Atherosclerotic morbidity of the ascending aorta is associated with an increased risk of perioperative cerebral damage during cardiac surgery. To minimize the risk, we developed a refined method for occluding the diseased ascending aorta. From April 2005 to December 2007, 18 patients underwent cardiac surgery. Just before aortic cross-clamping, the aorta was opened during brief circulatory arrest in order to flush out any possible remaining atheromatous debris. The specially designed intra-aortic occluder was applied to an extremely calcified aorta. There were no hospital mortalities or cerebrovascular accidents. In conclusion, our technique can greatly contribute to the prevention of embolic complications in patients with a severely diseased ascending aorta.

Some doctors change specialty from cardiac surgery to cardiology or peripheral vascular surgery or practice general medicine before retirement age. We carried out a survey to investigate their working conditions and reasons for changing their specialty. We sent questionnaires by mail to 154 doctors of whom 56 (36%) answered. The most common reason for changing specialty was taking over their family's practice, and the second most common reason was a small income. Actually, the annual income of 41 doctors increased after changing from cardiac surgery (75%). Many cardiac surgeons have to work with a years lest self-sacrifice and unpaid overtime work. Of the respordents 65% could not renew their Japanese Board of Cardiovascular Surgery, because of their limited operative numbers. If the current condition continues, the number of cardiac surgeons in Japan will decrease. It is necessary to improve working conditions and the environment so that surgeons can concentrate more on operations.

The left ventricle assist device (LVAD) has become an important therapeutic option in the treatment of acute or chronic heart failure. It is usually used as bridge to transplantation or recovery. At present, destination therapy with LVAD has been a therapeutic option in patients with heart failure in whom transplantation is not indicated. We describe a patient, who received destination therapy with LVAD, and was able to go home temporarily. The patient was a 63-year-old man with low output syndrome after acute myocardial infarction. An LVAD (TOYOBO) was implanted at Oita University Hospital, however the patient suffered from MRSA mediastinitis 6 months later. He and his family wished for him to temporarily go home to Ibaraki. The patient, supported by LVAD, was transferred from Oita to Ibaraki by a regular commercial flight and ambulance. Rehabilitation training involved stretching, in-bed muscle strength training, maintaining a standing position, walking on flat ground with a walker and going up and down ramps. All training was measured at the patient's home. The patient was out of hospital for 5 hours, and this period was uneventful upon leaving hospital. The patient also took an active part in rehabilitation after discharge. This program can help to improve the quality of life (QOL) of patients with implanted LVADs for destination therapy.

Spontaneous rupture of the thoracic aorta without trauma, aneurysm or dissection is a rare but fatal disease. We reported successful endovascular aortic repair of thoracic aortic spontaneous rupture in 3 patients. Generally, it is difficult to accurately identify the rupture site in the spontaneous rupture. However, by detailed planning based on the data of preoperative CT images, thoracic endovascular aortic repair (TEVAR) can be successfully performed, like surgical repair of spontaneous rupture of the distal aortic arch or descending thoracic aorta. TEVAR should be considered as a first-line therapy, especially, in patients with advanced age or significant comorbidities.