PurposeWe retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease.Materials and MethodsBetween March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%).ResultsThe early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0±81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively.ConclusionIn our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients.

Electroantennogram (EAG) recordings were made from the plaque organ receptors of the rice brown plant hopper, Nilaparvata lugens (Stål). The receptors of the distal plaque organ of both male and female hoppers responded to the air from above chopped rice plants, and those of females gave a larger response. Female hoppers, tested with 27 plant volatiles, gave dose-related responses to 16 of the compounds, including a range of green leaf volatiles. The aliphatic aldehydes hexanal and (E)-2-hexenal elicited a larger response than a range of green leaf alcohols. Of the remaining compounds, acetophenone, benzaldehyde, ethyl and methyl benzoate, and amyl and isoamyl acetate were among the most effective in eliciting responses. Receptor recovery times showed some variation between compounds. A comparison of the dose-related response of 16 compounds in paraffin oil and in pentane showed that considerably larger responses were recorded when the highly volatile solvent pentane was used.

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VV-ECMO support can be a feasible rescue strategy for adult patients who develop refractory ARDS after a cardiac surgery. Additionally, the RESP score seems a valuable prognostic tool for post-ECMO survival outcome in this patient population as well.

Objective: Although hybrid arch repair has gained widespread application as an alternative option for high-risk patients, concerns about its long-term durability remain an important issue. The aim of this study was to investigate late complications after hybrid arch repair.Methods: From January 2002 to December 2017, hybrid arch repair was performed in 65 patients with aortic arch disease (median age, 66.1 years; range, 41-86 years). Hybrid arch repair was defined as debranching involving at least one supraaortic vessel bypass and simultaneous or staged endovascular thoracic stent grafting. We retrospectively analyzed late complications including reintervention, open conversion, and aortic-related death. The median follow-up period was 60.1 months (range, 1-170 months).Results: The in-hospital mortality rate was 6% (4/65). Except for early death (n ¼ 4) and early open conversion (n ¼ 2), late complications were observed in 25 patients (25/59 [42%]). The median time interval between the initial procedure and late complication was 36.6 months (range, 1-92 months). Late complications included delayed type I endoleak (n ¼ 8), distal stent-induced new entry (n ¼ 3), stent migration (n ¼ 3), retrograde type A dissection (n ¼ 2), aortopulmonary fistula (n ¼ 2), aortoesophageal fistula (n ¼ 1), stent fracture (n ¼ 1), infection (n ¼ 1), and sudden death (n ¼ 4). Six of these patients (10%) underwent late open conversion. The overall survival rates at 3 years and 6 years were 71.1 6 7.4% and 57.2 6 11.3%, respectively. The aortic event-free rates at 3 years and 6 years were 52.1 6 7.3% and 39.4 6 10.3%, respectively.Conclusions: Late complications in hybrid arch repair occurred in a substantial proportion of patients during midterm follow-up. Regardless of zone type, the incidence of late complications was relatively high. This study suggests that timely reintervention and open conversion are important for rescuing patients, but repeated reinterventions and conservative strategies are not recommended. Aggressive management and life-long surveillance after hybrid arch repair are mandatory for better outcomes. (J Vasc Surg 2019;70:1023-30.)

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp s the indications for renin-angiotensin system (RAS) inhibitors expand for secondary prevention in patients with coronary artery disease, 1 an increasing number of patients presenting for coronary artery bypass graft surgery (CABG) have had chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker administration. Although continued RAS inhibitor therapy is associated with improved survival and retarded progression of renal disease, 2-4 concerns about the development acute kidney injury (AKI) in situations associated with decreased glomerular filtration pressure have been raised. 2,5,6 Editorial p 1800Indeed, cardiac surgery under cardiopulmonary bypass (CPB) is significantly associated with changes in the glomerular filtration rate and volume shift. Chronic preoperative RAS inhibitor therapy reportedly resulted in 28% increased risk of AKI following cardiac surgery, suggesting withholding of these medications prior to surgery. 2 However, from the currently available evidence no definite conclusion can be drawn on withdrawing RAS inhibitors prior to CABG at the expense of losing their anti-ischemic benefits. 2,7Use of the off-pump CABG (OPCAB) technique in patients presenting with high surgical risk has increased, with preferable results. 8-10 CPB itself is considered one of the main etiologic factors in the development of AKI. 11-14 In addition, because RAS inhibitor-associated AKI is more likely to develop under certain conditions, such as hypovolemia and renal hypoperfusion, 15,16 we hypothesized that preload augmentation before distal anastomosis and maintenance of pulsatile blood flow and pressure during surgery would mitigate the effect of RAS inhibitors on renal function after OPCAB. However, comprehensive data to support Background: Despite several studies that evaluated the effects of renin-angiotensin system (RAS) inhibitors on postoperative renal function in cardiac surgery patients, no final conclusions are available. The aim of the present study was to determine the effect of RAS inhibitors on renal function following off-pump coronary artery bypass grafting (OPCAB).