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We present the off-label use of a Thoraflex Hybrid Plexus prosthesis (Vascutek, Renfrewshire, Scotland, UK) to treat a post-dissection type IV thoracoabdominal aortic aneurysm (TAA) in a high-risk patient previously treated with a thoracic stent-graft for a chronic type B aortic dissection. The Thoraflex graft was used in a "reversed frozen elephant trunk" fashion: the stent graft portion deployed in the previously placed thoracic stent, and the branched portion used to revascularize visceral arteries and lower limbs. Our off-label use of the Thoraflex graft was technically successful. Further experiences are required to confirm the safety of this technique in high-risk patients., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

We have introduced a number of modifications to minimize the deleterious effects of cardiopulmonary bypass (CPB) by reducing the surface of the extracorporeal circulation (ECC), the length of the ECC circuit, the contact surface of the oxygenator, and the volume of priming solution, in addition to employing biocompatible systems and isolation of excess blood volumes of venous reservoirs in transfusion bags very early in CPB. Encouraged by the results of our initial "Compact ECC," we have decided to improve it by implementing other techniques such as controlled hemodilution of the patient by reducing the diameter of ECC venous tubing (from 1/2 in. to 3/8 in.), limiting contact surface of the oxygenator and venous reservoir, positioning the oxygenator and venous reservoir at the level of the patient's shoulder, and employing venous cannulae adapted to vacuum assisted venous drainage (VAVD) to replace venous drainage by gravity. The purpose of this study is to evaluate postoperative outcomes of Compact ECC. Three groups of patients undergoing coronary artery bypass graft (CABG) are compared. Our new Compact ECC shows improved outcomes through reduced postoperative ventilation time, blood loss, intensive care stay, need for blood transfusion, and levels of lactate dehydrogenase despite the patients' pathologies and surgeries being more complex.

Aneurysm of the celiac and/or superior mesenteric arteries are uncommon, accounting for 10% of visceral artery aneurysms. Aneurysms involving a common celiomesenteric trunk are extremely rare. Up to now only two cases have been reported. In this report we describe a saccular aneurysm originating from the bifurcation of a common celiomesenteric trunk. Treatment consisted of resection followed by suture of the aneurysmal neck. This anatomic variation of the visceral arteries probably resulted from a defect in embryonic development suggesting that the aneurysm was congenital in origin. Other etiologies of aneurysms in this location are atherosclerosis, infection, inflammation, and arterial dystrophy. These lesions are almost always surgical indications requiring complete angiographic study of the visceral vasculature.

A 13-year-old child presented with a ruptured aneurysm of the trunk of the superior mesenteric artery most likely due to incipient fibromuscular disease localized in the adventitia. The aneurysm was resected and replaced by an autologous saphenous vein graft. The postoperative course was uneventful. Diagnosis and operative strategy are discussed.

The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve.