The 44-year-old female was admitted to the hospital due to the severe pain in the right arm. Doppler ultrasonography revealed occlusion of the right brachial and right common carotid artery. Subsequently, computed tomography (CT) scan confirmed the occlusion of the right brachial and common carotid artery, and revealed pedunculated floating ascending aortic mass. The floating thrombus in ascending aorta is a rare and potentially very dangerous pathological condition. Although aetiology is still unclear, ascending aorta atherosclerosis and coagulation disorder are probably the most common reasons. Hypercoagulable state, high level of antiphospholipid antibody and factor VIII are closely relating with vascular thrombosis. Since the outbreak of the coronavirus-2019 (COVID-19) pandemic, increasing evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might produce hypercoagulable state with subsequent thrombosis and thromboembolism. The infection elevated the level of factor VIII in the blood and, consequently, increased the risk of adverse thrombotic and embolic events.Additionally, endothelial inflammation and injury mediated by coronavirus represent an additional risk factor.According to literature, this is the first case of the floating ascending aorta thrombus in the patient with SARS-CoV-2 infection. The thrombus' fragile structure and high blood velocity through the ascending aorta significantly increases cerebral and peripheral embolization incidence, with potentially fatal outcome. Due to frequent adverse events, urgent surgical extirpation is the best therapy option. We presented successfully surgically treated giant floating thrombus in the ascending aorta and aortic arch in a patient with recent SARS-CoV-2 infection with acute right arm ischemia due to embolic complication.

Introduction: Technical improvement and new operative strategies significantly influence survival and outcomes after the treatment of acute aortic dissection type A (AADA). However, postoperative complications and particularly neurological dysfunctions (ND) are still very common. Aim: To identify preoperative and intraoperative factors as well as immediate postoperative conditions with an influence on the occurrence of neurological complications of surgical treatment of AADA and accordingly take action to reduce them. Material and methods: Between January 2013 and December 2018, 240 patients with AADA were emergently surgically treated. All patients were divided into two groups: group I-patients with postoperative ND (subgroup Ia-patients with mild, transient ND and Ib-patients with severe ND) and group II-patients without ND. Results: Neurological damage after the operation was registered in 87 (39.5%) patients. Thirty (13.6%) patients had mild ND and 57 (25.9%) severe. Presence of preoperative neurological deficit, reduced level of consciousness, supra-aortic vessel dissection, hemodynamic instability, and excessive postoperative bleeding with hypotension are factors with a highly statistically significant association with the occurrence of severe ND. Neurological complications were not identified in 66.7% of patients who were axillary cannulated versus 55.9% of patients cannulated in the other way but the difference did not reach statistical significance (p = 0.1099). Conclusions: Advanced neuroprotective strategies during surgical treatment of AADA are associated with favorable neurological outcomes, especially in a group of patients with identified risk factors for ND.

Background and Objectives: The saphenous vein is one of the most common used grafts (SVG) for surgical revascularization. The mechanism of the SVGs occlusion is still unknown. Surgical preparation techniques have an important role in the early and late graft occlusion. Our study analyzed the influence of the three different surgical techniques on the histological and immunohistochemical characteristics of the vein grafts. Methods: Between June 2019 and December 2020, 83 patients who underwent surgical revascularization were prospectively randomly assigned to one of the three groups, according to saphenous vein graft harvesting (conventional (CVH), no-touch (NT) and endoscopic (EVH)) technique. The vein graft samples were sent on the histological (hematoxylin-eosin staining) and immunohistochemical (CD31, Factor VIII, Caveolin and eNOS) examinations. Results: The CVH, NT, and EVH groups included 27 patients (mean age 67.66 ± 5.6), 31 patients (mean age 66.5 ± 7.4) and 25 patients (mean age 66 ± 5.5), respectively. Hematoxylin-eosin staining revealed a lower grade of microstructural vein damage in the NT group (2, IQR 1-2) in comparison with CVH and EVH (3, IQR 2-4), (4, IQR 2-4) respectively (p < 0.001). Immunohistochemical examination revealed a high grade of staining in the NT group compared to the CVH and EVH group (CD 31 antibody p = 0.02, FVIII, p < 0.001, Caveolin, p = 0.001, and eNOS, p = 0.003). Conclusion: The best preservation of the structural vein integrity was in the NT group, while the lowest rate of leg wound complication was in the EVH group. These facts increase the interest in developing and implementing the endoscopic no-touch technique.

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The left ventricular aneurysm is a pathological condition defined as an akinetic or dyskinetic area of the left ventricle (LV) wall associated with reduced ejection fraction. The most common surgical technique to reconstruct a left ventricular aneurysm is endoventricular patch plasty (Dor procedure). In this case, endoventricular reconstruction of the left ventricular aneurysm using a double-layer extracellular matrix was performed.

Introduction/Objective. Even with the current treatment mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could have influence on it. Methods. The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). Patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results. The study included 246 patients, of an average 57.54+/-12.88 years of age and mostly male sex (74%). Early postoperative mortality occurred in 17% of patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative complications. Postoperative complications started occurring after ?33.5 minutes hypothermic cardiac arrest and ?67.5 minutes cross clamp time. Having more postoperative complications (p = 0.034) increased, while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion. The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra- and postoperative factors can impact patient survival.