(1) Background: Conventional open surgery is still the gold standard for aortic arch disease, and despite recent developments in optimizing strategies for neuroprotection, distal organ perfusion, and myocardial protection, aortic arch replacement is still associated with high morbidity and mortality rates. (2) Methods: We present our case series of 12 patients undergoing surgical management of multiple cardiac diseases involving the aortic arch. In this single-center study, we report our initial experience over a five-year period (from December 2018 to October 2023) with the use of a \"debranching first\" technique for the supra-aortic vessels of a beating heart, followed by the cardiac step addressing proximal diseases, and a final distal step treating the aortic arch. This strategy aims to minimize cardiac, cerebral, and peripheral ischemia. (3) Results: Six patients underwent aortic root replacement with either Bentall (n = 4) or valve-sparing aortic root (David procedure) (n = 2). The mean nasopharyngeal temperature was 34 °C and the mean cardiocirculatory arrest was 14.3 min. The early mortality was 8.3% (1 patient); no patient experienced a permanent neurologic event. (4) Conclusions: In patients with complex aortic disease and concomitant cardiac disease, this approach reduces the need for hypothermia and decreases cardiopulmonary bypass time and myocardial arrest time and therefore could represent a valid surgical option, even in high-risk patients.

BACKGROUND: The classical elephant trunk (ET) technique is a very useful surgical procedure; however, haemolysis in the aorta associated with ET has been previously reported. It normally occurs within several years after the surgery, and it is a rare case of rapidly progressing haemolysis 10 or more years after aortic arch replacement with ET.
METHODS: A 53-year-old man with a history of Stanford type A aortic dissection (DeBakey type Is), who was treated with total arch aortic replacement and aorto-femoral bypass using a prosthetic graft 17 years ago, developed severe progressive haemolytic anaemia. The ET used for the initial surgery was narrowed, and mechanical haemolysis was suspected. We assumed that progressive mechanical haemolysis occurred because of degeneration of the prosthetic graft. Thoracic endovascular aortic repair was performed, and haemolysis and anaemia were mitigated postoperatively.
CONCLUSIONS: Haemolysis occurred 17 years after the initial surgery with ET. When haemolysis is suspected in a patient with ET, it must be identified as a cause of haemolysis even if 10 years or more have passed since the ET was inserted. To prevent this complication, attention should be paid to an appropriate ET length and diameter to avoid folding of the ET, particularly when the true cavity diameter is small.

暂无摘要。

UNASSIGNED: Symptomatic common carotid artery (CCA) occlusion is rare and its treatment remains unestablished. Although cases of subclavian-to-carotid bypass have been reported, very few cases of carotid-tocarotid crossover bypass have been reported, despite its advantages. We report a case of Riles type 1A symptomatic CCA occlusion after aortic arch replacement that was treated with carotid-to-carotid crossover bypass with favorable outcomes.
UNASSIGNED: A 65-year-old woman with a history of hypertension, hyperlipidemia, diabetes, and total arch replacement for thoracic aortic aneurysm was admitted to our hospital with a complaint of the right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed a fresh infarction in the left cerebral hemisphere. Cervical computed tomography (CT) angiography revealed left CCA occlusion. Thoracic CT angiography showed severe stenosis of the left subclavian artery. SPECT showed a general decrease in blood flow in the left cerebral hemisphere. We performed a carotid-to-carotid crossover bypass with a synthetic graft that was passed through the subcutaneous tunnel. First, the right carotid artery-synthetic graft end-to-side anastomosis was performed. Subsequently, we performed synthetic graft-left CCA end-to-side anastomosis. The postoperative course was uneventful. Cervical computed tomography angiography showed perfect patency of the crossover bypass. The patient recovered almost completely and was independently performing daily activities.
UNASSIGNED: Carotid-to-carotid crossover bypass is a durable treatment for symptomatic CCA occlusion. Further studies are needed to compare its outcomes with those of other methods and to confirm our findings with larger sample size.

Type A aortic dissection (AD) is a critical and severe disease with high mortality. The Sun\'s operation is a standard surgical method for this kind of disease at present. For the procedure, an elephant trunk stent is inserted into the true lumen of the descending aorta and the aortic arch is replaced. A patient was admitted to the First Hospital of Lanzhou University due to sudden chest and back pain for 6 days. Computed tomography angiography (CTA) showed type A AD. Ascending aorta replacement, Sun\'s operation, and ascending aorta to right femoral artery bypass grafting were performed. After surgery, the patient\'s condition was worsened. The digital subtraction angiography (DSA) showed the elephant trunk stent was inserted into the false lumen of AD, leading to the occlusion of the large blood vessel at the distal part of the abdominal aorta and below. Although we performed intima puncture and endovascular aortic repair, the patient was still dead.
A型主动脉夹层(aortic dissection，AD)是一种危急重症，病死率高。“孙氏”手术是治疗当前复杂A型AD的标准术式，该术式在使用人工血管替换主动脉弓的同时，于降主动脉植入象鼻支架人工血管。兰州大学第一医院收治了1例A型AD患者，该患者突发胸背部疼痛6 d，CT血管造影(computed tomography angiography，CTA)示A型AD。入院后急诊行升主动脉置换+“孙氏”手术+升主动脉-右股动脉转流术。术后患者病情加重，数字减影血管造影(digital subtraction angiography，DSA)证实为象鼻支架植入主动脉夹层假腔，导致腹主动脉远端及以下大血管闭塞，行主动脉破膜加主动脉覆膜支架植入抢救患者，但最终患者仍死亡。.

BACKGROUND: Although complete surgical resection of thymic carcinoma is a prognostic factor, extended surgery combined with a major blood vessel procedure remains controversial because of the increased risk of mortality. We report a case of Stage IVa thymic carcinoma successfully resected with a pneumonectomy along with aortic arch replacement after chemotherapy.
METHODS: A 45-year-old male was diagnosed with thymic carcinoma invasion to the aortic arch and left pulmonary artery. Malignant pericardial effusion was also noted, though disappeared after chemotherapy, thus surgical options were considered. A radical resection procedure including left pneumonectomy, aortic arch replacement with total rerouting of the supra-arch vessels, and right pulmonary artery plication was performed. The postoperative course was uneventful and the patient has been disease-free for 3 years.
CONCLUSIONS: Extended salvage surgery might be a valuable option for advanced thymic carcinoma.

BACKGROUND: Although complete surgical resection of thymic carcinoma is a prognostic factor, it is not always an option for advanced tumors because of locoregional invasion. Extended surgery combined with a major blood vessel procedure remains controversial because of the increased risk of mortality.
METHODS: Chest computed tomography (CT) uncovered an abnormal shadow in the mediastinum of a 74-year-old man. An irregularly shaped tumor obstructed the left innominate vein, and invasion of the aortic arch was suspected. A CT-guided percutaneous needle biopsy revealed squamous cell carcinoma of the thymus, which was considered unresectable. The patient underwent chemotherapy elsewhere, then was referred to us for surgical resection. We combined extended surgery with total aortic arch replacement under a cardiopulmonary bypass. Complete resection was achieved, and the patient remains alive without recurrence at 3 years after surgery CONCLUSION: Resection including aortic arch replacement might be an option that can achieve complete resection of local advanced thymic carcinoma.