Surgical and Long Term Results for Double Outlet Right Ventricle by the Type of Ventricular Septal Defect

Background: The results of biventricular repair for double outlet right ventricle have been improved in recent series. We studied the surgical and long term results for total correction of double outlet right ventricle by the type of ventricular septal defect. Material and Method: Between November 1979 and December 2003, 126 patients had biventricular repair for double outlet right ventricle. The mean age was 1.8 years (range 1∼44) and 86 patients (68.3%) were male. We classified and studied this disease by the type of VSD. Result: The locations of VSD were subaortic in 79 (62.7%), subpulmonary in 17 (13.5%), doubly committed in 16 (12.7%) and noncommitted in 14 (11.1%). 28 patients had palliative operation before total correction and the mean interval to total correction was 41.0±45.1 months. The methods of total correction were intraventricular baffling in 37 (29.4%), intraventricular baffling with patch enlargement of right ventricular outflow tract in 49 (38.9%), intraventricular baffling with Rastelli procedure in 15 (11.9%), arterial switch operation in 8 (6.3%) and REV procedure in 4 (3.2%), etc. Hospital mortality rate was 10.3% (13 patients) and 25 reoperations were performed in 24 patients (19.0%). The risk factors for hospital mortality and reoperation were cardiopulmonary bypass time (p=0.020) and previous palliative operation (p=0.013), respectively. Follow up was possible in 98 patients and mean follow up period was 118.9±70.7 months. The percent survival and survival for freedom from reoperation at 15 years were 82.5% and 66.7%, respectively. The survival rate was significantly lower (p=0.003) in transposition of great artery type and remote type than in simple ventricular septal defect type and tetralogy of Fallot type, but there was no statistical differences in survival rate for freedom from reoperation. Conclusion: It is thought to be that acceptible surgical and long term results can be obtained with application of appropriate methods of repair for double outlet right ventricle.ope

Postoperative Progress and Influencing Factors in Patients after Rastelli Procedure

Purpose : We have performed an analysis on patients who received Rastelli operation in our institute and reviewed their progress postoperatively. Various factors with suspected relationship to the outcome have been considered to help in future treatment and follow-up. Methods : We analyzed retrospectively 43 patients who either received Rastelli operation in Yonsei University Cardiovascular Center from March 1995 to April 1997 or who received post-procedural cardiac catheterization and follow-up echocardiography in the out-patient department after the procedure. Results : No statistically valid relationships were found between the age of the patient, their body weight, preoperative pulmonary arterial index and pressure, presence of pulmonary branchial stenosis and postoperative results. Cases with atrioventricular concordance showed lower age and body weight, and discordant cases exhibited lower ejection fraction 3 days postoperatively. Upon follow up, lower NYHA score was seen in patients with severe residual stenosis. In the group that received cardiac catheterization after the procedure, residual stenosis and right ventricular pressure measurement in echocardiography showed good correlation with the catheterization data. Conclusion : In cases where conduit insertions of the right ventricular outflow tract are required to achieve total correction in complex cardiac deformity, early operation does not seem to provide a clear risk to the patient. In patients with atrioventricular discordance, careful postoperative observation of the ventricular function seems to be needed. Also, echocardiography appears to be a sound method in follow-up of patients after the correctional procedure.ope

Conversion of Total Atrio-pulmonary Connection to Total Cavo-pulmonary Connection -Review of Indications and Hemodynamic Characteristics-

Purpose : Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. Methods : Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization 11? months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. Results : There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range : 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was 18.0?.6 mmHg, but baffle pressure, corresponding to right atrial pressure decreased to 14.8?.6 mmHg after TCPC. The size of the pulmonary arteries did not regress after TCPC. Conclusion : The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.ope

Morphologic Change of Pulmonary Arteries and Right Ventricular Outflow Tract after Total Correction of Tetralogy of Fallot : Risk Factors for Pulmonary Artery Junctional Stenosis

Background and Objectives: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. Methods: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.1±19.8 months, follow-up duration after operation 13.9±5.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. Results: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=0.776, p<0.01) and post-operative RVEDP(r=0.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade Ⅱ of residual PI than grade Ⅲ∼Ⅳ. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(pressure gradient, ㎜Hg)=5.43+16.24×[false aneurysmal change of RVOT]+14.13×[RVOT patch enlargement to LPA] + 16.89×PDA. Conclusion: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.ope

Mid-term Result of the Transcatheter Occlusion of Patent Ductus Arteriosus with Duct-Occlud Device and Procedure-Related Problems

Purpose : We will present our mid-term result of transcatheter closure of PDA with Duct-Occlud device(pfm. AG. Germany) after 12 months follow up and report the problems during the procedure. Methods : In total 154 patients, the Duct-Occlud devices were inserted in our institute from March, 1996 to August, 2002. Three types of Duct-Occlud device, i.e standard, reinforced, reinforced reverse cone coil were used. Echocardiographic examination was performed at 1, 6, 12 months after procedure. Results : The echocardiographic closure rate was 96% after 12 months. The rates of residual shunt in the standard coil, the reverse cone coil, and the reinforced reverse cone group were 8%, 4% and 3% respectively. In PDA with diameter less than 4 mm, the closure rate was up to 98% while in large PDA with more than 4 mm, it was 72% after 12 months. Embolization of the inserted coils had occurred in 5 cases with successful retrieval using snare catheter. The rupture of the core wire during the procedure and distortion of the original coil shape had occurred in 4 cases. Conclusion : The transcatheter occlusion with Duct Occlud is safe and effective method for small to moderate sized PDA less than 4 mm. The minimum diameter of the PDA seems to be the predictor of residual shunt. Further refinement of the device to overcome the procedure-related problems seems to be needed.ope

Medico-Surgical Cooperative Treatment of Pulmonary Atresia with Intact Ventricular Septum

Purpose : The actual clinical examples of co-appliance of catheter intervention with surgical procedures in the treatment of pulmonary atresia with an intact ventricular septum(PA/IVS) which we have experienced in our institution are here shown, and the anatomical and hemodynamical profiles between each method is compared. Methods : Medical records of 33 patients with PA/IVS who underwent various treatment from January, 1995 to December, 2000 were reviewed for a retrograde study. Results : In three out of 10 patients who underwent percutaneous balloon pulmonary valvotomy (PPV), residual pulmonary stenosis were observed in their out patient department(OPD) follow-ups, eventually necessitatig balloon pulmonary valvuloplasty(BPV). One out of three patients exhibited deterioration of tricuspid regurgitation after BPV, requiring surgical tricuspid annuloplasty(TAP). Two out of the seven patients who received primarily surgical right ventricle outlet tract(RVOT) repair without any systemic-pulmonary shunt or intervention needed additional intervention employing cardiac catheterization after operation. Two patients received interventional catheterization before surgical RVOT repair. In five out of 11 cases of Fontan type operation, coil embolization of collateral circulation was done before total cavo-pulmonary connection(TCPC), and in three cases, interventional catheterization was needed after TCPC. Conclusion : Both medical and surgical treatment modalities are widely used in management of PA/IVS patients, and recent results prove that medico-surgical cooperative treatment is essential.ope

Clinical Evaluation of Coronary Artery Fistula

Background: Coronary artery fistula is rare congenital anomaly, which account for 0.27∼0.40% of all congenital heart diseases. We report the clinical observations of 45 patients with coronary artery fistula. Material and Method: We reviewed all patients presented with or without symptoms of coronary artery fistula between 1987 and 2004. Age ranged from 1 to 83 years. Twenty-six patients were female. The patients were divided into 2 groups according to the presenting symptoms. Twelve patients were in group A (asymptomatic) and 33 patients in group B (symptomatic). The most common clinical presentation in group B was angina (18) followed by dyspnea (7), atypical chest pain (5), syncope (1), fatigue (1), and palpitation (1). Twenty-five patients were associated with other cardiac diseases, which were atrial septal defect (4), coronary artery occlusive disease (6), hypertension (12), and valvular heart disease (2). Result: Patients were followed-up for a mean period of 64.8±62.7 months. There was no complication related to coronary artery fistula during the follow-up period in both group. There was no mortality related to coronary artery fistula. Conclusion: In symptomatic patients, early surgical treatment is recommended considering the low perioperative morbidity. In asymptomatic patients receiving medical treatment, close follow up may be necessary.ope

Clinical studies on the heart diseases and pericardial fluid protein in Korean

의학과/박사[한글] 1929년 Forssmann이 수뇨관 도자를 이용하여 자기의 우심에 삽입하여 우심도자법을 시도한 이후 Cournand 및 Ranges(1941)는 이 방법을 심장질환진단 목적으로 이용하였고, Zimmerman등 (1950)은 좌심도자법에 성공하였으며, Sodi-Pollaries등 (1954)은 전극도자를 이용 좌우심장에 혈역학적 변동을 비교적 정확히 이해할 수 있게 하였다. 대부분의 심장질환은 심장내 혈역학적 변호를 초래하여 심장내의 혈류 및 압력등을 변동시키고 이 변화는 심질환의 진단, 수술의 적응, 수술후 예후를 추정하는데 지침이 되고 있다. 이와 같은 혈역학적 변동으로 인한 혈관의 압력변화는 심낭액의 분비 흡수 및 그 생화학적 성분의 변동을 관계하고 있는 것으로 생각된다. 심낭액의 분비 및 흡수기전 그 생화학적 성분 및 그 변동에 관하여 계통적 연구보고는 없다. Mellins등 (1970)에 의하면 동물실험에서 폐 및 체정맥의 압력이 상승하면 심낭액의 삼출증가를 가져온다고 하였고 Miller등 (1971)은 심장의 정맥과 임파관을 차단하여 epicardium(visceral pericardium)으로부터 심낭액이 유출되는 것을 관찰 보고하였으며, Hutchin 등 (1971)은 환자의 심낭액과 동맥혈의 전해질, 산염기조성 등에 관하여 비교 검토하였다. 즉 심낭액의 삼출 및 흡수기전, 그 생화학적 성분등은 심장 임파액의 유입 및 유출과정, 폐 동정맥 및 체 동정맥의 압력 및 plasma colloid osmotic pressure등등 여러 요소 가 관계하는 것으로 생각된다. 저자는 1963년부터 1975년까지 세브란스병원 심장검사실에서, 심도자검사에 의하여 심질환이 확진된 환자 1,252예와, 이 환자중 외과적 수술을 시행한 508예를 대상으로 심도자검사에 의한 심질환의 분포, 수술 성적, 심낭액 단백과 폐 동정맥의 혈류양 및 압력과 의 관계를 검색하는 동시에 단백분리에 있어 가장 예민한 원반전기 영동법(disc electrophoresis) 및 isoelectic focusing법을 이용하여 심낭액을 분획시도 하였다. 이상의 실험결과를 요약하면 다음과 같다. 1. 과거 12년간 (1963-1975) 세브란스 병원에서 심도자 검사로 진단한 심장질환 1,252예중 절반이 선청성(640예)이며 이 선천성 심질환예중 심실중격결손이 20.47%로 가장 많았고 활로씨 4증후는 17.66%로써 서구의 보고에서 보다 빈도가 높았다. 그러나 서구에서 적지않은 대동맥 교약증은 과거 12년간에 발견되지 않았고 심한 폐동맥 전색증은 1예에 불과하였다. 2. 개심술 265예의 사망률은 14%(37예), 비개심술 243예의 사망률은 4.5%(11예)로 총 심장수술 508예중 9.5%(48예)가 사망하였다. 3. 활로씨 4증후 및 심방중격결손증 환자의 심낭액 단백량은 정상이었으나 승모판 협착증에서는 심낭액단백량이 현저히 증가하였으며 이는 폐동맥 또는 좌심방의 압력이 정상보다 상승되면 단백량도 증가하는 것으로 해석된다. 4. 원반 전기영동법에 의한 심낭액단백의 분획상은 9-20개로 평균 13.7개의 분핵으로 나타났으며 그 양상이 혈청의 분획상과 거의 유사하였다. 5. Isoelectric focusing에 나타난 심낭단백 분획수는 19개로 나타났다. Clinical Studies on the Hear Diseases and Pericardial Fluid Protein in Korean Bum Koo Cho, Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Woo Choo Lee) Since 1929, Forssmann attempted originally the method of right heart catheterization by the insertion of the catheter into his own heart, it was developed as a diagnostic methods by Cournand and Ranges(1941). In 1950, the left heart catheterization was developed by Zimmermann, and it was popularized with the aid of electrode catheter which was modified by Sodi-Pollaries(1954). The hemodynamic changes in cardiac disoders in of great value to dertermine the status of the disoder, the surgical indication or its prognosis. Often the hemodynamic changes lead to elicit the accumulation of the pericardial fluid and bring about biochechemical changes of its contents. Little was known on the mechanism of pericardial fluid accumulation and resorption. Recently, Mellins et al (1970) reported some studies on the pericardial fluid accumulation during combined pulmonary and systemic venous hypertention. Hutchin et al (1971) reported on the changes of electolyte and Acid-Base composition of pericardial fluid. Miller et al suggested that the obstruction of the venous blood and lymph outflow from the heart muscle might lead to the formation of a pericardial effusion originating primarily from the epicardial surface of the heart(the visceral pericardium). Many factors have been identified as causing a pericardial effusion, but little attention has been given the mechanism by which pericardial fluid forms and accumulates. The present study was undertaken to observe 1) the incidence of the cardiac disease in 1,252 Korean patients who were diagnosed by the invasive technique, 2) the results of the heart surgery in 508 patients including open cardiac surgery, 3) the effects on pericardial fluid protein concentration due to pulmonary and left atrial hypertension in various cardiac disease, 4) results of fractionation of pericardial fluid by disc electrophoresis or isoelectric focusing. The results are summarized as follows; 1. Among 1,252 Korean heart disorders confirmed by invasive technique, one-half (640 cases) were congenital. In these congenital diseases 20.47% (131 cases) were revealed Ventricular Septal Defect and 17.66% (113 cases) were Tetralogy of Fallot, These incidences are higher than those of western and none of Coarctation of Aorta and only a case of severe Pulmonary Embolism was noted during past 12 years. 2. Overall hospital morality of cardiac surgery among 508 patients is 9.4%, and mortality of open cardiac surgery (14%) is higher than closed procedure (4.6%). 3. Protein concentration of pericardial fluid is normal in Tetralogy of Fallot and Atrial or Ventricular Septal Defect, but significantly increased in mitral stenosis which has pulmonary arterial and left arterial hypertension. 4. By means of disc electrophoresis, the human pericardial fluid separated into 9-20 fractions and the pattern of fraction is similar between protein in serum and pericardial fluid. 5. By isoelectric focusing of the human pericadial fluid, 19 fractions are identied. This study is Partially supported by the Faculty Grant(1975) of Yonsei University College of Medicine. [영문] Since 1929, Forssmann attempted originally the method of right heart catheterization by the insertion of the catheter into his own heart, it was developed as a diagnostic methods by Cournand and Ranges(1941). In 1950, the left heart catheterization was developed by Zimmermann, and it was popularized with the aid of electrode catheter which was modified by Sodi-Pollaries(1954). The hemodynamic changes in cardiac disoders in of great value to dertermine the status of the disoder, the surgical indication or its prognosis. Often the hemodynamic changes lead to elicit the accumulation of the pericardial fluid and bring about biochechemical changes of its contents. Little was known on the mechanism of pericardial fluid accumulation and resorption. Recently, Mellins et al (1970) reported some studies on the pericardial fluid accumulation during combined pulmonary and systemic venous hypertention. Hutchin et al (1971) reported on the changes of electolyte and Acid-Base composition of pericardial fluid. Miller et al suggested that the obstruction of the venous blood and lymph outflow from the heart muscle might lead to the formation of a pericardial effusion originating primarily from the epicardial surface of the heart(the visceral pericardium). Many factors have been identified as causing a pericardial effusion, but little attention has been given the mechanism by which pericardial fluid forms and accumulates. The present study was undertaken to observe 1) the incidence of the cardiac disease in 1,252 Korean patients who were diagnosed by the invasive technique, 2) the results of the heart surgery in 508 patients including open cardiac surgery, 3) the effects on pericardial fluid protein concentration due to pulmonary and left atrial hypertension in various cardiac disease, 4) results of fractionation of pericardial fluid by disc electrophoresis or isoelectric focusing. The results are summarized as follows; 1. Among 1,252 Korean heart disorders confirmed by invasive technique, one-half (640 cases) were congenital. In these congenital diseases 20.47% (131 cases) were revealed Ventricular Septal Defect and 17.66% (113 cases) were Tetralogy of Fallot, These incidences are higher than those of western and none of Coarctation of Aorta and only a case of severe Pulmonary Embolism was noted during past 12 years. 2. Overall hospital morality of cardiac surgery among 508 patients is 9.4%, and mortality of open cardiac surgery (14%) is higher than closed procedure (4.6%). 3. Protein concentration of pericardial fluid is normal in Tetralogy of Fallot and Atrial or Ventricular Septal Defect, but significantly increased in mitral stenosis which has pulmonary arterial and left arterial hypertension. 4. By means of disc electrophoresis, the human pericardial fluid separated into 9-20 fractions and the pattern of fraction is similar between protein in serum and pericardial fluid. 5. By isoelectric focusing of the human pericadial fluid, 19 fractions are identied. This study is Partially supported by the Faculty Grant(1975) of Yonsei University College of Medicine.restrictio

(A) clinical study of the intrahepatic calculi

의학과/석사[한글] [영문] It has been suggested that there may be many differences between Korean and Western cholelithiasis by late Professor Ludlow (1930) of Severance Union Medical College. Following the years clinical and pathological investigation had confirmed the Ludlow's statement and furthermore it is suggested that a high incidence of intrahepatic calculi may be the other factor contributing to the different clinical picture of Korean cholelithiasis. However, no document studies of the intraheoatic claculi of Korean are available yet. 85 cases of surgically proved intrahepatic calculi were observed among the 462 cases of the gall stone patients encountered at the Dept. of Surgery Yonsei University Medical College(1958, Jan-1967, June, 68 cases) and Korea General Hospital (1968. Nov.-1971. April, 17 cases) for the last 12 years. Clinical incidence, symptomatology, location of the stones, the classification for the selection of the method of treatment, and the change of operative method for the last 12 years were reviewed and evaluated. Incidence of the intrahepatic calculi to the all gall stone patients is about 18.4%. Peak incidence was noted at the 4th decade and youngest patient was 17 years old and oldest patient was 74 years old. There is no significant sex differences. The most prominent symptoms and signs are pain (89%) and tenderesis(93%) in the fight upper quardrant and epigastric region. Two third of all intrahepatic calculi harbored stones in the common hepatic or bileduct and one third of them were combined with gall bladder stones. The calculi were found in the left intrahepatic duct in 76(89.4%) cases, in the right intrahepatic duct in 55(64.7%) cases. In 6 cases (7.1%). calculi were limited only in the left intrahepatic duct but in no case right intrahepatic calculi was seen without combinations. The classification of the intrahepatic calculi based upon our clinical experiences is as follows; A type: Simple intrahepatic calculi B type: complicated intrahepatic calculi Ⅰ-: Intrahepatic calculi with stenosis at bifureation of both intrahepatic duct Ⅱ-: Intrahepatic calculi with stenosis in the left intrahepatic duct with or without contralateral intrahepatic calculi Ⅲ-: Intrahepatic calculi with stenosis in the right intrahepatic duct withor without contralateral intrahepatic calculi Ⅳ-: Intrahepatic calculi with multiole stenosis in the both intrahepatic ducts Most of the intrahepatic calculi is Simple type (34.8%) but Complicated B-Ⅳ type is the next most common (28.9%). First period of early 5 years (1958. Jan.-1962. Dec.) 22 out of 25 cases had no by-pass procedures and recurrent rate of biliary colic and the other symptoms were 81.8% (18 out of 22) and the most of them had to undergo another operations. At the second period (1963. Jan.-1967. June) 21 out of 43 had by-pass operation and the rest of 43(22 cases) had no by-pass operation with recurrent rate of 72.7%. During 3rd period from 1968. Nov. to 1971. April. 11 (64.7%) out of 17 cases had by-pass procedures without recurrency, and only 6 (35.3%) out of 11 had no by-pass procedure with 2 (33.3%) cases of recurrency. Throughout the three period of observations, there is increased tendency of indication of by-pass procedures at the time of primary surgery. The following surgical procedures for each type of intrahepatic calculi is considered as a choice of proper approach to conouer the problems of the intrahepatic calculi. A Type: Simple by-pass procedure(preferably Roux-en-Y type) B-Ⅰ Type: Templeton-Dodd's procedure with Roux-en-Y type B-Ⅱ Type: Longmire's procedure B-Ⅲ Type: Roux-en-Y choledocho-jejunostomy and right intrahepatico-jejunostomy B-Ⅳ Type: No definite treatment but simple by-pass procedure may be helpfulrestrictio

Outcomes of Stentless Thoracic Endovascular Aortic Repair for Chronic DeBakey IIIb Aneurysms

Background: We introduce a new endovascular procedure for favorable aortic remodeling in patients with chronic DeBakey IIIb (CDIIIb) aneurysms and present outcomes. Methods: This study included 19 patients who underwent stentless thoracic endovascular aortic repair (TEVAR) for CDIIIb aneurysms between 2014 and 2016. Stentless TEVAR is defined as an endovascular procedure involving closure of communicating channels or obliteration of the false lumen itself using various materials. Thoracic false lumen thrombosis was defined as there was no flow in the false lumen of the thoracic aorta. Aortic diameter was measured at 3 levels (left subclavian artery, pulmonary artery bifurcation, and celiac axis). Results: Fifteen of 19 (78.9%) patients demonstrated thoracic false lumen thrombosis. There was no mortality, and the mean follow-up duration was 16.8 months. False and true lumen diameters at the left subclavian and pulmonary artery levels significantly changed after the procedure (false lumen: 22.6 ± 16.6 versus 16.1 ± 14.4 mm, 23.2 ± 14.6 versus 18.0 ± 13.2 mm, p = 0.001 and p = 0.002, respectively; true lumen: 22.7 ± 8.7 versus 27.9 ± 6.3 mm, 19.0 ± 8.3 versus 24.3 ± 6.7 mm, p = 0.001 and p = 0.001, respectively). The number of visceral stent grafts and preoperative true lumen diameter at the pulmonary artery were independent predictors for thoracic false lumen thrombosis (hazard ratio, 3.445, 95% confidence interval, 1.494 to 7.946; p = 0.004; and hazard ratio, 1.106; 95% confidence interval, 1.029 to 1.189; p = 0.006, respectively). Conclusions: Stentless TEVAR seems to be a safe procedure and enables favorable aortic remodeling. Thus, this technique can be useful in a selected group of patients with CDIIIb aneurysms.restrictio