New-onset antegrade Stanford type B aortic dissection (TBAD) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is rare. The extension of aortic dissection leads to various symptoms and affects the stent graft. Moreover, various symptoms may arise owing to a stent graft being present. We describe 2 cases of complicated acute TBAD occurring after EVAR, which were ultimately fatal. The case in which rupture occurred could not be treated and the patient died. In another case with bilateral lower extremity malperfusion caused by collapse and occlusion of the endograft, extra-anatomical bypass was performed. Although the collapsed endograft gradually re-expanded, the patient ultimately died because of multiorgan failure. We have reviewed the literature and analyzed the treatment of complicated TBAD after EVAR.

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Transcatheter aortic valve implantation (TAVI) is less invasive compared to surgical aortic valve replacement and is indicated for patients with symptomatic aortic valve stenosis (AS) at high operative risk. The incidence of cerebral embolism following the procedure is reported to be over 70% as evaluated by diffusion-weighted magnetic response imaging, which includes silent stroke [1]. The large Transcatheter Valve Therapies registry showed that the composite outcome of mortality and stroke occurs in 26.0% of patients over 1 year of follow-up [2]. Various devices that are designed to prevent emboli into the cerebral arteries need to be inserted before navigating through the aortic arch. However, inserting such protective devices into a diseased aorta is regarded as a risk factor for stroke.Here, we report a case of TAVI in a patient with an extremely shaggy and porcelain aorta and congestive heart failure using a modified isolation technique with cardiopulmonary bypass (CPB). The patient consented to the publication of this report. Case reportAn 89-year-old man was seen by a family physician for complaints of nocturnal dyspnea. He had a history of brain

A 49-year-old man, who had undergone total arch replacement (TAR) with frozen elephant trunk (FET) technique for type A acute aortic dissection, was subsequently transferred to our hospital for uncontrollable infection. Since multiple blood cultures were positive for Candida parapsilosis and transesophageal echocardiography revealed vegetation attached to the FET, he was diagnosed with a graft infection. In addition, on the 18-fluorodeoxyglucose positron emission tomography scans, high uptake lesions were found around the quadrifurcated graft as well as the FET. Therefore, an extensive TAR through anterolateral thoracotomy with partial sternotomy was performed to remove all infected prothesis. Consequently, the patient completely recovered.

Although virtual reality (VR) techniques that enable visualizing a patient’s anatomy stereoscopically have been developed recently, these techniques are still scarcely used in clinical settings, and their benefits remain uncertain. Herein, we demonstrate how VR preoperative planning facilitated the efficiency of a complex surgical procedure. A 53-year-old male was diagnosed as type 0 bicuspid aortic stenosis. To take haemodynamical advantage and to lower valve-related reoperation risks, an aortic valve reconstruction was scheduled; however, anatomical tri-leaflet neocuspidalization for type 0 bicuspid aortic root is particularly challenging. To optimize the procedure, VR preoperative planning was applied to create a blueprint of the aortic root rearrangement and suture line design. This allowed for a competent aortic valve to be reconstructed speedily, resulting in an excellent postoperative course.