An 80-year-old man was admitted to our hospital with a diagnosis of distal aortic arch aneurysm. A preoperative chest CT demonstrated a 54 mm in diameter distal aortic arch and coronary angiography revealed stenosis of LAD and the diagonal branch. We planned a thoracic endovascular repair after total arch replacement with a coronary artery bypass graft. A ZTEG-2P-30-200-JP was deployed at the proximal side of the elephant trunk, and a ZTEG-2P-34-152-JP was deployed. About 10 months later, a chest CT demonstrated a 90 mm in diameter distal native aortic arch, and anemia had increased to Hb 7.7 g/dl. A CT and angiography revealed a type II endoleak and so we tried to close the endoleak through a left thoracotomy approach. Twenty-eight months after the TEVAR, the patient had esophageal perforation and stent graft infection. At first, we resected the esophagus and reconstructed it with a gastric tube. Secondly, a descending thoracic aorta replacement was performed. The patient suffered from a cerebral infarction. However, infection was controlled successfully and he was transferred to another hospital for rehabilitation 69 days after the descending aorta replacement.

A 54-year-old man with unstable angina and Wolff-Parkinson-White (WPW) syndrome was admitted. Coronary angiography showed 90% stenosis of the left main trunk and 75% stenosis of the obtuse marginal branch. Coronary artery bypass grafting under cardioplegic arrest was done emergently. The left internal mammary artery graft was anastmosed to the left anterior descending artery, and a saphenous vein graft was used as a sequential bypass graft to the high lateral branch and obtuse marginal branch. Immediately after weaning from cardiopulmonary bypass, paroxysmal supraventricular tachycardia (PSVT) requiring electrical cardioversion was occurred, and catheter ablation was performed on the first postoperative day. There are controversus concerning the strategies of surgical treatment for unstable angina concomitant with WPW syndrome. Coronary bypass operation may trigger PSVT in patients with WPW syndrome. The optimal timing of perioperative catheter ablation needs further discussion.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.