An 87-years-old woman with a history of right mastectomy for breast cancer, currently undergoing chemotherapy for multiple metastasis via a central venous catheter placed in the left subclavian vein, presented with bradycardia and dyspnea. Electrocardiogram revealed a 2:1 atrioventricular block. Implantation of a leadless pacemaker (LLPM) was planned for the patient. During implantation, right ventricular rupture occurred. Percutaneous cardiopulmonary support was initiated immediately. Subsequently, emergency surgery was performed. LLPM is considered a useful and safe device;however, serious complication, such as cardiac injury, have been reported in a small number of cases. Thorough risk assessment and preparation for complication, including cardiac surgery, may be life-saving.

In recent years, endovascular aortic repair has become one of the standard treatments for aortic aneurysms. However, when the aneurysm involves the branches of the abdominal aorta or the aortic arch, the procedure becomes more complex and often necessitates surgical reconstruction of the involved branches. To address these challenges, the use of physician-modified endografts in which fenestrations are manually created by physicians has been reported. This approach, known as fenestrated and branched endovascular aortic repair, involves the placement of small-diameter bridging stent grafts through the fenestrations, and its utility has recently been highlighted. Herein, we report a case of successful fenestrated and branched endovascular aortic repair using physician-modified endografts in a patient with both thoracoabdominal and aortic arch aneurysms.

This retrospective analysis assessed surgical outcomes in patients aged 85 years or older who underwent emergency open thoracic aortic surgery for acute Stanford type A dissection between 2012 and 2025. Among 352 patients, 27 were classified as very elderly. Compared to younger cohorts, this group exhibited a higher prevalence of DeBakey typeⅡ dissection and thrombotic false lumen occlusion, with a lower incidence of malperfusion. The majority underwent hemiarch replacement. In-hospital mortality was low at 3.7%, and postoperative complication rates were comparable to the control group. Due to slow functional recovery, the proportion of patients discharged directly home was reduced. Despite a limited follow-up rate, three-year outcomes-including overall survival (77.4%), freedom from aortic-related mortality( 91.7%), and distal reoperation-free survival( 91.7%)-were favorable. The implementation of advanced techniques, such as staged thoracic endovascular aortic repair (TEVAR) and zone 0 TEVAR utilizing the retrograde in-situ branched stent graft (RIBS) method, effectively minimized the necessity for reintervention via thoracotomy or laparotomy. These findings underscore the clinical viability of surgical intervention in selected very elderly patients, notwithstanding inherent limitations such as referral bias and incomplete longitudinal data.

To evaluate the outcomes of aortic root preservation in patients undergoing surgery for Stanford type A acute aortic dissection(AAAD)without concomitant root replacement, Methods:We retrospectively analyzed 79 consecutive AAAD patients(mean age 68±13 years;52% male)who underwent supra-coronary repair(SCR)between January 2012 and December 2022, excluding those requiring Bentall or valve-sparing root replacement(VSRR), Preoperative root involvement, aortic regurgitation(AR), surgical procedures, early outcomes, long-term aortic root dilation, AR progression, and reoperation rates were assessed mean follow-up of 5.7±3.4 years, Results:Preoperative root dissection was present in 66%, with moderate or greater AR in 16%, Early mortality was low(30-day mortality 2.5%, in-hospital mortality 3.8%), Long-term follow-up, mean aortic root enlargement was minimal(0.28 mm/year), with no cases of progression to moderate or severe AR, Reoperation occurred in 3.8%(3 cases), primarily due to pseudoaneurysm or new entry formation at the proximal anastomosis, Conclusions:Aortic root preservation with careful proximal anastomosis placement provided excellent early and mid-term outcomes, with minimal late aortic root dilation or AR progression.

In Japan, surgical repair for Stanford type A acute aortic dissection(AAAD)has been increasingly performed, accompanied by gradual improvement in early outcomes, While ascending or hemiarch replacement remains the mainstream strategy, late aneurysmal dilatation of the residual dissected aorta is still a concern, The frozen elephant trunk(FET)technique, which facilitates aortic remodeling, has been increasingly adopted in AAAD surgery, Since the introduction of a domestic integrated four-branched FET device in late 2022, expectations have risen for improved procedural safety and simplicity, We report our early institutional outcomes of total arch replacement(TAR)using the integrated four-branched FET, Methods:Among 211 AAAD cases treated between December 2022 and April 2025, 110 underwent TAR with FET, of which the first 50 consecutive cases using the integrated four-branched FET[FROZENIX 4 Branched(FZX4B)]were retrospectively analyzed, The primary endpoint was early postoperative outcome, including mortality and spinal cord ischemia(SCI), Secondary endpoints included midterm survival, freedom from aortic events, and morphologic changes in the descending aorta, Results:The median age was 65 years[interquartile range(IQR):56~74], and 29 patients(58%)were male, The median operative time was 372 minutes(IQR:315~506), and the hypothermic circulatory arrest time was 42 minutes(IQR:38~50), The distal anastomosis was performed in zone 3 in 84% of cases, The FZX4B diameter most used was 25 mm(60%), In-hospital mortality was 4%, SCI occurred in one patient(2%), Two patients(4%)required additional thoracic endovascular aortic repair(TEVAR)for FET stenosis, The median follow-up was 248 days(IQR:165~472), Overall survival was 93% at 1 year and 86% at 2 years, and freedom from aortic events was 87% and 81% at 1 and 2 years, respectively, The FET distal level was mainly at Th6(62%), The aortic diameter at the distal edge of the FET decreased from 30 mm(IQR:28~33)preoperatively to 27 mm(25~31)at 1 year(p<0.001), The FET tip diameter correlated with the preoperative outer diameter at the anastomotic site(r=0.66, p<0.001), Conclusions:Although FET-related stenosis should be recognized as a potential procedural risk, TAR using the integrated FET for AAAD achieved acceptable early outcomes, A larger comparative study with conventional repair is warranted to elucidate its statistical impact.

This single-center retrospective study evaluated postoperative outcomes in Stanford type A acute aortic dissection(AAAD)patients presenting with preoperative cardiopulmonary arrest(CPA)between January 2021 and May 2025, Methods:Among 390 consecutive AAAD cases undergoing emergency surgery, 18(4.6%)presented with CPA, We assessed 30-day mortality, return of spontaneous circulation(ROSC), and use of preoperative veno-arterial extracorporeal membrane oxygenation(VA-ECMO), Results:The 30-day mortality was 72.2%, ROSC occurred in 4 cases(22.2%), and ROSC-positive patients had significantly lower mortality(p=0.022), Preoperative VA-ECMO was used in 7 cases(38.9%), none of whom survived(p=0.013), Conclusions:AAAD with preoperative CPA carries extremely high mortality, but patients achieving ROSC may benefit from urgent surgical intervention, VA-ECMO appears to confer no survival advantage, Early survivors often achieve favorable long-term outcomes, in line with prior literature.

Emergency surgery remains the standard of treatment for acute Stanford type A aortic dissection(AAAD), Nevertheless, in real-world practice a minority of patients do not undergo immediate surgery due to clinical constraints, We sought to delineate the outcomes and practical limits of such nonoperative management under strict protocols, Methods:Of 668 consecutive AAAD patients(Jan 2019~Mar 2025), we retrospectively analyzed 100 who did not receive immediate surgery after excluding 13 with cardiopulmonary arrest, Patients were stratified into a criteria group(C;thrombosed/occluded false lumen in the ascending aorta with ascending diameter≦50 mm and false lumen≦11 mm;n=59)and a non-criteria group(NC;outside these criteria;n=41), The primary endpoint was in-hospital mortality;secondary endpoints included aortic-related death, post-discharge events, and associations with imaging/clinical indices, Results:NC patients were older and more often female, with larger ascending aortas and false lumens(both p<0.001), In-hospital mortality was 31.7% in NC vs 1.7% in C(p<0.001);48-hour mortality in NC was 12.2%, and aortic-related deaths clustered within 4.56±2.99 days(range 1~12), Seven patients underwent delayed surgery for imaging changes;all survived, Discharge alive occurred in 98.3%(C)and 68.3%(NC), Among those discharged alive, survival up to 2 years was similar, Low body mass index(BMI)and hemodynamically significant tamponade were associated with in-hospital death in NC, Conclusions:These data support surgery as the default strategy for AAAD, When surgery is unavoidably deferred, conservative management should be considered only in strictly selected patients, with early hemodynamic/computed tomography(CT)triggers for conversion, In NC patients, the first hospital week is the highest-risk window, and low BMI or tamponade should prompt heightened vigilance and a low threshold for intervention.

This study aimed to evaluate the outcomes of surgical strategies for DeBakey typeⅢ retrograde Stanford type A dissection(RAAD), Methods:We retrospectively analyzed 46 patients with RAAD treated at our hospital, Surgical procedures included ascending aorta repair(AAR, n=20), total arch replacement(TAR, n=17), and thoracic endovascular aortic repair(TEVAR, n=9), Early and late outcomes were assessed, Results:The AAR group had shorter operative times but a higher incidence of long-term aortic-related mortality, The TAR group showed no long-term aortic-related mortality but experienced early complications such as spinal ischemia, In the TEVAR group, several patients required early reintervention, Conclusion:An individualized surgical strategy is essential for the management of RAAD, While secure entry closure may improve long-term outcomes, each approach carries specific risks, AAR and TEVAR remain appropriate options for selected cases.

Bleeding from the proximal anastomosis site during Stanford type A acute aortic dissection(AAAD)surgery can be a fatal problem, to avoid this, we use the proximal stepwise(PS)method for proximal anastomosis at our institution, and we examined its usefulness and results, we retrospectively analyzed 53 emergency surgeries(22 males, mean age 72.4±9.3 years)performed between October 2016 and December 2024, there were 39 ascending replacements and 12 total ascending replacements, there were no cases of difficult hemostasis during proximal anastomosis, the in-hospital mortality rate was 3.7%(2 cases), during the observation period of 1,245.7±924.6 days, there were no aortic events or aortic-related deaths related to the proximal anastomosis, and the 3-year survival rate was 93.4%, the PS method is useful as a proximal anastomosis technique in AAAD surgery and may contribute to a favorable long-term prognosis by avoiding late complications.

Systemic antihypertensive medications may influence glaucoma-related outcomes through intraocular pressure-dependent and vascular mechanisms. While topical α₂-agonists are established glaucoma therapies, the association between systemic α₂-agonists and glaucoma hazard remains unexamined; we compared their hazard with systemic β-blockers in adults with hypertension.

We conducted a multicentre retrospective cohort study using deidentified electronic health records. Adults aged ≥40 years with hypertension and chronic exposure to systemic α₂-agonists or β-blockers were included. Patients with pre-existing ocular hypertension (OHT), primary open-angle glaucoma (POAG), concomitant comparator use, or inadequate ophthalmic follow-up were excluded. We balanced cohorts using propensity score matching (PSM) and assessed the hazard of OHT and POAG at 1, 3, and 5 years. Cox models estimated adjusted HRs (aHRs) with 95% confidence intervals (CIs).

Patients treated with α₂-agonists (n=4186) were matched to those treated with β-blockers (n=360 399), resulting in 4152 patients per group after PSM. In Cox models (on the unmatched cohorts) adjusted for demographics, comorbidities, medications, laboratory and biometric measures, socioeconomic indicators and selected procedures, α₂-agonist exposure was associated with a lower hazard of OHT (aHR (95% CI) 0.582 (0.473 to 0.716), 0.559 (0.468 to 0.669) and 0.534 (0.450 to 0.634)) and POAG (aHR (95% CI) 0.359 (0.300 to 0.429), 0.333 (0.282 to 0.392) and 0.334 (0.286 to 0.390)) at 1-year, 3-year, and 5-year follow-up, respectively (all p<0.001).

Systemic α₂-agonist use was associated with a substantially lower hazard of glaucoma-related diagnoses compared with systemic β-blocker use. These findings are limited by the observational design, potential residual confounding, and reliance on diagnostic coding. These results warrant further investigation in prospective mechanistic studies and randomised clinical trials.