A 64-year-old man with a diagnosis of aortic valve stenosis presented with chest pain. The patient is a Jehovah's Witnesses and wanted surgery without blood transfusion. Therefore, we planned minimally invasive aortic valve replacement (MICS AVR) avoiding sternotomy. He underwent aortic valve replacement with a mechanical valve (ATS AP360 20 mm) through a right anterolateral thoracotomy at the fourth intercostal space. The value of hemoglobin was 11.2 g/dl after surgery. He recovered uneventfully and was discharged 17 days after surgery. MICS AVR has the advantage of less risk of bleeding, therefore MICS AVR is useful for Jehovah's Witness patients who refuse blood transfusion.

Abdominal compartment syndrome (ACS) is an important postoperative complication of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA). Open abdominal management (OAM) has been reported to be effective in EVAR ; however, only a limited number of reports are available on when and how to close the abdomen. Here we report a case of early abdominal wall closure achieved through the combined use of retroperitoneal hematoma evacuation after EVAR and OAM for rAAA. The patient was a 79-year-old woman who underwent EVAR for rAAA on an emergency basis. She developed ACS after EVAR and underwent OAM. Four days after surgery, a decrease in intraabdominal pressure was confirmed, and subsequent contrast-enhanced computed tomography revealed the absence of an endoleak ; retroperitoneal hematoma evacuation was performed, during which the abdominal wall was closed. The postoperative course was good, and the patient was discharged. Early closure of the abdomen may be possible by concomitant retroperitoneal hematoma evacuation after EVAR and OAM for rAAA.