The Edwards MC³ tricuspid annuloplasty system has recently become available commercially. Its anatomically correct design conforms to the three-dimensional tricuspid orifice and minimizes stress on sutures. We handled 71 patients with functional tricuspid regurgitation by open heart surgery and tricuspid valve repair between May 2005 and April 2007 in our institute. Cosgrove-Edwards annuloplasty rings were used for tricuspid regurgitation in 33 patients before October 2006. Among them, there were 30 mitral valve surgeries, 6 aortic valve surgeries, and 2 cases of atrial septal defect. Since then, we used the MC³ system in 38 cases, consisting of 30 mitral valve surgeries, 9 aortic valve surgeries, and 2 cases of atrial septal defect. Three patients died postoperatively with the Cosgrove-Edwards system, but there was no fatality with the MC³ system. The degree of tricuspid regurgitation was reduced from 2.6±0.58 to 0.34±0.46 (regurgitation severity scale: 0 to 4) in the patients with the MC³ ring at discharge. In the 33 patients with the Cosgrove-Edwards ring, it was from 2.8±0.67 to 0.92±0.99. The severity of tricuspid regurgitation in patients with the Cosgrove-Edwards ring and the MC³ ring about nine months postoperative was 1.5±1.2 and 0.42±0.50, respectively. The MC³ (rigid ring) system was more effective than the Cosgrove-Edwards (flexible band) system for decreasing tricuspid regurgitation in immediate and short-term postoperative periods.

A 64-year old man was admitted to our hospital with a diagnosis of aortic stenosis. Pre-operative chest CT revealed pseudocoarctation of the aorta with a hypoplastic aortic arch, elongation and kinking of the aortic arch and proximal descending aorta. There was also a large aneurysm from the distal arch to descending aorta. We performed a single-stage repair of the aortic lesion from the ascending to the descending aorta with aortic valve replacement. For the surgical approach, transverse clamshell incision was applied safely. Concomitant aortic valve replacement in surgical repair of pseudocoarctation and thoracic aneurysm was rare, and clamshell incision seemed beneficial in such single-stage repair from the aortic root to the descending aorta.

A 74-year old man, presented with dyspnea following acute abdominal pain, was admitted to an initial hospital. The plain computed tomography (CT) scan revealed a ruptured abdominal aortic aneurysm (AAA). Emergency insertion of intra-aortic balloon occlusion (IABO) catheter was carried out due to his unstable hemodynamic condition. The patient was transferred to our hospital after surgical consultation. Open surgical repair was carried out, and massive retroperitoneal hematoma and excessive bowel edema made it difficult to close the abdomen primarily. Delayed closure following Open Abdomen Management (OAM) was effective.

We report a case of performing a 4-stage operations, including TEVAR through the descending aorta as an access route, for multiple aortic aneurysms complicated by severe COPD. The patient was a 71-year-old woman. A chest X-ray suggested a thoracic aortic aneurysm (TAA). CT scans revealed significant aortic tortuosity and six aortic aneurysms, including a TAA with a maximum diameter of 65 mm. However, due to severe mixed ventilatory impairment with an FEV1 of 39% and a %VC of 64%, a multi-stage surgery including TEVAR was chosen from the perspective of surgical tolerance. Additionally, due to severe calcification and stenosis extending from both iliac arteries to the femoral arteries and significant aortic tortuosity, careful planning for endovascular access was necessary. In the first stage, TEVAR was performed through the descending aorta as the access route for the TAA. In the second stage, a prosthetic graft replacement (abdominal four-branched reconstruction) was performed for the thoracoabdominal aortic aneurysm. In the third stage, TEVAR was performed using a prosthetic graft branch as the access route for the remaining TAA. In the fourth stage, additional TEVAR was performed for the endoleak, and EVAR was performed for the abdominal aortic aneurysm and common iliac artery aneurysm, completing the treatment in four stages. By carefully designing treatment strategies, such as access routes for endovascular stent-graft insertion with a focus on minimal invasiveness, severe postoperative complications, including respiratory issues, were successfully avoided.