Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
Sun
200 papers
[Stanford Type A Acute Aortic Dissection Localized in the Aortic Root with Difficulty in a Definitive Diagnosis:Report of a Case].
Inoue E, Fukunaga N, Wakami T … +3 more , Shimoji A, Mori O, Tamura N
Kyobu Geka · 2026 Feb · PMID 42098014
A 39-year-old man presented with sudden onset of chest pain. The initial computed tomography angiography (CTA) showed a small amount of pericardial effusion and a soft tissue density localized in the aortic root, but no...
A 39-year-old man presented with sudden onset of chest pain. The initial computed tomography angiography (CTA) showed a small amount of pericardial effusion and a soft tissue density localized in the aortic root, but no intimal flap was identified in the aorta. Aortic dissection was suspected, and the patient was hospitalized at the intensive care unit for close monitoring. On the day of admission, repeated non-contrast computed tomography (CT) showed no significant changes in the aorta or pericardial effusion. Electrocardiography-gated, thin-slice contrast-enhanced CTA revealed an intimal flap localized at the sinotubular junction. Intraoperative transesophageal echocardiography showed a flap at the sinotubular junction. An ascending aorta was successfully replaced using a vascular graft. An aortic wall submitted to the pathology showed no evidence of connective tissue disorders. The postoperative course was uneventful.
[Papillary Muscle Rupture of Tricuspid Valve due to Leadless Pacemaker Implantation:Report of a Case].
Ukegawa K, Heima D, Suenaga E
Kyobu Geka · 2026 Feb · PMID 42098013
Leadless pacemaker (LP) is reported to have serious complications including cardiac tamponade and ventricular perforation during and after implantation. We report a case of severe tricuspid regurgitation (TR) caused by p...
Leadless pacemaker (LP) is reported to have serious complications including cardiac tamponade and ventricular perforation during and after implantation. We report a case of severe tricuspid regurgitation (TR) caused by papillary muscle rupture and hypoxia during LP re-implantation, which required surgical intervention. The patient was an 88-year-old man who had undergone LP implantation for complete atrioventricular block 2 years before. Due to the battery depletion, the additional LP was implanted. After the procedure, he developed persistent hypoxemia despite 9 l oxygen administration. He was hemodynamically stable. On the second postoperative day, a transthoracic echocardiogram revealed papillary muscle rupture of the tricuspid valve. A bubble test was performed, which revealed a right-toleft shunt through the patent foramen ovale (PFO). Tricuspid valve replacement and PFO closure were performed. The patient had a good postoperative course and was moved to cardiology department on postoperative day 14. We report this case with a review of the literature.
[Surgical Repair for Right Ventricular Perforation due to Leadless Pacemaker Implantation:Report of a Case].
Tano K, Ikebuchi M, Taki R … +1 more , Kimura Y
Kyobu Geka · 2026 Feb · PMID 42098012
An 87-years-old woman with a history of right mastectomy for breast cancer, currently undergoing chemotherapy for multiple metastasis via a central venous catheter placed in the left subclavian vein, presented with brady...
An 87-years-old woman with a history of right mastectomy for breast cancer, currently undergoing chemotherapy for multiple metastasis via a central venous catheter placed in the left subclavian vein, presented with bradycardia and dyspnea. Electrocardiogram revealed a 2:1 atrioventricular block. Implantation of a leadless pacemaker (LLPM) was planned for the patient. During implantation, right ventricular rupture occurred. Percutaneous cardiopulmonary support was initiated immediately. Subsequently, emergency surgery was performed. LLPM is considered a useful and safe device;however, serious complication, such as cardiac injury, have been reported in a small number of cases. Thorough risk assessment and preparation for complication, including cardiac surgery, may be life-saving.
[Mediastinal Metastasis of Mixed Hepatocellular Carcinoma Requiring Differential Diagnosis from Thymic Carcinoma].
Ida A, Matsumoto I, Yoshida S … +5 more , Fujii Y, Takayama T, Saito D, Tanaka N, Ikeda H
Kyobu Geka · 2026 Feb · PMID 42098011
A 71-year-old man underwent S8 segmentectomy for mixed hepatocellular carcinoma. The disease recurred three months postoperatively, prompting a right lobectomy of the remaining liver. Prior to the liver recurrence, three...
A 71-year-old man underwent S8 segmentectomy for mixed hepatocellular carcinoma. The disease recurred three months postoperatively, prompting a right lobectomy of the remaining liver. Prior to the liver recurrence, three nodules were identified in the anterior mediastinum. At the patient's request, dendritic cell vaccine therapy was administered following the recurrence. Two of the nodules decreased in size, while one nodule increased. Consequently, the patient was referred to our department for further evaluation. Differentiating between thymic carcinoma and mediastinal metastasis of hepatocellular carcinoma was challenging, leading to the decision to perform resection under the assumption of thymic carcinoma. A bilateral simultaneous thoracoscopic total thymectomy was conducted. Pathological examination revealed a poorly differentiated carcinoma with sarcomatoid morphology. Histologically similar lesions were observed in the preexisting liver tumor and lymph nodes, indicating metastasis from the mixed liver cancer. As of four and three months post-surgery, no recurrence has been noted. The patient will continue to receive immunotherapy and will be monitored closely. This case represents an extremely rare instance of mediastinal metastasis from mixed hepatocellular carcinoma. The prognosis for mediastinal metastasis of liver cancer is generally poor, underscoring the importance of vigilant follow-up.
[Lung Hernia at the Port Site After Thoracoscopic Resection for Lung Cancer].
Matsuda E
Kyobu Geka · 2026 Feb · PMID 42098010
A lung hernia is a rare condition in which the lung parenchyma protrudes beyond its normal thoracic cavity boundaries. Traditionally, lung hernias have been associated with chest trauma or congenital weakness of the ches...
A lung hernia is a rare condition in which the lung parenchyma protrudes beyond its normal thoracic cavity boundaries. Traditionally, lung hernias have been associated with chest trauma or congenital weakness of the chest wall. However, in recent years, there have been increasing reports of lung hernias developing at small surgical wound sites, such as those created by minimally invasive cardiac surgery or thoracoscopic procedures. Here, we present a case of a lung hernia that occurred at the port site following a thoracoscopic partial lung resection. The hernia was successfully repaired using a thoracoscopic approach with prosthetic reinforcement. We also discuss relevant literature on the etiology, diagnosis, and treatment of port-site lung hernias, highlighting the importance of careful surgical technique and appropriate wound closure to prevent this rare but significant complication.
[Staged Endovascular Aortic Repair for Thoracoabdominal and Aortic Arch Aneurysms].
Aratame A, Baba T, Sakaguchi M … +4 more , Sumii Y, Ieguchi R, Ikuta T, Nishimura S
Kyobu Geka · 2026 Feb · PMID 42098009
In recent years, endovascular aortic repair has become one of the standard treatments for aortic aneurysms. However, when the aneurysm involves the branches of the abdominal aorta or the aortic arch, the procedure become...
In recent years, endovascular aortic repair has become one of the standard treatments for aortic aneurysms. However, when the aneurysm involves the branches of the abdominal aorta or the aortic arch, the procedure becomes more complex and often necessitates surgical reconstruction of the involved branches. To address these challenges, the use of physician-modified endografts in which fenestrations are manually created by physicians has been reported. This approach, known as fenestrated and branched endovascular aortic repair, involves the placement of small-diameter bridging stent grafts through the fenestrations, and its utility has recently been highlighted. Herein, we report a case of successful fenestrated and branched endovascular aortic repair using physician-modified endografts in a patient with both thoracoabdominal and aortic arch aneurysms.
[Brachiocephalic Artery Graft Occlusion Caused by Compression from a Pseudoaneurysm at the Proximal Anastomosis After Total Arch Replacement].
Suzuki Y, Hayashi J, Kuroda Y … +8 more , Mizumoto M, Hirooka S, Nakai S, Kobayashi K, Akabane K, Ochiai T, Konaka M, Uchida T
Kyobu Geka · 2026 Feb · PMID 42098008
A 75-year-old man, who had undergone total arch replacement for a thoracic aortic aneurysm 4 years earlier, presented with transient left hemiplegia and right upper extremity weakness. Contrast-enhanced computed tomograp...
A 75-year-old man, who had undergone total arch replacement for a thoracic aortic aneurysm 4 years earlier, presented with transient left hemiplegia and right upper extremity weakness. Contrast-enhanced computed tomography (CT) revealed a large pseudoaneurysm at the proximal anastomosis of the ascending aortic graft, compressing and occluding the brachiocephalic graft. Surgical resection of the pseudoaneurysm and ascending aortic graft replacement with a 1-branched graft were performed. Cardiopulmonary bypass was established via peripheral vessels prior to re-median sternotomy. Thrombi were removed from the brachiocephalic graft, followed by replacement of the ascending aorta with a branched artificial graft for the brachiocephalic artery. The patient was discharged without complications. We report a rare case of transient hemiplegia due to brachiocephalic graft compression by a pseudoaneurysm.
[Surgical Outcomes of Stanford Type A Acute Aortic Dissection in the Patients Aged 85 Years or Above].
Mizuta S, Sato S, Nakajima S … +3 more , Osanai A, Yamamoto J, Sawazaki M
Kyobu Geka · 2026 Feb · PMID 42098007
This retrospective analysis assessed surgical outcomes in patients aged 85 years or older who underwent emergency open thoracic aortic surgery for acute Stanford type A dissection between 2012 and 2025. Among 352 patient...
This retrospective analysis assessed surgical outcomes in patients aged 85 years or older who underwent emergency open thoracic aortic surgery for acute Stanford type A dissection between 2012 and 2025. Among 352 patients, 27 were classified as very elderly. Compared to younger cohorts, this group exhibited a higher prevalence of DeBakey typeⅡ dissection and thrombotic false lumen occlusion, with a lower incidence of malperfusion. The majority underwent hemiarch replacement. In-hospital mortality was low at 3.7%, and postoperative complication rates were comparable to the control group. Due to slow functional recovery, the proportion of patients discharged directly home was reduced. Despite a limited follow-up rate, three-year outcomes-including overall survival (77.4%), freedom from aortic-related mortality( 91.7%), and distal reoperation-free survival( 91.7%)-were favorable. The implementation of advanced techniques, such as staged thoracic endovascular aortic repair (TEVAR) and zone 0 TEVAR utilizing the retrograde in-situ branched stent graft (RIBS) method, effectively minimized the necessity for reintervention via thoracotomy or laparotomy. These findings underscore the clinical viability of surgical intervention in selected very elderly patients, notwithstanding inherent limitations such as referral bias and incomplete longitudinal data.
[Pneumothorax Due to Formation of Pneumatocele During Treatment of Eosinophilic Pneumonia:Report of a Case].
Ohba D, Matsutake H, Tomimitsu S … +1 more , Hayashi A
Kyobu Geka · 2026 Jan · PMID 42098006
The patient was a 79-year-old male, During the course of treatment for eosinophilic pneumonia, he developed left-sided pneumothorax, Despite the implementation of thoracic drainage, air leakage persisted, Computed tomogr...
The patient was a 79-year-old male, During the course of treatment for eosinophilic pneumonia, he developed left-sided pneumothorax, Despite the implementation of thoracic drainage, air leakage persisted, Computed tomography(CT)revealed a left pneumatocele, which was deemed to be the underlying cause of pneumothorax, Consequently, thoracoscopy-assisted operation was performed, Six months postoperatively, no recurrence of pneumothorax was observed, and the pneumatocele had significantly decreased in size, Surgical intervention for refractory pneumothorax associated with pneumatocele is therefore considered to be an appropriate and effective therapeutic approach.
[Should Aortic Root Intervention Be Performed in All Cases of Stanford Type A Acute Aortic Dissection?].
Niizaki S, Inafuku H, Miyaguni S … +9 more , Toyama M, Miyaishi K, Higa S, Ando M, Maeda T, Kise Y, Nakaema M, Nagano T, Furukawa K
Kyobu Geka · 2026 Jan · PMID 42098005
To evaluate the outcomes of aortic root preservation in patients undergoing surgery for Stanford type A acute aortic dissection(AAAD)without concomitant root replacement, Methods:We retrospectively analyzed 79 consecutiv...
To evaluate the outcomes of aortic root preservation in patients undergoing surgery for Stanford type A acute aortic dissection(AAAD)without concomitant root replacement, Methods:We retrospectively analyzed 79 consecutive AAAD patients(mean age 68±13 years;52% male)who underwent supra-coronary repair(SCR)between January 2012 and December 2022, excluding those requiring Bentall or valve-sparing root replacement(VSRR), Preoperative root involvement, aortic regurgitation(AR), surgical procedures, early outcomes, long-term aortic root dilation, AR progression, and reoperation rates were assessed mean follow-up of 5.7±3.4 years, Results:Preoperative root dissection was present in 66%, with moderate or greater AR in 16%, Early mortality was low(30-day mortality 2.5%, in-hospital mortality 3.8%), Long-term follow-up, mean aortic root enlargement was minimal(0.28 mm/year), with no cases of progression to moderate or severe AR, Reoperation occurred in 3.8%(3 cases), primarily due to pseudoaneurysm or new entry formation at the proximal anastomosis, Conclusions:Aortic root preservation with careful proximal anastomosis placement provided excellent early and mid-term outcomes, with minimal late aortic root dilation or AR progression.
[Early Outcomes of Total Arch Replacement Using an Integrated Frozen Elephant Trunk for Acute Type A Aortic Dissection].
Shijo T, Seike Y, Inoue Y … +3 more , Koda Y, Yoshida K, Matsuda H
Kyobu Geka · 2026 Jan · PMID 42098004
In Japan, surgical repair for Stanford type A acute aortic dissection(AAAD)has been increasingly performed, accompanied by gradual improvement in early outcomes, While ascending or hemiarch replacement remains the mainst...
In Japan, surgical repair for Stanford type A acute aortic dissection(AAAD)has been increasingly performed, accompanied by gradual improvement in early outcomes, While ascending or hemiarch replacement remains the mainstream strategy, late aneurysmal dilatation of the residual dissected aorta is still a concern, The frozen elephant trunk(FET)technique, which facilitates aortic remodeling, has been increasingly adopted in AAAD surgery, Since the introduction of a domestic integrated four-branched FET device in late 2022, expectations have risen for improved procedural safety and simplicity, We report our early institutional outcomes of total arch replacement(TAR)using the integrated four-branched FET, Methods:Among 211 AAAD cases treated between December 2022 and April 2025, 110 underwent TAR with FET, of which the first 50 consecutive cases using the integrated four-branched FET[FROZENIX 4 Branched(FZX4B)]were retrospectively analyzed, The primary endpoint was early postoperative outcome, including mortality and spinal cord ischemia(SCI), Secondary endpoints included midterm survival, freedom from aortic events, and morphologic changes in the descending aorta, Results:The median age was 65 years[interquartile range(IQR):56~74], and 29 patients(58%)were male, The median operative time was 372 minutes(IQR:315~506), and the hypothermic circulatory arrest time was 42 minutes(IQR:38~50), The distal anastomosis was performed in zone 3 in 84% of cases, The FZX4B diameter most used was 25 mm(60%), In-hospital mortality was 4%, SCI occurred in one patient(2%), Two patients(4%)required additional thoracic endovascular aortic repair(TEVAR)for FET stenosis, The median follow-up was 248 days(IQR:165~472), Overall survival was 93% at 1 year and 86% at 2 years, and freedom from aortic events was 87% and 81% at 1 and 2 years, respectively, The FET distal level was mainly at Th6(62%), The aortic diameter at the distal edge of the FET decreased from 30 mm(IQR:28~33)preoperatively to 27 mm(25~31)at 1 year(p<0.001), The FET tip diameter correlated with the preoperative outer diameter at the anastomotic site(r=0.66, p<0.001), Conclusions:Although FET-related stenosis should be recognized as a potential procedural risk, TAR using the integrated FET for AAAD achieved acceptable early outcomes, A larger comparative study with conventional repair is warranted to elucidate its statistical impact.
[Antegrade Cerebral Perfusion in Stanford Type A Acute Aortic Dissection with Cerebral Malperfusion].
Uehara K, Inada M, Hayashi M … +5 more , Shirakami T, Takehara M, Hara H, Hamuro M, Tsuji T
Kyobu Geka · 2026 Jan · PMID 42098003
Stanford type A acute aortic dissection(AAAD)is a life-threatening cardiovascular emergency, Early surgical repair is essential to prevent fatal outcomes, According to the 2023 Annual Report of the Japanese Association f...
Stanford type A acute aortic dissection(AAAD)is a life-threatening cardiovascular emergency, Early surgical repair is essential to prevent fatal outcomes, According to the 2023 Annual Report of the Japanese Association for Thoracic Surgery, AAAD cases increased by 4.4% in 2022, with an in-hospital mortality of 10% for AAAD, Although surgical outcomes have improved with advances in cerebral protection techniques, patients with cerebral malperfusion remain at high risk of poor neurological outcomes and mortality, with postoperative death rates reported between 15~30%, Antegrade selective cerebral perfusion(ASCP)is the standard method for cerebral protection during circulatory arrest, However, in AAAD patients with carotid artery occlusion or severe stenosis, conventional ASCP may result in uneven cerebral perfusion, risking ischemia in the affected hemisphere, To address this, we introduced a two-roller pump technique, in which each carotid artery(affected and non-affected)is perfused independently using separate ASCP circuits, Cerebral perfusion was monitored with transcranial Doppler and regional cerebral oxygen saturation(rSO2), The common carotid artery(CCA)was exposed via median sternotomy without additional neck incision, and direct cannulation was performed to establish targeted perfusion, The two-roller pump technique allowed independent regulation of flow and pressure for each carotid artery, Intraoperative monitoring confirmed stable perfusion to all cerebral vessels, including the previously occluded CCA, The two-pump technique prevented uneven blood distribution, reduced cerebral ischemia time, and was associated with improved immediate neurological outcomes, It enables immediate, controlled reperfusion of the affected hemisphere, potentially improving neurological outcomes, and offers a practical option for urgent surgical management of severe cerebral malperfusion in AAAD.
[Open Superior Mesenteric Artery Bypass for Stanford Type A Acute Aortic Dissection with Mesenteric Malperfusion].
Inoue T, Hashino A, Tsuji Y … +2 more , Masuyama S, Ichihara T
Kyobu Geka · 2026 Jan · PMID 42098002
The optimal management of Stanford type A acute aortic dissection with mesenteric malperfusion(AMI)is controversial, Our strategy of AMI is open superior mesenteric artery(SMA)bypass prior to aortic repair, if we suspect...
The optimal management of Stanford type A acute aortic dissection with mesenteric malperfusion(AMI)is controversial, Our strategy of AMI is open superior mesenteric artery(SMA)bypass prior to aortic repair, if we suspect AMI on computed tomography(CT)scan, whatever other findings might be or not, The need of treatment of mesenteric malperfusion prior to aortic repair is not always concerned with digestive symptom, lactate, intraoperative finding, The mortality was 15.8%, which was an allowable result, Our strategy might be proper at instances of, allowable time for management of open SMA bypass, unnecessarily of endovascular treatment, confirming an enteric property and ability to respond to various rapid hemodynamic changes.
[Perfusion-first Strategy for Acute Aortic Dissection with Superior Mesenteric Artery Malperfusion].
Sumi K, Iwakura T, Ono M … +3 more , Yun R, Marui A, Nakahara Y
Kyobu Geka · 2026 Jan · PMID 42098001
Superior mesenteric artery(SMA)malperfusion in acute aortic dissection(AAD)is a highly lethal complication with no established treatment strategy, We introduced a "perfusion-first strategy," prioritizing SMA revasculariz...
Superior mesenteric artery(SMA)malperfusion in acute aortic dissection(AAD)is a highly lethal complication with no established treatment strategy, We introduced a "perfusion-first strategy," prioritizing SMA revascularization via laparotomy for patients with preoperative computed tomography(CT)evidence of SMA obstruction, Methods:Our strategy involves an initial laparotomy for direct visual assessment of intestinal ischemia, After identifying the occluded segment of the SMA with vascular ultrasound, a bypass is created to the distal SMA using a heparin-coated expanded polytetrafluoroethylene(ePTFE)graft, Initial reperfusion is established via a side branch of the extracorporeal circulation circuit from the femoral artery, This is followed by a median sternotomy for central aortic repair, Finally, the SMA bypass graft is anastomosed to the central aortic graft to complete the revascularization, Results:Between April 2024 and May 2025, this strategy was performed on six consecutive patients, All six patients survived to discharge without requiring bowel resection, Postoperative CT scans confirmed the patency of all SMA bypass grafts, Conclusion:Our perfusion-first strategy, a single-stage hybrid approach, was shown to be a safe and effective treatment for AAD complicated by SMA malperfusion in this initial series, This approach allows for accurate assessment of intestinal ischemia and reliable revascularization while avoiding the risks of delaying central aortic repair, It represents a promising new therapeutic option for this fatal condition.
[Treatment for Stanford Type A Acute Aortic Dissection with Malperfusion].
Ohashi Y, Washiyama N, Okamoto K
Kyobu Geka · 2026 Jan · PMID 42098000
For malperfusion in Stanford type A acute aortic dissection, we resolve static intestinal ischemia prior to central repair, rapidly unload the left ventricle for myocardial ischemia, and resolve cerebral or lower limb is...
For malperfusion in Stanford type A acute aortic dissection, we resolve static intestinal ischemia prior to central repair, rapidly unload the left ventricle for myocardial ischemia, and resolve cerebral or lower limb ischemia using cardiopulmonary bypass, We evaluated the validity of this strategy, Subjects:Among 165 emergency surgeries for Stanford type A acute aortic dissection performed since 2009, malperfusion was present in 52 cases(brain 23/heart 9/kidney 8/intestine 4/lower extremity 21)[overlap present], Results:Mean age was 63±12 years;29 patients were male;1 case had Marfan syndrome, The median time from onset to extracorporeal circulation initiation was 5 hours(range 2~51), Postoperative extracorporeal membrane oxygenation(ECMO)was used in 5 cases;in-hospital mortality occurred in 8 cases;and 8 cases had residual sequelae of cerebral infarction(controlled reperfusion in 1), Conclusion:Strategies for treating coronary malperfusion require improvement, In cerebral malperfusion, controlled reperfusion may be effective, with fewer residual sequelae in treated cases.
[Postoperative Outcomes of Stanford Type A Acute Aortic Dissection with Preoperative Cardiac Arrest].
Hishikawa T, Hosoba S, Ohashi T
Kyobu Geka · 2026 Jan · PMID 42097999
This single-center retrospective study evaluated postoperative outcomes in Stanford type A acute aortic dissection(AAAD)patients presenting with preoperative cardiopulmonary arrest(CPA)between January 2021 and May 2025,...
This single-center retrospective study evaluated postoperative outcomes in Stanford type A acute aortic dissection(AAAD)patients presenting with preoperative cardiopulmonary arrest(CPA)between January 2021 and May 2025, Methods:Among 390 consecutive AAAD cases undergoing emergency surgery, 18(4.6%)presented with CPA, We assessed 30-day mortality, return of spontaneous circulation(ROSC), and use of preoperative veno-arterial extracorporeal membrane oxygenation(VA-ECMO), Results:The 30-day mortality was 72.2%, ROSC occurred in 4 cases(22.2%), and ROSC-positive patients had significantly lower mortality(p=0.022), Preoperative VA-ECMO was used in 7 cases(38.9%), none of whom survived(p=0.013), Conclusions:AAAD with preoperative CPA carries extremely high mortality, but patients achieving ROSC may benefit from urgent surgical intervention, VA-ECMO appears to confer no survival advantage, Early survivors often achieve favorable long-term outcomes, in line with prior literature.
[Conservative Management of Stanford Type A Acute Aortic Dissection].
Okugi S, Nakayama T, Ito Y … +9 more , Hayashi Y, Kuroda M, Yasumoto Y, Niitsuma K, Konaka M, Niitsuma K, Higuma Y, Tamagawa K, Nakamura Y
Kyobu Geka · 2026 Jan · PMID 42097998
Emergency surgery remains the standard of treatment for acute Stanford type A aortic dissection(AAAD), Nevertheless, in real-world practice a minority of patients do not undergo immediate surgery due to clinical constrai...
Emergency surgery remains the standard of treatment for acute Stanford type A aortic dissection(AAAD), Nevertheless, in real-world practice a minority of patients do not undergo immediate surgery due to clinical constraints, We sought to delineate the outcomes and practical limits of such nonoperative management under strict protocols, Methods:Of 668 consecutive AAAD patients(Jan 2019~Mar 2025), we retrospectively analyzed 100 who did not receive immediate surgery after excluding 13 with cardiopulmonary arrest, Patients were stratified into a criteria group(C;thrombosed/occluded false lumen in the ascending aorta with ascending diameter≦50 mm and false lumen≦11 mm;n=59)and a non-criteria group(NC;outside these criteria;n=41), The primary endpoint was in-hospital mortality;secondary endpoints included aortic-related death, post-discharge events, and associations with imaging/clinical indices, Results:NC patients were older and more often female, with larger ascending aortas and false lumens(both p<0.001), In-hospital mortality was 31.7% in NC vs 1.7% in C(p<0.001);48-hour mortality in NC was 12.2%, and aortic-related deaths clustered within 4.56±2.99 days(range 1~12), Seven patients underwent delayed surgery for imaging changes;all survived, Discharge alive occurred in 98.3%(C)and 68.3%(NC), Among those discharged alive, survival up to 2 years was similar, Low body mass index(BMI)and hemodynamically significant tamponade were associated with in-hospital death in NC, Conclusions:These data support surgery as the default strategy for AAAD, When surgery is unavoidably deferred, conservative management should be considered only in strictly selected patients, with early hemodynamic/computed tomography(CT)triggers for conversion, In NC patients, the first hospital week is the highest-risk window, and low BMI or tamponade should prompt heightened vigilance and a low threshold for intervention.
[Surgical Strategies for DeBakey TypeⅢ Retrograde Stanford Type A Dissection].
Takinami G, Midorikawa H, Nomura C … +6 more , Kurihara Y, Hotta A, Ueno K, Satokawa H, Kanno M, Takano T
Kyobu Geka · 2026 Jan · PMID 42097997
This study aimed to evaluate the outcomes of surgical strategies for DeBakey typeⅢ retrograde Stanford type A dissection(RAAD), Methods:We retrospectively analyzed 46 patients with RAAD treated at our hospital, Surgical...
This study aimed to evaluate the outcomes of surgical strategies for DeBakey typeⅢ retrograde Stanford type A dissection(RAAD), Methods:We retrospectively analyzed 46 patients with RAAD treated at our hospital, Surgical procedures included ascending aorta repair(AAR, n=20), total arch replacement(TAR, n=17), and thoracic endovascular aortic repair(TEVAR, n=9), Early and late outcomes were assessed, Results:The AAR group had shorter operative times but a higher incidence of long-term aortic-related mortality, The TAR group showed no long-term aortic-related mortality but experienced early complications such as spinal ischemia, In the TEVAR group, several patients required early reintervention, Conclusion:An individualized surgical strategy is essential for the management of RAAD, While secure entry closure may improve long-term outcomes, each approach carries specific risks, AAR and TEVAR remain appropriate options for selected cases.
[Proximal Stepwise Anastomosis in Stanford Type A Acute Aortic Dissection Surgery].
Kira H, Shimamoto T, Takeda T … +8 more , Kawatou M, Nishio H, Osada H, Takatoku K, Fujimoto H, Mouri K, Kanno K, Minatoya K
Kyobu Geka · 2026 Jan · PMID 42097996
Bleeding from the proximal anastomosis site during Stanford type A acute aortic dissection(AAAD)surgery can be a fatal problem, to avoid this, we use the proximal stepwise(PS)method for proximal anastomosis at our instit...
Bleeding from the proximal anastomosis site during Stanford type A acute aortic dissection(AAAD)surgery can be a fatal problem, to avoid this, we use the proximal stepwise(PS)method for proximal anastomosis at our institution, and we examined its usefulness and results, we retrospectively analyzed 53 emergency surgeries(22 males, mean age 72.4±9.3 years)performed between October 2016 and December 2024, there were 39 ascending replacements and 12 total ascending replacements, there were no cases of difficult hemostasis during proximal anastomosis, the in-hospital mortality rate was 3.7%(2 cases), during the observation period of 1,245.7±924.6 days, there were no aortic events or aortic-related deaths related to the proximal anastomosis, and the 3-year survival rate was 93.4%, the PS method is useful as a proximal anastomosis technique in AAAD surgery and may contribute to a favorable long-term prognosis by avoiding late complications.
[Mediastinal Lymphangioma:Report of a Case].
Akiba Y, Iwata Y, Ito T … +1 more , Okasaka T
Kyobu Geka · 2025 Dec · PMID 41361987
A 76-year-old woman was admitted to our hospital with an abnormal shadow on a chest computed tomography (CT) scan. A chest magnetic resonance imaging (MRI) revealed an anterior mediastinal cyst of 7 cm in diameter with a...
A 76-year-old woman was admitted to our hospital with an abnormal shadow on a chest computed tomography (CT) scan. A chest magnetic resonance imaging (MRI) revealed an anterior mediastinal cyst of 7 cm in diameter with an internal septal-like structure, leading to the differential diagnosis of mediastinal lymphangioma. After administering milk, we performed video-assisted thoracoscopic excision of the lesion. After excision of the cyst, no cloudy fluid leakage was observed from the excised margin. Immunohistochemical analysis showed that the cells lining the cyst walls were stained positive for D2-40, therefore the lesion was diagnosed as a mediastinal lymphangioma. Mediastinal lymphangioma is rare, and postoperative lymphatic leakage is common in surgical cases. In this case, mediastinal lymphangioma was selected as the differential diagnosis based on the preoperative MRI findings, and complete resection was achieved without complications by administering milk before surgery.
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