Objective and Methods : Data on isolated coronary artery bypass grafting (CABG) performed in 2013 and 2014, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Results : Isolated CABG was performed off-pump in 54.7% of cases, and graft material for the LAD was left internal thoracic artery in 74.3% and right internal thoracic artery in 15.6%. Operative mortality was 2.0% in elective cases, 8.2% in emergency cases, and 3.0% overall. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 3.0% for on-pump CABG. Conclusions : Clinical results of our isolated CABG was reasonable and acceptable.

A 72-year-old woman was admitted to our department with a diagnosis of severe aortic stenosis was also diagnosed Inherited antithrombin deficiency was also diagnosed after she suffered from a pulmonary thromboembolic event 10 years previously and had been taking warfarin since then. On admission, her antithrombin activity was 53% of normal, and her PT-INR level was maintained around 2.5. Preoperative management of anticoagulation therapy included discontinuation of warfarin, and supplementation of antithrombin with heparin infusion. On the day of operation, antithrombin activity was maintained above 80% by administering antithrombin, and aortic valve replacement with a mechanical valve prosthesis was carried out under standard cardiopulmonary bypass support using heparin. Heparin infusion was continued with antithrombin supplementation until PT-INR recovered to round 2.5 with warfarin. Her intra- and postoperative courses did not show any thromboembolic events, and she was discharged 14 days after the surgery.

Although insulin resistance in peripheral tissue has been demonstrated in patients with cardiac disease, expression of glucose transporter (GLUT) isoform mRNA in the cardiac muscle is not known. We analyzed GLUT isoform mRNA in the cardiac muscle of 10 patients by RT-PCR. GLUT 4 mRNA was semi-quantitated by kinetic analysis, altering the cycles of PCR, and insulin resistance was examined by euglycemic hyperinsulinemic glucose clamp with an artificial pancreas. In addition to GLUT 2, 3, and 4 mRNA, all of which were constantly demonstrated in the skeletal muscle of normal volunteers, GLUT 1 was documented in all the cardiac samples examined. The quantity of GLUT4 mRNA was not related to the degree of insulin resistance or M values. These results may suggest that glucose uptake in the cardiac muscle is maintained by 4 different glucose transporters and that the response of GLUT 4 mRNA to insulin resistance is different in the cardiac muscle and in the skeletal muscle.

Cerebral malperfusion is a serious complication of acute aortic dissection type A(AADA), and the best strategy for its management remains unclear. A 71-year-old woman was brought to our hospital because of consciousness disorder and right hemiplegia. Contrast-enhanced CT showed AADA and occlusion of the left common carotid artery. As the symptoms gradually improved and CT showed flow in the left distal carotid artery, we prioritized central repair by total arch replacement and Frozen Elephant Trunk with deep hypothermia and antegrade cerebral perfusion (ACP). Although the ACP cannula did not go into the left common carotid artery and we eventually had to do a left intra-carotid bypass, she was discharged home without any symptoms. It is acceptable that we give the priority to central repair over direct carotid artery re-perfusion when her symptoms improve. Besides we have to perform carotid bypass if the malperfusion is remains.

Data on isolated coronary artery bypass grafting (CABG) performed in 2017 and 2018, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 54.6% (n＝14,684) of all CABG cases (n＝26,913), and graft material for the LAD was left internal thoracic artery in 76.4% and right internal thoracic artery in 19.0%. Operative mortality was 1.5% in elective cases (On-pump CABG : ONCAB 1.9%, off-pump CABG : OPCAB 1.2%, p＜0.001), 7.4% in emergency cases (ONCAB 10.2%, OPCAB 4.3%, p＜0.001), and 2.5% overall. Postoperative morbidity was low in almost all aspects in OPCAB, and average JapanSCORE II is elevating every year. Overall short-term operative results for isolated CABG is stable, and operative candidates are shifting to higher-risk patients.

We reviewed the data of the isolated coronary artery bypass grafting (CABG) procedures performed in 2015 and 2016, as registered in the Japan Cardiovascular Surgery Database, for preoperative characteristics, surgical outcomes, and the choice of graft material used for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 55.0% (n = 16,173) of all CABG cases (n = 29,392). The left internal thoracic artery and the right internal thoracic artery were used as the graft materials in 72.1 and 17.4% cases respectively. The operative mortality rates remained unchanged since the last report, with 1.7% for elective cases, 8.8% for emergency cases, and 3.0% overall. In elective cases, the operative mortality rate was 1.1% for off-pump CABG (OPCAB) compared with 2.5% for on-pump CABG. The morbidity rates for all OPCAB cases were significantly better except for those falling in the ‘readmission ＜30 days’ group.

A 61-year-old male presented to another hospital with sudden chest and back pain, and CT revealed a diagnosis of type A acute aortic dissection with patent false lumen. The ascending aortic diameter was 45 mm and the right common carotid artery was occluded. There were no neurological abnormalities, no pericardial effusion, and only mild AR. Eight hours after onset, the patient was transferred to our hospital. The laboratory data showed severe DIC with fibrinogen <50 mg/dl, so that medical DIC treatment was given first because of the high risk of bleeding. Twenty-two hours after the onset, DIC improved and surgery was initiated. The right common carotid artery was ligated for fear of thrombus dispersion at the periphery of the occlusion site. An ascending arch replacement was then performed. Postoperative hemostasis was good, and no new neurological abnormalities were observed. Usually, type A acute aortic dissection is indicated for emergency surgery, but in this case, DIC treatment took precedence. We report here a rare experience.