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Nafamostat mesilate, with which we can reduce anticoagulation values of patient to a safe level without losing the ECMO anticoagulation values is expected to be useful as a regional anticoagulant in patients with bleeding complications or a high risk of bleeding during ECMO.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp rug-eluting stents (DES) have dramatically reduced the in-stent restenosis (ISR) rates by suppressing neo-intimal hyperplasia. 1,2 However, the complications of DES and safety concerns such as stent thrombosis (ST) have been widely publicized. 3,4 Editorial p 779Another less common complication of DES is coronary artery aneurysm (CAA). CAA is a rare complication after percutaneous coronary intervention (PCI) with the reported rates ranging from 0.3% to 6.0%, and most aneurysms are pseudoaneurysms rather than true aneurysms. 5-8In the DES era, several case reports have been published on the development of CAA after DES implantation 9-12 and 1 reported their incidence to be 1.25%. 13 However, there continues to be scant clinical data on the factors leading to this uncommon complication of DES implantation.The aim of this study is to assess the risk factors and clinical outcomes for CAA that developed after DES implantation by 2 serial angiographic follow-up. Background: There is only limited data on coronary artery aneurysms (CAA) after drug-eluting stent (DES) implantation. Methods Study Population

BackgroundThe feasibility of single-port video-assisted thoracic surgery (SPVATS) for primary lung cancer is not well understood. In this study, we compared SP and multi-port (MP) VATS for the surgical treatment of patients with primary lung cancer.MethodsSurgical treatment was performed in 181 patients with primary lung cancer at Inje University Haeundae Paik Hospital between June 2012 and December 2015. A propensity-matched analysis was used to compare the postoperative outcomes and to evaluate the comparative feasibility and safety of SPVATS and MPVATS.ResultsThere were 37 patients in the SPVATS group and 67 patients in the MPVATS group. Propensity matching produced 32 pairs. The operation time (210 minutes versus 200 minutes, p=0.11), volume of the estimated blood loss (170 mL versus 160 mL, p=0.19), duration of chest tube drainage (5 days versus 6 days, p=0.66), and length of hospital stay (9 days versus 10 days, p=0.89) were similar between the 2 groups.ConclusionIn our study, SPVATS for primary lung cancer was safe and feasible in well selected patients. A prospective, randomized study with a large group and long-term follow-up is necessary to evaluate the clinical feasibility and the advantages of SPVATS for primary lung cancer.

Although intraoperative monitoring of MEP has been shown to be effective in detecting cord ischemia during DTAA or TAAA surgery, it is not definitive and cannot predict all neurologic deficits. Other postoperative preventive strategies such as CSF drainage and maintaining a high blood pressure are important to prevent paraplegia.

Anomalous origin of the right coronary artery from the left coronary sinus is rare but potentially dangerous if any ischemic signs are present. Multiple therapeutic options were advocated so far. We experienced three different situations and surgical approaches to these anomalies, and reviewed retrospectively. For the first case, we made a neo-ostium on the right sinus of Valsalva and anastomosed with the right coronary artery after arteriotomy. For the second and third cases, we applied coronary artery bypasses emergently: patient 2 the gastroepiploic artery during off-pump coronary artery bypass and patient 3 the left internal thoracic artery during surgery for acute aortic dissection. For the better outcomes, it is important to understand anatomic and hemodynamic characteristics of each patient and select the surgical options considering each characteristic.

Papillary muscle (PM) rupture is an emergency surgical condition that may occur after acute myocardial infarction. In patients with compete rupture of the PM, mitral valve replacement is preferred or recommended generally because of unstable vital signs or technical difficulties with successful repair, as compared with patients with partial PM rupture. This case report describes the successful repair of a complete anterolateral PM rupture by using the single PM formation technique with subsequent ring annuloplasty.

Background Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. Methods This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. Results Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was 2.1±1.8 days and 5.4±3.6 days, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. Conclusion Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.