Background Little information is available regarding the incidence of aortic dissection or rupture in patients with a dilated ascending aorta after aortic valve replacement (AVR). The present clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with a dilated ascending aorta and to clarify those risk factors associated with the progression of a dilated ascending aorta or late aortic events. Methods and Results A total of 35 patients with a dilated ascending aorta at the time of AVR were enrolled. A dilated ascending aorta was defined as 40 mm or greater in diameter by preoperative computed tomography or operative findings. The baseline ascending aorta diameter ranged from 40 to 55 mm with a mean of 44.8±4.4 mm. There was a high frequency of bicuspid valve disease in patients with a dilated ascending aorta (57%). The mean follow-up interval was 8.1±3.5 years (range: 2.3-13). Aortic events occurred in 5 patients (aortic dissection in 1, rupture in 2, reoperation in 2) during the follow-up. One aortic dissection developed at a baseline aortic size of 42 mm, whereas 2 aortic ruptures occurred at baseline aortic sizes of 47 mm and 50 mm. There was no statistically significant univariate association between any of the patient clinical characteristics and late aortic events or ascending aortic progression. Conclusion Although the clinical course of patients with a dilated ascending aorta is unpredictable, aortic events may occur even in patients with a baseline aortic diameter of <50 mm. Therefore, preventive aortic surgery at the time of AVR should be considered to prevent aortic dissection or rupture in patients with an even slightly dilated ascending aorta with a diameter of 40 to 50 mm, unless the patient has a high operative risk or older age. (Circ J 2005; 69: 392 -396)

A floating thrombus in the ascending aorta was incidentally discovered in a patient with a descending thoracic aortic aneurysm and a history of alcoholism. The patient developed deep venous thrombosis and pulmonary embolism. However, he refused to undergo surgical excision of the thrombus in the ascending aorta. Therefore, treatment with rivaroxaban was administered for 3 months, and it completely dissolved the thrombus. Anticoagulant therapy may be an alternative treatment when surgery cannot be performed.

Complete implementation of simple multidisciplinary prevention measures as a bundle can greatly decrease the incidence of DSWI.

We performed emergency repeat surgery for aneurismal rupture due to graft perforation with mechanical stress of the Z stent in a kinking graft after frozen elephant trunk procedure. Graft kinking occurred due to cranial migration of the Z stent. It is important to prevent stent dislodgement in order to achieve long-term durability and reliability in the frozen elephant trunk procedure.

Although hypothermic circulatory arrest with antegrade selective cerebral perfusion is used for cerebral protection, optimal perfusion characteristics are still unclear. Between May 2006 and March 2008, 26 patients (mean age, 68.9 years; 14 males) underwent thoracic aortic repair with mild hypothermic circulatory arrest (34.3 degrees C +/- 1.9 degrees C) and antegrade selective cerebral perfusion (30 degrees C) for various indications including 16 acute type A aortic dissections. Mean cerebral perfusion rate was 21.1 +/- 4.3mL kg(-1) min(-1). Non-elective operations were carried out in 16 (61.5%) cases. Operative procedures were ascending aortic replacement in 16 patients, hemiarch replacement in 4, and total arch replacement in 6. Cardiopulmonary bypass time was 209 +/- 61 min, cardiac ischemic time was 141 +/- 45 min, cerebral perfusion time was 81 +/- 67 min, and lower body circulatory arrest time was 65 +/- 22 min. Mean rectal temperature drifted to 30.6 degrees C +/- 1.3 degrees C. There was 1 (3.8%) hospital death due to rupture of a residual descending thoracic aneurysm. One patient needed reexploration for bleeding, and 2 (7.7%) suffered permanent neurologic dysfunction. No postoperative spinal cord dysfunction was observed. Mild hypothermic circulatory arrest with antegrade selective cerebral perfusion could be performed safely in our patient population.