Because of increasing life expectancy and the high incidence of aortic stenosis (AS) in high-age groups, aortic valve replacement (AVR) for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting (CABG) for coronary artery disease. Between 2003 and 2010, 77 patients (18 men) aged over 80 years (80∼88 years ; mean age, 82.7 years) underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA) class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients (33.8%) underwent associated CABG operations (1-4 grafts ; mean, 1.8 grafts) with AVR. Operative mortality was 5.2% (4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit (ICU) stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.

We report an interesting case of thoracic vascular graft infection treated by in situ replacement using bovine pericardial roll. A 65-year-old man who had undergone graft replacement of ascending aorta for acute type A aortic dissection 9 months prior was admitted to our hospital with purulent discharge from his chest wound. Fluid accumulation surrounding the vascular graft was detected by chest CT, and methicillin-resistant Staphylococcus aureus (MRSA) was positive from his blood culture. These findings led to a diagnosis of aortic graft infection. We gave the antibiotics intravenously, opened the abscess cavity around the infected graft, and irrigated with 0.04% gentian violet solution for 6 months, but failed to control the graft infection. Then we did redo replacement of the ascending aortic vascular graft using a bovine pericardial roll graft with a concomitant omental flap wrapping and obtained successful healing of the graft infection. During follow-up, no recurrent infection occurred, however he died of acute subdural hematoma 8 months after surgery. In situ replacement of the infected vascular grafts using a bovine pericardial roll graft with a concomitant omental flap wrapping may be an option for treating infected aortic grafts.

Because of increasing life expectancy and the high incidence of aortic stenosis (AS) in high-age groups, aortic valve replacement (AVR) for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting (CABG) for coronary artery disease. Between 2003 and 2010, 77 patients (18 men) aged over 80 years (80∼88 years ; mean age, 82.7 years) underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA) class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients (33.8%) underwent associated CABG operations (1-4 grafts ; mean, 1.8 grafts) with AVR. Operative mortality was 5.2% (4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit (ICU) stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.

Anomalous aortic origin of a coronary artery (AAOCA) can cause sudden death, especially in young athletes. AAOCA does not have any clinical cardiovascular manifestations and sudden death is often the first manifestation ; hence, it is difficult to diagnose AAOCA before a major episode occurs. We report the case of a 58-year old woman with a right coronary artery arising from the left sinus and passing between the aorta and the pulmonary artery. Although the results of the exercise treadmill test and various other tests were normal, this patient underwent coronary artery bypass, surgery using the right internal thoracic artery to preventing sudden death. Two years after the operation, she is asymptomatic and has normal results on the exercise treadmill test.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.