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OBJECTIVES To compare short-term outcomes, long-term survival and reinterventions in patients requiring surgery after chronic Type I and chronic primary Type III aortic dissections. METHODS Over an 11-year period, 466 patients underwent thoraco-abdominal aortic aneurysm repair for chronic Type III (n  = 239) and Type I (n  = 227) aortic dissections. Short-term outcomes and reinterventions were evaluated by multivariable regression analysis for the entire group; propensity matching produced 169 pairs. RESULTS Mortality was 6% (n  = 28) in the overall cohort and 6.2% (n  = 14) and 5.9% (n  = 14) in those with chronic Type I and Type III aortic dissections, respectively. Overall stroke and persistent spinal cord deficit rates were 4.0% and 2.6%, respectively, in the Type I group and 1.3% and 3.8% in the Type III group. In the propensity-matched patients, analysis showed no neurological differences between the 2 groups, but respiratory failure was significantly more frequent in the chronic Type I group (30.2% vs 15.4%; P  =   0.001). Multivariable analysis identified chronic Type I dissection as an independent risk factor for postoperative pulmonary complications (odds ratio 1.612; 95% confidence interval 1.060–2.452; P  =   0.026) and an association between chronic Type I dissection and stroke (odds ratio 4.013; 95% confidence interval 1.026–15.698; P  =   0.046). Six-year survival was 74.4%   ±   4.1% and 74.4%   ±   4.6% in the chronic Type I and Type III groups, respectively (P  =   0.87). CONCLUSIONS Short- and long-term mortality and reintervention rates were comparable after open repair for chronic Type I and primary chronic Type III aortic dissections. Respiratory failure was more frequent in the chronic Type I aortic dissection group. [ABSTRACT FROM AUTHOR]

In the conventional way of thoraco-abdominal aortic replacement, the intercostal arteries are reimplanted directly to the main aortic graft or by the interposition of branch grafts. To overcome the disadvantages of these techniques, we adopted a different technique using a parallel side graft. The good patency rate of reimplanted intercostal arteries achieved by this technique and its potential technical advantages can contribute to the improvement of the surgical outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate surgical outcomes in open repair of thoracoabdominal aortic (TAAA) and descending thoracic aortic aneurysms (DTA) in patients with preoperative renal failure (PRF). METHODS: Our database was examined for all patients undergoing open TAAA/DTA repair. Patients with a creatinine greater than or equal to 1.5 gm/dl or on haemodialysis were defined as having PRF and were compared to those having normal preoperative renal function. Logistic and Cox regression analysis were used to identify independent determinants of in-hospital outcomes and long-term survival. RESULTS: From 1997 to 2015, 711 patients underwent open TAAA/DTA repair. Two hundred and two were categorized as having PRF, of which, 22 where on preoperative haemodialysis. PRF patients had significantly worse comorbidities; smoking (95.5% vs 69.0%; P < 0.001), chronic pulmonary disease (65.8% vs 29.7%; P < 0.001), peripheral vascular disease (44.1% vs 19.4%; P < 0.001) and diabetes (16.3% vs 6.7%; vs P < 0.001). Operative mortality (OM) was seven-times higher in patients with PRF (14.2 vs 2.2%; P < 0.001). Logistic regression analysis showed that PRF was a predictor of OM [odds ratio (OR): 4.91; confidence interval (CI): 2.01–11.97; P < 0.001] and major adverse events (OR: 2.05; CI: 1.21–3.46; P = 0.007). Kaplan–Meier 5-years survival was significantly lower in PRF patients (45.0% vs 69.8%; P < 0.001). CONCLUSIONS: PRF predicts higher OM and major adverse events incidence following open TAAA/DTA repair. Long-term survival is negatively impacted. Strategies for improving preoperative and intraoperative renal function may lead to better outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE Throughout the history of surgery for pectus excavatum (PE), the Nuss procedure and open repair have been performed with many modifications, with most of these procedures using a metal bar. However, the use of a metal bar has several drawbacks. Thus, we aimed to develop a procedure that did not require a metal bar. METHODS Through our experience of 426 pediatric cases that underwent various procedures for open repair of PE at Nagoya City University, we arrived at the current procedure that we describe herein. We have evaluated this procedure by review of clinical results and deformity indices (Haller's, steepness, excavation volume, and asymmetry index). RESULTS The latest and current procedure that supports the sternum with a bridge constructed by the 4th or 5th costal cartilages is associated with fewer complications, a lower re-operation rate, and striking improvement in the indices examined. CONCLUSIONS Our current open-repair procedure that does not require a metal bar is recommended for correction of deformities of PE in children. [ABSTRACT FROM AUTHOR]

The author comments on the state of total aortic arch replacement surgery in 2013. According to the author, despite technological progress and development and exploration of hybrid procedures to manage the disorder, high stroke and operative mortality rates have been reported in centers worldwide. He believes that only sufficient data can provide the answer whether hybrid procedures are as good or better than open ones for total repair of the aortic arch.

Reconstruction of the visceral and intercostal arteries is the most challenging part in the open repair of thoraco-abdominal aortic aneurysm. For efficient and expeditious reconstruction of these branching vessels, a technique of using a pre-handsewn 8-branch aortic graft (octopod technique) has been adopted. The octopod graft was manually constructed using commercially available two 4-branch aortic grafts that were spatially oriented based on the preoperative computed tomographic images and connected each other prior to surgery. This approach was adopted in 12 open repairs of extent II thoraco-abdominal aortic aneurysms from 2015 to 2017, including 8 Marfan patients. Median pump and procedural times were 173 (102-207) min and 437 (343-489) min, respectively. There was no operative mortality or spinal cord injury. The octopod technique for open thoraco-abdominal aortic aneurysm repair showed excellent early results with high procedural efficiency. [ABSTRACT FROM AUTHOR]