The patient was a 49-year-old male who had undergone total arch replacement with Elephant trunk procedure for acute aortic dissection Stanford type A at another institution. Eight months post-surgery, he presented with hematuria and jaundice. Mechanical hemolysis by grafts was considered, and he was referred to our hospital. Subsequently, we conducted transesophageal echocardiography, which revealed the inversion of felt strips at the proximal anastomosis site, accompanied by blood turbulence at the same site. Consequently, we established a diagnosis of mechanical hemolysis attributed to the inversion of the inner felt strip within the anastomosis, prompting a redo surgery. The utilization of felt strips for reinforcing the anastomosis has become a prevalent technique in ascending aortic replacement for acute aortic dissection. This technique serves to mitigate hemorrhage from the anastomosis and counteract the formation of pseudoaneurysms. In this study, we report an uncommon complication caused by the presence of felt strips within the anastomosis.

We present herein the case of a 45-year-old man with a coronary artery aneurysm (diameter 19 mm) in the proximal part of the left anterior descending branch associated with eosinophilic granulomatosis with polyangiitis (EGPA). As coronary angiography showed #6 : 100% and #12-2 : 90%, and Tc-99 m myocardial scintigraphy showed exertional ischemia in the anterior septum, revascularization was considered to be indicated. Prednisolone and mepolizumab were administered preoperatively to suppress the activity of vasculitis due to eosinophilia, and surgery was performed when the eosinophil count normalized. The patient underwent off-pump coronary artery bypass grafting (LITA-LAD, SVG-OM2). The patient was discharged, and the postoperative course was uneventful. In coronary artery bypass grafting for EGPA, eosinophils may infiltrate the internal thoracic artery and result in vasculitis, which may affect the patency rate. Perioperative management of vasculitis may thus be important.