results: Overall, in-hospital mortality was 27%, with only 1 of 9 patients surviving with preoperative peripheral extracorporeal membrane oxygenation (ECMO). Mortality and morbidity did not significantly differ between groups. Univariate analysis identified left coronary artery involvement and preoperative hemodynamic instability as significant risk factors. Additionally, preoperative diagnostic-only coronary angiography (CAG) with unsuccessful reperfusion was a potential risk factor (P = 0.06)., Conclusions: Regardless of transportation type, preoperative peripheral ECMO itself could not be a definitive solution in AAAD patients with coronary malperfusion. Also, patients who underwent preoperative CAG with unsuccessful reperfusion might be fatal, especially with suspected left coronary artery involvement.