Updated on 2023/07/19

写真a

 
TOKUDA Yoshiyuki
 
Organization
Nagoya University Hospital Cardiac Surgery Associate professor of hospital
Title
Associate professor of hospital
Contact information
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Degree 2

  1. 医学博士 ( 2008.1   名古屋大学 ) 

  2. 医学士 医師 ( 1997.3   北海道大学 ) 

Research Interests 4

  1. valvular heart disease TAVI SHD TAVR TMVR mitraclip MVP MAP AVR

  2. TEVAR EVAR hybrid aortic arch repair

  3. aortic aneurysm

  4. 医療経済 大規模データベース研究

Research Areas 7

  1. Life Science / Cardiovascular surgery

  2. Life Science / General surgery and pediatric surgery

  3. Life Science / Medical technology assessment

  4. Life Science / Cardiovascular surgery

  5. Life Science / Cardiology

  6. Life Science / Medical management and medical sociology

  7. Life Science / Medical systems

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Current Research Project and SDGs 6

  1. 大動脈の外科治療の成績向上

  2. 心臓弁膜症の低侵襲治療の成績向上と開発

  3. 大規模データベース研究

  4. Cost effectiveness of trans catheter aortic valve implantation

  5. 心臓血管外科領域 低侵襲血管内治療の成績向上 安全な治療とコストパフォーマンスの両立 卒後教育の推進

  6. Active Participation Speciality Surgeons in developing countries medical care

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Research History 7

  1. 独立行政法人労働者健康福祉機構 中部ろうさい病院心臓血管外科部長

    2009.8 - 2011.1

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    Country:Japan

  2. 国立病院機構名古屋医療センター心臓血管外科医員

    2008.4 - 2009.7

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    Country:Japan

  3. 名古屋大学附属病院 心臓外科医員

    2007.9 - 2008.3

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    Country:Japan

  4. 岐阜県立多治見病院 心臓血管外科医員

    2005.10 - 2007.8

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    Country:Japan

  5. Prince of Wales Hospital Cardiothracic surgery Registrar

    2004.6 - 2005.8

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    Country:Australia

  6. Wellington hospital Cardiothracic surgery Registrar

    2002.12 - 2004.6

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    Country:New Zealand

  7. 天理よろづ相談所病院レジデント

    1997.5 - 2002.11

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    Country:Japan

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Education 2

  1. Nagoya University   Graduate School, Division of Medical Sciences

    - 2008.1

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    Country: Japan

  2. Hokkaido University   Faculty of Medicine

    1991.4 - 1997.3

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    Country: Japan

Professional Memberships 16

  1. The Society of Thoracic Surgeons

  2. 日本集中治療学会

  3. 日本循環器学会

  4. 日本心臓血管外科学会

  5. 日本胸部外科学会

  6. 日本人工臓器学会

  7. European association of cardiothoracic surgery

  8. 日本血管外科学会

  9. 日本外科学会

  10. 日本経カテーテル心臓弁治療学会(JTVT)

  11. 関西胸部外科学会   評議員

  12. 日本集中治療学会

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  13. 日本胸部外科学会

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  14. 日本心臓血管外科学会

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  15. 日本循環器学会

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  16. The Society of Thoracic Surgeons

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Awards 4

  1. Best Reviewers Awards for 2020, Circulation Journal

    2021.4   Japanese circulation society  

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    Award type:Honored in official journal of a scientific society, scientific journal 

  2. Circulation Journal Best Reviewers Award for 2020

    2020  

    徳田順之

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  3. Presented at Best Papers Focus Session in 2016 European Association for Cardio-Thoracic Surgery Annual Meeting

    2017.10   European Association for Cardio-Thoracic Surgery   Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis

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    Award type:Award from international society, conference, symposium, etc. 

  4. 第64回 胸部外科学会優秀演題賞

    2011.10   日本胸部外科学会  

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    Award type:Award from Japanese society, conference, symposium, etc.  Country:Japan

 

Papers 99

  1. Impact of an improved driveline management for HeartMate II and HeartMate 3 left ventricular assist devices. Reviewed International journal

    Masato Mutsuga, Takahiro Okumura, Ryota Morimoto, Toru Kondo, Hideki Ito, Sachie Terazawa, Yoshiyuki Tokuda, Yuji Narita, Kazuki Nishida, Toyoaki Murohara, Akihiko Usui

    Artificial organs   Vol. 47 ( 2 ) page: 387 - 395   2023.2

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    BACKGROUND: We evaluated the impact of a standardized driveline care strategy, including a subfascial-tunneling method and dressing protocol, on the incidence of driveline infection (DLI). METHODS: DLI data from all HeartMate II (HMII) and HeartMate 3 (HM3) patients (including exchange devices) were retrospectively collected between 2013 and 2021. The driveline subfascial-tunneling method was altered in three steps (A: right direct; B: left triple, C: right triple), and the shower protocol was changed in two steps (A: with/without cover, B: with cover). Disinfection was individually tailored after changing the shower protocol. Complications associated with morbidity and mortality were evaluated for each modification. RESULTS: During the study period, 80 devices were implanted (HMII, n = 54; HM3, n = 26). The 8-year incidence of DLI was 15% (n = 8) in HMII patients and 0% in HM3 patients (p = 0.039). DLI was not associated with hospital mortality. The modified dressing protocol and tunneling method was associated with a significantly better DLI incidence rate in comparison to the previous one: Protocol-A (n = 17), Protocol-B (n = 63), 35% vs 3% (p = 0.0009), Method-A (n = 13), Method-B (n = 42), Method-C (n = 25), 46% vs 5% vs 0% (p = 0.0001). The rete of freedom form DLI at 1, 2, and 3 years had also significant difference between groups: Protocol-A and Protocol-B, 80%, 54%, 54% vs 96%, 96%, 96%, respectively (p < 0.0001), Method-A, Method-B and Method-C, 76%, 44%, 44%, vs 94%, 94%, 94% vs 100%, 100%, respectively (p < 0.0001). CONCLUSIONS: A standardized triple driveline tunneling strategy and waterproof dressing protocol reduced driveline infection in HM3 patients to 0%.

    DOI: 10.1111/aor.14426

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  2. Impact of Early Ambulation on the Prognosis of Coronary Artery Bypass Grafting Patients Reviewed

    Tsuchikawa Yohei, Tokuda Yoshiyuki, Ito Hideki, Shimizu Miho, Tanaka Shinya, Nishida Kazuki, Takagi Daichi, Fukuta Akimasa, Takeda Natsuki, Yamamoto Hiromasa, Hori Masaya, Nishida Yoshihiro, Mutsuga Masato

    Circulation Journal   Vol. 87 ( 2 ) page: 306 - 311   2023.1

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:The Japanese Circulation Society  

    <p><b><i>Background:</i></b> The effect of delayed ambulation on the outcome of coronary artery bypass grafting (CABG) remains to be clarified.</p><p><b><i>Methods and Results:</i></b> The long-term and in-hospital outcomes of 887 patients who underwent isolated CABG (455 off-pump cases, 135 urgent cases) were evaluated, with a focus on the timing of first ambulation. In-hospital mortality cases were excluded. Early ambulation (first ambulation within 3 days after operation) was achieved in 339 (38%) patients. In the multivariable logistic regression analysis, longer operation time and urgent case, EuroSCORE II, re-thoracotomy, and respiratory time were associated with delayed (≥4 days) ambulation. Delayed ambulation was associated with a high incidence of postoperative complications, such as pneumonia, and stroke (P<0.01). Following discharge, 22.2% of patients experienced major cardiac events and 13.8% died during the follow-up period (median follow-up 60 months). Cox hazards analysis revealed that delayed ambulation was associated with long-term adverse events (hazard ratio 1.04 per day, P<0.001). With adjustment for preoperative factors, the estimated future risk of adverse events was found to be increased day-by-day during the delay until initial ambulation.</p><p><b><i>Conclusions:</i></b> In isolated CABG patients, delayed ambulation was associated with poor outcomes, even in the long-term period. The results support the current guideline recommending early ambulation protocol after cardiac surgery.</p>

    DOI: 10.1253/circj.CJ-22-0416

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  3. Impact of Albuminuria on the Prognosis After Transcatheter Aortic Valve Implantation.

    Tobe A, Tanaka A, Tokuda Y, Shirai Y, Miyazaki T, Yuhara S, Akita S, Furusawa K, Ishii H, Mutsuga M, Murohara T

    The American journal of cardiology   Vol. 186   page: 156 - 162   2023.1

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:American Journal of Cardiology  

    The impact of preoperative albuminuria on the prognosis after transcatheter aortic valve implantation (TAVI) has not been studied. A total of 228 patients who underwent TAVI for severe aortic stenosis (AS) and for whom preoperative urinary data was available were retrospectively investigated. Patients were divided into two groups according to the urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). The urinary total protein-to-creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was the composite outcome of all-cause death and readmission for heart failure. In total, 117 patients had a high ACR and 111 patients had a low ACR. During the median follow-up period of 467 days, patients with a high ACR had a higher incidence of the primary outcome than those with a low ACR (p<0.001). Patients with a high PCR or positive dipstick proteinuria were also at a higher risk for the primary outcome (p<0.001 and p=0.008, respectively). Multivariable Cox proportional hazards analysis showed a high ACR was independently associated with a primary outcome (hazard ratio, 4.98; 95% confidence interval, 1.84–13.49; p=0.002). In conclusion, preoperative albuminuria is an independent predictor of cardiac events in patients with severe AS undergoing TAVI.

    DOI: 10.1016/j.amjcard.2022.09.020

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  4. Higher F-wave frequency associates with poor procedural success rate after Maze procedure.

    Usui R, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Inden Y, Murohara T, Usui A

    General thoracic and cardiovascular surgery   Vol. 70 ( 12 ) page: 997 - 1004   2022.12

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    Objectives: Persistent atrial fibrillation (AF) causes atrial remodeling, which causes myocardial fibrosis and micro-reentry. Fibrosis may reduce wave voltage and micro-reentry may enhance the dominant frequency (DF) of the F-wave. We investigated whether the DF predicts procedural success by the Maze procedure. Methods: In 138 consecutive patients who underwent mitral valve surgery and a modified Cox-Maze III procedure for persistent AF in Nagoya University in 2002–2018, 96 (70%) were successfully cardioverted (group S); 42 had persistent or relapsed AF after surgery (group F). Patient data were compared between the groups. Cut-off values were determined by an ROC analysis and predictors of procedural success were evaluated. The DF was obtained from the F-wave of V1 by a high-speed Fourier analysis using the CEPAS software program. Results: Group F showed a significantly larger LA diameter, better LVEF, lower F-wave voltage, higher DF, and longer duration of AF. The cut-off values were as follows: LA diameter, 56 mm; EF, 64.5%; F-wave voltage, 0.13 mV; DF, 7.3 Hz; and duration of AF, 44 months. Each factor showed statistical significance in a univariate analysis; DF lost significance in the multivariate analysis. The higher (DF ≥ 7.3 Hz) and lower voltage group (≤ 0.13 mV) showed the worst procedural success rate (36%), while the lower DF (< 7.3 Hz) and higher voltage group (> 0.13 mV) showed a good rate (86%). Conclusions: The DF of the F-wave is a useful predictor of procedural success after the Maze procedure in addition to the voltage of F-wave.

    DOI: 10.1007/s11748-022-01836-0

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  5. Albuminuria predicts short-term worsening renal function after transcatheter aortic valve replacement Reviewed International journal

    Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yoshinori Shirai, Satoshi Otsuka, Toshikuni Yamamoto, Masayoshi Tokoro, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

    Cardiovascular Revascularization Medicine   Vol. 42   page: 178 - 181   2022.9

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    DOI: 10.1016/j.carrev.2022.03.014

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  6. Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus. International journal

    Yano D, Yokoyama Y, Tokuda Y, Kato M, Mashiko Y, Kuwabara F, Ebata T, Usui A

    Surgery today   Vol. 52 ( 7 ) page: 1016 - 1022   2022.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Surgery Today  

    Purposes: The optimal surgical management of renal cell carcinoma with tumor thrombus within the inferior vena cava (IVC) remains to be clarified. Methods: Sixteen consecutive cases were reviewed. Incision, the IVC clamping position, and the venous drainage procedure were modified according to the tumor thrombus extension level: level I or II (below the hepatic vein, n = 8), level III (above the hepatic vein but below the right atrium, n = 5), and level IV (extending into the right atrium, n = 3). Results: For level I or II, resection could be simply achieved by clamping the IVC below the hepatic vein, without hemodynamic collapse. For level III, clamping the IVC above the hepatic vein and the hepatoduodenal ligament was required. Venous drainage from the lower body (cannulation to distal IVC) and portal system (cannulation to ileocolic vein) were applied. When opening the IVC, the significant backflow was controlled using cardiopulmonary bypass with drop-in suckers. For level IV, median sternotomy, exposure of the right atrium, and cardiopulmonary bypass were mandatory. With the combination of these approaches, the perioperative mortality rate was 0% and the 5-year overall survival rate was 52%. Conclusions: A multidisciplinary surgical approach is essential, especially for level III and IV cases.

    DOI: 10.1007/s00595-021-02415-1

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  7. Albuminuria predicts worsening renal function after transcatheter aortic valve replacement Reviewed International journal

    Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Taro Fujii, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

    Journal of Cardiology   Vol. 79 ( 5 ) page: 648 - 654   2022.5

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    DOI: 10.1016/j.jjcc.2021.11.014

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  8. Predictors of Failure of Mitral Valve Repair Using Artificial Chordae. Reviewed International journal

    Masato Mutsuga, Yuji Narita, Yoshiyuki Tokuda, Wataru Uchida, Hideki Ito, Sachie Terazawa, Masato Nakaguro, Akihiko Usui

    The Annals of thoracic surgery   Vol. 113 ( 4 ) page: 1136 - 1143   2022.4

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    BACKGROUND: We investigated predictors of failure of mitral valve repair (MVr) using expanded polytetrafluoroethylene (ePTFE) and its durability in the long term in a single institution. METHODS: Four hundred twenty-one consecutive patients with primary mitral valve disease underwent MVr using artificial chordae (group A, n = 304) and suture repair (group S, n = 117) at our institution from January 2002 to April 2020. A comparison study was performed to examine the long-term outcomes, reoperation rate, and risk factors for reoperation. RESULTS: One hospital death and 5 late deaths occurred in group S, and 20 late deaths occurred in group A. The reoperation rates were similar: group A, n = 8 (2.6%); and group S, n = 6 (5%). The major cause of reoperation was ruptured ePTFE (CV-4, n = 1; CV-5, n = 6) in group A, and suture rupture in group S. Reoperation was performed after a median of 88 months for ruptured ePTFE, and 26 months for group S. The rate of ePTFE rupture was 1.8% with CV-5 and 0.2% with CV-4. Risk factors for reoperation included postoperative arrhythmia, urgent operation, no annular ring, ruptured ePTFE, and suture rupture. The rates of freedom from reoperation and actuarial mitral valve survival rates at 5, 10, and 15 years were 99%, 95%, and 93% and 96%, 91%, and 89%, respectively, in group A; and 96%, 91%, and 91% and 95%, 94%, and 94%, respectively, in group S. CONCLUSIONS: The long-term surgical outcomes of MVr using both techniques were feasible. Over the long term, the ePTFE rupture rate of CV-5 was higher than that of CV-4.

    DOI: 10.1016/j.athoracsur.2021.04.084

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  9. Computed tomography imaging using split-bolus contrast injection with volume scan of aortic root and heart for preoperative evaluation of transcatheter aortic valve implantation. International journal

    Koyanagi H, Tsutsumi Y, Tokuda Y, Tanaka A, Endo M, Furukawa Y, Abe S

    Heart and vessels   Vol. 37 ( 1 ) page: 132 - 141   2022.1

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    Authorship:Corresponding author   Language:English   Publishing type:Research paper (scientific journal)   Publisher:Heart and Vessels  

    The purpose of this study was to investigate using split-bolus contrast injection (SPBI) with volume scanning of the heart and aortic root with helical scanning of the access route, compared to single bolus contrast injection (SI) with variable helical pitch scanning (VHP) of the heart and aortic root and access route in a preoperative evaluation before transcatheter aortic valve implantation (TAVI). Thirty-five patients who underwent preoperative CT before TAVI using SPBI (contrast media: 24.5 mgI /kg/s, injected for 12 s for heart scan and then injected for 8 s for access route) were examined. Electrocardiogram (ECG) gated scans of the heart were performed by volume scan, after a period of time, non-gated helical scans of the aorto-iliac were performed (SPBI method). For comparison, 40 patients who had a single bolus injection (26.5 mg I/kg/s, injected for period of the scan time plus 3 s) and a VHP scan (SI method) before the SPBI method was performed were included in the study. The image qualities of the coronary arteries, aortic root, and access route (aorta-iliac), as well as radiation and iodine doses, were assessed. In visual assessment, image quality of coronary artery was significantly better with the SPBI method (grade; excellent: 57.1% in SPBI vs. 24.3% in SI, p = 0.03). There was no significant difference in image quality of the aortic root by visual assessment. The signal-to-noise (SNR) and contrast-to-noise ratio (CNR) of coronary and aortic root were not significantly different between the two methods. The access route showed significantly higher SNR (45.7 ± 11.5 vs. 34.3 ± 9.8, p < 0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p < 0.001) for the SPBI method. The SPBI method compared to SI method reduced iodine dose by 10% and radiation dose by 45%. Preoperative CT imaging before TAVI using SPBI with volume scan is useful and can reduce iodine and radiation doses.

    DOI: 10.1007/s00380-021-01899-8

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  10. Alternative therapeutic strategy for existing aortic aneurysms using mesenchymal stem cell-derived exosomes. Reviewed

    Kozakai M, Narita Y, Yamawaki-Ogata A, Fujimoto KL, Mutsuga M, Tokuda Y, Usui A

    Expert opinion on biological therapy   Vol. 22 ( 1 ) page: 95 - 104   2022.1

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    Background: Several studies demonstrated the therapeutic potential of mesenchymal stem cell–derived exosomes (MSC-exs) based on their anti-inflammatory properties. The objective was to determine the therapeutic effects of MSC-exs on aortic aneurysms (AAs) caused by atherosclerosis. Research design and methods: Apolipoprotein E knockout mice with AAs induced by angiotensin II were injected with MSC-exs or saline as a control. The change in the diameter of the aorta was measured. The expression of AA-related proteins and the histology of the aortic wall were investigated at 1 week after treatment. MicroRNA and protein profiles of MSC-exs were examined. Results: MSC-exs significantly attenuated AA progression (2.04 ± 0.20 mm in the saline group and 1.34 ± 0.13 mm in the MSC-ex group, P = 0.004). In the MSC-ex group, the expression of IL-1β, TNF-α and MCP-1 decreased, and expression of IGF-1 and TIMP-2 increased. MSC-ex induced the M2 phenotype in macrophages and suppressed the destruction of the elastic lamellae in the aortic wall. MSC-exs contained high levels of 10 microRNAs that inhibit AA formation and 13 proteins that inhibit inflammation and promote extracellular matrix synthesis. Conclusions: MSC-ex might be a novel alternative therapeutic tool for treatment of existing AAs.

    DOI: 10.1080/14712598.2022.2005575

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  11. Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients. Reviewed

    Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yusuke Miki, Kenji Furusawa, Sho Akita, Taro Fujii, Yoshinori Tsutsumi, Hideki Ishii, Shingo Iwano, Shinji Naganawa, Akihiko Usui, Toyoaki Murohara

    Heart and vessels   Vol. 36 ( 12 ) page: 1911 - 1922   2021.12

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    Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19-40) days vs. 27 (19-43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223-805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

    DOI: 10.1007/s00380-021-01875-2

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  12. Sudden circulatory collapse caused by mechanical obstruction of the left main coronary trunk with infective endocarditis vegetation: a case report.

    Usui R, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Usui A

    Surgical case reports   Vol. 7 ( 1 ) page: 223   2021.10

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    DOI: 10.1186/s40792-021-01296-3

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  13. Hypofibrinogenemia can be estimated by the predictive formula in aortic surgery. Reviewed

    Toshihiko Nishi, Masato Mutsuga, Toshiaki Akita, Yuji Narita, Kazuro Fujimoto, Yoshiyuki Tokuda, Kazuki Nishida, Shigeyuki Matsui, Kimitoshi Nishiwaki, Akihiko Usui

    General thoracic and cardiovascular surgery   Vol. 69 ( 10 ) page: 1376 - 1382   2021.10

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    OBJECTIVE: Aortic surgery often causes massive bleeding due to hypofibrinogenemia. Predicting hypofibrinogenemia is useful for developing a hemostasis strategy, including preparing for blood transfusion. We made a formula for predicting the serum fibrinogen level (SFL) at the termination of cardiopulmonary bypass (CPB) in aortic surgery and examined its validity. METHODS: We performed a retrospective observational study that consisted of 267 patients (group A) who underwent aortic surgery from July 2013 to December 2016 and made a formula for predicting the SFL at the termination of CPB in group A by a multiple linear regression analysis. The validity of this formula was then examined in another 60 patients (group B) who underwent aortic surgery from January 2017 to December 2017. RESULTS: We developed the following predictive formula: SFL at the termination of CPB (mg/dL) = 14.7 + 0.44 × preoperative SFL (mg/dL) + (- 0.14) × CPB time (min) + 0.64 × preoperative body weight (kg) + (- 17.3) × lateral thoracotomy (Yes/No, Yes: 1, No: 0). In group B, the predictive formula proved to be statistically valid in group B (R2 = 0.531, p < 0.001). CONCLUSION: The SFL at the termination of CPB in aortic surgery can be predicted by the preoperative SFL, body weight, CPB time and surgical approach. The predictive formula is useful for developing a hemostasis strategy, including preparing for blood transfusion.

    DOI: 10.1007/s11748-021-01594-5

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  14. Improvement in the nutritional status after transcatheter aortic valve implantation Reviewed International journal

    Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Sho Akita, Yusuke Miki, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

    Journal of Cardiology   Vol. 78 ( 3 ) page: 250 - 254   2021.9

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    DOI: 10.1016/j.jjcc.2021.04.006

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  15. Worsening renal function after transcatheter aortic valve replacement and surgical aortic valve replacement. Reviewed International journal

    Tobe A, Tanaka A, Tokuda Y, Nishi T, Miki Y, Furusawa K, Ishii H, Usui A, Murohara T

    Heart and vessels   Vol. 36 ( 7 ) page: 1080 - 1087   2021.7

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    Several prior reports have investigated worsening renal function around transcatheter aortic valve replacement (TAVR) procedures. However, in clinical practice, it seems more important to evaluate changes associated with TAVR-related procedures, including preoperative enhanced computed tomography (CT), as well as the TAVR procedure itself, as CT assessment is considered essential for safe TAVR. This study evaluated worsening renal function during the TAVR perioperative period, from the preoperative enhanced CT to 1 month after TAVR, and then compared the incidence with that in patients undergoing surgical aortic valve replacement (SAVR). This retrospective single-center study investigated 123 TAVR patients and 130 SAVR patients. We evaluated baseline renal function before enhanced CT in TAVR patients and before operation in SAVR patients, and again at 1 month post-operatively. We defined worsening renal function at 1 month according to three definitions: (1) an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline or initiation of dialysis, (2) a decline in eGFR at 1 month ≥ 20% from baseline or initiation of dialysis, (3) a decline in eGFR at 1 month ≥ 30% from baseline or initiation of dialysis. TAVR patients were significantly older and had higher surgical risk scores than SAVR patients. In TAVR patients, serum creatinine levels were 1.00 ± 0.32 mg/dL at baseline and 1.01 ± 0.40 mg/dL at 1 month post-operatively (p = 0.58), while in SAVR patients, these levels were 0.99 ± 0.51 mg/dL and 0.98 ± 0.49 mg/dL, respectively (p = 0.59). In TAVR patients, 7 (5.7%), 14 (11.4%), and 3 (2.4%) patients experienced worsening renal function according to the three definitions, respectively, but there were no significant differences from those in SAVR patients, for any definition. Worsening renal function after TAVR was uncommon, and the incidence rate was comparable to that in SAVR patients, even though TAVR patients had worse baseline characteristics.

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  16. Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis International journal

    Tobe Akihiro, Tanaka Akihito, Tokuda Yoshiyuki, Akita Sho, Fujii Taro, Miki Yusuke, Furusawa Kenji, Ishii Hideki, Usui Akihiko, Murohara Toyoaki

    Circulation Journal   Vol. 85 ( 7 ) page: 1093 - 1098   2021.6

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    <p><b><i>Background:</i></b>The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated.</p><p><b><i>Methods and Results:</i></b>The study group included 64 patients who underwent TAVI for aortic stenosis. Their 12-lead ECGs before and at 2 days and 1, 6 and 12 months after TAVI were analyzed, and ECG-LVH was evaluated using various definitions. Values and prevalence of each ECG-LVH parameter significantly decreased between 1 and 6 months after TAVI. Values of ECG-LVH parameters decreased especially in patients with ECG-LVH at baseline.</p><p><b><i>Conclusions:</i></b>Regression of ECG-LVH was observed between 1 and 6 months after TAVI.</p>

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  17. Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair. Reviewed International journal

    Banno H, Mutsuga M, Sugimoto M, Tokuda Y, Kodama A, Usui A, Komori K

    European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery   Vol. 61 ( 6 ) page: 938 - 944   2021.6

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    Objective: Type I hybrid arch repair has become popular as a procedure that is less invasive than total arch replacement. The major advantage of this technique is that antegrade endograft implantation can be performed during the procedure, thereby avoiding the complications of introducing the endograft from the groin. The aim of this study was to assess the midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation. Methods: Thirty consecutive patients who underwent type I hybrid repair with antegrade endograft implantation from 2009 to 2015 were reviewed retrospectively. Patient demographics, and peri-operative and late results were collected from a prospective database and analysed. Results: Four patients (13%) were female and the median age was 78 years. Median aneurysm size was 64 mm. Six patients (20%) developed stroke, and the 30 day mortality rate was 3%. Two patients suffered aortic dissection at the site of debranching anastomosis. The median follow up was 5.2 years. All aneurysms remained stable or had decreased in size at three years, and 82% were stable at five years. Overall survival was 79% at three years and 71% at five years. The rates of freedom from aorta related death were 86% at three and five years, respectively. During the follow up period, three additional left subclavian artery embolisations and one endograft relining due to type IIIb endoleak were required. Conclusion: Midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation for aortic arch aneurysms are reported. Although the incidence of peri-operative stroke was high, late sac behaviour was acceptable.

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  18. Is Hybrid Repair for an Entire Shaggy Aorta Feasible? Reviewed International journal

    Mutsuga M, Tokuda Y, Narita Y, Terazawa S, Ito H, Usui A

    Heart, lung & circulation   Vol. 30 ( 5 ) page: 765 - 772   2021.5

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    Objective: This paper reviewed clinical experiences to evaluate the feasibility of a surgical strategy for an entire shaggy aorta. Methods: Fifty-two (52) surgeries (47 men, average age 72±7 years) were performed for an entire shaggy aorta at the current institution from 2002–2017. Open surgery was performed in 30 cases, including total arch replacement in 12, extended aortic arch replacement via L-shaped thoracotomy in 10 and median sternotomy combined with left thoracotomy in two, and thoracoabdominal aortic replacement in six. Hybrid procedures were performed in 22 cases: type I hybrid arch repair in six, type II hybrid arch repair in seven and type III hybrid arch repair in nine. Results: Hospital mortality was significantly higher with a hybrid repair: surgical, one case (3%); hybrid, six cases (27%), (p=0.0125). Stroke occurred at relatively high rates in both groups: surgical, seven cases (23%); hybrid, six cases (27%) (p=0.75). Spinal cord injury was significantly higher in hybrid repair: surgical, one case (3%); hybrid, seven cases (32%), (p=0.004). Open surgery revealed a better long-term survival rate than the hybrid procedure at 5 and 10 years: surgical, 82%, 65.7%; hybrid, 53%, 35.1%, respectively (p=0.0452). The rate of freedom from aortic events was significantly better with open surgery than a hybrid procedure at 5 and 10 years: surgical, 96%, 85%; hybrid, 83%, 41.3%, respectively (p=0.0082). Conclusions: Surgery for an entire shaggy aorta was frequently associated with embolic complications such as stroke, paraplegia, renal failure, and bowel necrosis. However, open surgical repair may produce better early and late outcomes and freedom from aortic events compared with hybrid repair.

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  19. Surgery for anomalous papillary muscle directly into the anterior mitral leaflet. Reviewed International journal

    Masato Mutsuga, Yoshiyuki Tokuda, Kazuro Fujimoto, Sachie Terazawa, Hideki Ito, Yuji Narita, Akihiko Usui

    The Annals of thoracic surgery   Vol. 111 ( 5 ) page: 1512 - 1518   2021.5

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    BACKGROUND: The anomalous insertion of papillary muscle directly into the anterior mitral leaflet is a rare congenital anomaly concomitant with hypertrophic cardiomyopathy. We herein report our surgical technique, which is designed to relieve left ventricular obstruction and preserve the mitral valve and sub-valvular apparatus. METHODS: Among 38 patients who underwent septal myectomy from 2007 to 2020, 4 had an anomalous mitral sub-valvular apparatus with papillary muscle with direct insertion into the anterior mitral leaflets. In all cases, mitral valve repair was accomplished with excision and reconstruction of all anomalous PMs, concomitant with septal myectomy. In other 34 patients, 20 cases needed mitral valve repair with regards to systolic anterior motion by hypertrophic cardiomyopathy. The comparison study was conducted between anomalous papillary muscle group (group A) and the others (group B). RESULTS: There was no early or late death in group A, three early death and two late death in group B. The mean peak gradient in the left ventricle was significantly decreased in both groups. Mitral valve regurgitation grade was also significantly decreased from 3 to 0.5 without valve replacement in group A, from 2 to 0.6 in group B. Six patients needed mitral valve replacement due to the thickness of anterior mitral leaflet in group B. CONCLUSIONS: Hypertrophic obstructive cardiomyopathy associated with the anomalous insertion of papillary muscle can be successfully treated without mitral valve replacement. Excision and reconstruction with the anomalous papillary muscle seems to be a feasible operation to reduce mitral regurgitation and relieve outflow tract obstruction.

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  20. Beating-heart total arch replacement for an octogenarian patient with severe heart failure. Reviewed International journal

    Mutsuga M, Banno H, Tokuda Y, Usui A

    Journal of cardiac surgery   Vol. 36 ( 3 ) page: 1126 - 1129   2021.3

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    Surgical outcomes of total arch replacement (TAR) have improved dramatically over the last decades. However, patients of advanced age and with a severely reduced cardiac function and an extended aortic arch aneurysm may not be candidates for conventional TAR. Endovascular and hybrid treatment for extended aortic aneurysm have demonstrated lower mortality and morbidity, and considered for the advanced age and high-risk patients. But endovascular with total de-branching technique remains challenging with the slightly dilated ascending aorta. Reducing the operation time, cardiac arrest time, and circulatory arrest time should be needed to resolve the problem for the conventional TAR with an advanced age and a severely reduced cardiac function. We herein introduce our surgical technique for the case of an 84-year-old man with a severely reduced cardiac function, who was successfully treated with beating heart TAR with minimization of the operation time, cardiac arrest time, and circulatory arrest time.

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  21. Sutures on the Anterior Mitral Leaflet to Prevent Systolic Anterior Motion. Reviewed International journal

    Tokuda Y, Fujimoto K, Narita Y, Mutsuga M, Usui A

    The Annals of thoracic surgery   Vol. 111 ( 3 ) page: e213 - e215   2021.3

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    Mitral valve systolic anterior motion and associated regurgitation remain a challenging problem in mitral valve plasty. A simple procedure to correct intraoperative systolic anterior motion using sutures applied between the tip of the anterior leaflet and the posterior annulus is presented. This technique reduces the movement of the anterior leaflet toward the septum while maintaining sufficient valve orifice area.

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  22. Perioperative D-dimer levels after transcatheter aortic valve replacement: Comparison of patients with and without anticoagulant therapy Reviewed International journal

    Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Toshihiko Nishi, Yusuke Miki, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

    Cardiology Journal   Vol. 28 ( 1 ) page: 170 - 172   2021

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  23. Upper thoracoabdominal aortic repair through partial posterior incision of the diaphragm via left thoracotomy Reviewed International journal

    Hideki Ito, Masato Mutsuga, Yoshiyuki Tokuda, Akihiko Usui

    General Thoracic and Cardiovascular Surgery   Vol. 68 ( 12 ) page: 1594 - 1595   2020.12

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  24. Serial Images of Aortic Plaque Rupture During Transfemoral Transcatheter Aortic Valve Replacement Reviewed International journal

    Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Sho Akita, Yusuke Miki, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

    JACC: Cardiovascular Interventions   Vol. 13 ( 22 ) page: e203 - e204   2020.11

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  25. Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement International journal

    Nishi Toshihiko, Tokuda Yoshiyuki, Tanaka Akihito, Furusawa Kenji, Miki Yusuke, Tobe Akihiro, Murohara Toyoaki, Usui Akihiko

    Circulation Reports   Vol. 2 ( 11 ) page: 701 - 702   2020.10

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  26. Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients: predictors of in-hospital mortality and failure to be weaned from extracorporeal membrane oxygenation. Reviewed

    Yuji Mashiko, Tomonobu Abe, Yoshiyuki Tokuda, Hideki Oshima, Akihiko Usui

    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs   Vol. 23 ( 3 ) page: 225 - 232   2020.9

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    Postcardiotomy cardiogenic shock (PCCS) is a rare clinical entity associated with substantial morbidity and mortality. It is characterized by heart failure that results in an inability to be weaned from cardiopulmonary bypass (CPB). The aim of this study was to analyze the outcomes of extracorporeal membrane oxygenation (ECMO) in patients with PCCS and to identify predictors of in-hospital mortality and failure to be weaned from ECMO. From January 2002 to August 2016, 3248 patients underwent cardiac surgery in our hospital. Of these, 29 patients (0.89%) required ECMO because of an inability to be weaned from cardiopulmonary bypass. The median duration of ECMO support was 144 h (340-52 h) (range 17-818 h). Sixteen patients (55.2%) were weaned from ECMO, and 6 (20.7%) survived to hospital discharge. The multivariate analysis revealed that reoperation [odds ratio (OR): 13.667, 95% confidence interval (CI): 0.999-187.056, p = 0.05] and ECMO support duration > 130 h (OR: 17.688, 95% CI: 1.324-236.233, p = 0.03) were independent predictors of failure to be weaned from ECMO. Temporarily being weaned from CPB > 15 min (OR: 0.027, 95% CI: 0.001-0.586, p = 0.02) was found to be a protective factor. The multivariate analysis revealed that CPB time > 270 min (OR: 12.503, 95% CI: 1.058-147.718, p = 0.05) and ECMO support duration > 60 h (OR: 12.503, 95% CI: 1.058-147.718, p = 0.05) were independent predictors of in-hospital mortality. ECMO is an acceptable technique for treating PCCS in patients undergoing cardiac surgery. Our data suggest a reevaluation of therapeutic strategies after 60 h and again after 130 h of ECMO support.

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  27. Correction to: Extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients: predictors of in‑hospital mortality and failure to be weaned from extracorporeal membrane oxygenation. Reviewed

    Yuji Mashiko, Tomonobu Abe, Yoshiyuki Tokuda, Hideki Oshima, Akihiko Usui

    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs   Vol. 23 ( 3 ) page: 233 - 233   2020.9

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    In the original publication of the article, author group affiliation was published incorrectly.

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  28. Modified sutureless repair using left atrial appendage flap for acquired left-sided pulmonary vein stenosis Reviewed International journal

    Hideki Ito, Masato Mutsuga, Yoshiyuki Tokuda, Akihiko Usui

    European Journal of Cardio-Thoracic Surgery   Vol. 58 ( 2 ) page: 395 - 397   2020.8

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    <title>Abstract</title>
    Pulmonary vein stenosis is a well-known complication after radiofrequency catheter ablation of atrial fibrillation. Although surgical repair is indicated for younger patients and patients with multiple stenoses, the appropriate procedure for acquired pulmonary vein stenosis has not been established. In this study, we report the successful outcome of our modified sutureless technique using a left atrial appendage flap for left-sided pulmonary vein stenosis after radiofrequency catheter ablation.

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  29. Bilateral versus single internal thoracic artery grafting in hemodialysis patients Reviewed International journal

    Hisaaki Munakata, Kazuyoshi Tajima, Wataru Kato, Keisuke Tanaka, Yoshiyuki Tokuda, Masato Mutsuga, Akihiko Usui

    General Thoracic and Cardiovascular Surgery   Vol. 68 ( 8 ) page: 768 - 773   2020.8

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  30. Management of Patients With Aortic Stenosis Requiring Non-Cardiac Surgery International journal

    Tokuda Yoshiyuki, Usui Akihiko

    Circulation Journal   Vol. 84 ( 7 ) page: 1064 - 1066   2020.6

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  31. Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database. Reviewed International journal

    Tomonobu Abe, Hiroyuki Yamamoto, Hiroaki Miyata, Noboru Motomura, Yoshiyuki Tokuda, Kazuo Tanemoto, Akihiro Usui, Shinichi Takamoto

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   Vol. 57 ( 4 ) page: 660 - 667   2020.4

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    OBJECTIVES: To evaluate the background trends and surgical outcomes for more than 10 000 patients with acute type A dissection in Japan in a recent 8-year period. METHODS: Data on replacement of the ascending aorta and/or aortic arch for acute type A dissection were collected from the Japan Cardiovascular Surgery Database from 2008 to 2015. Linear-by-linear association tests or Cuzick's test for trend was used to evaluate group trends over time. The results were calculated for ascending or hemiarch replacement and arch replacement. A multivariable logistic regression model was used to calculate the risk-adjusted operative mortality rate. RESULTS: A total of 11 843 patients were included. The overall 30-day mortality and operative mortality rates were 7.6% and 9.5%, respectively. The number of surgically treated cases increased from 2436 patients in 2008-2009 to 3533 in 2014-2015, a 45.0% increase. A trend analysis revealed significant changes in patient characteristics with time, including increasing age and rate of preoperative renal failure. Despite worsening risk factors, the unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01; test of trend). The risk-adjusted mortality rate showed a downward trend both in ascending aorta or hemiarch replacement and arch replacement, although the trend was not statistically significant (P > 0.05). CONCLUSIONS: Unadjusted and adjusted operative deaths have shown a decreasing trend, although patients undergoing surgery for acute type A dissection have demonstrated worsening of risk factors, such as age and renal failure. The number of surgeries performed for acute type A dissection significantly increased throughout the study period in Japan.

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  32. The incidence and risk factors of hypofibrinogenemia in cardiovascular surgery Reviewed International journal

    Toshihiko Nishi, Masato Mutsuga, Toshiaki Akita, Yuji Narita, Kazuro Fujimoto, Yoshiyuki Tokuda, Sachie Terazawa, Hideki Ito, Kimitoshi Nishiwaki, Akihiko Usui

    General Thoracic and Cardiovascular Surgery   Vol. 68 ( 4 ) page: 335 - 341   2020.4

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  33. Spinal cord injury following aortic arch replacement Reviewed International journal

    Yoshiyuki Tokuda, Kazuro Fujimoto, Yuji Narita, Masato Mutsuga, Sachie Terazawa, Hideki Ito, Yasumoto Matsumura, Wataru Uchida, Hisaaki Munakata, Shinichi Ashida, Tsukasa Ono, Toshihiko Nishi, Daisuke Yano, Shinichi Ishida, Fumiaki Kuwabara, Toshiaki Akita, Akihiko Usui

    Surgery Today   Vol. 50 ( 2 ) page: 106 - 113   2020.2

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  34. Contemporary Outcomes of Surgical Aortic Valve Replacement in Japan

    Tokuda Yoshiyuki, Yamamoto Hiroyuki, Miyata Hiroaki, Usui Akihiko, Motomura Noboru, The Japan Cardiovascular Surgery Database Organization

    Circulation Journal   Vol. 84 ( 2 ) page: 277 - 282   2020.1

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    <p><b><i>Background:</i></b>Given the rapid expansion in the use of transcatheter aortic valve implantation (TAVI), recent outcomes of surgical aortic valve replacement (SAVR) should be re-evaluated.</p><p><b><i>Methods and Results:</i></b>Using the data from the Japan Cardiovascular Surgery Database of 160 enrolled hospitals, trends in elective isolated SAVR were evaluated until the introduction of TAVI in Japan. Trend analyses were performed over 4 periods: period 1, 2008–2009 (4,415 cases); period 2, 2010–2011 (4,861 cases); period 3, 2012–2013 (5,674 cases); and period 4, 2014–2015 (5,563 cases). Baseline risk, evaluated on JapanSCORE, increased significantly over the 4 periods, from a median of 1.56 (IQR, 0.99–2.61) in period 1 to 2.08 (IQR, 1.33–3.96) in period 4 (P<0.001, trend test). Despite the increased risk, the composite major complication and operative mortality rate decreased significantly (10.7% in period 1 to 9.2% in period 4, P=0.01). Using a risk-adjusted model, the OR of operative mortality was 1.61 (95% CI: 1.29–2.02) in period 1 (P<0.0001) compared with period 4. An increase in the use of bioprostheses was also observed, from 60.4% to 76.8% (P<0.001) over the 4 periods.</p><p><b><i>Conclusions:</i></b>Even in a short 8-year period, SAVR outcomes improved in Japan. This should be taken into account when discussing the indications for aortic valve intervention.</p>

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  35. Mechanical haemolytic anaemia assessed with four-dimensional flow cardiac magnetic resonance International journal

    Uchida Wataru, Tokuda Yoshiyuki, Takehara Yasuo, Usui Akihiko

    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY   Vol. 56 ( 4 ) page: 813 - 814   2019.10

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    A 66-year-old woman developed marked haemolytic anaemia 2 years after total aortic arch replacement using a branched Dacron graft. Echocardiography confirmed bicuspid aortic valve stenosis. A four-dimensional flow magnetic resonance imaging revealed a jet flow arising from the aortic valve along with the vortex and turbulent flow inside the kinked prosthetic graft at the ascending aorta. She underwent a reoperation to replace the aortic valve and correct the kinking. The estimated energy loss after intervention was relieved to 2.9 mJ/cardiac cycle from 4.3 mJ/cardiac cycle before intervention. The patient's anaemia resolved immediately after the reoperation.

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  36. Temporary immobile leaflet following transcatheter aortic valve replacement of a SAPIEN-XT valve. Reviewed International journal

    Aoki T, Tanaka A, Tokuda Y, Oshima H, Suzuki S, Ishii H

    Cardiovascular intervention and therapeutics   Vol. 34 ( 3 ) page: 277 - 278   2019.7

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  37. Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis Reviewed International journal

    Yoshiyuki Tokuda, Yuji Narita, Kazuro Fujimoto, Masato Mutsuga, Sachie Terazawa, Hideki Ito, Wataru Uchida, Akihiko Usui

    The Annals of Thoracic Surgery   Vol. 108 ( 1 ) page: 107 - 114   2019.7

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  38. Conservative treatment of type A aortic dissection following hybrid arch repair

    Yoshizumi Tomo, Tokuda Yoshiyuki, Abe Tomonobu, Usui Akihiko

    GENERAL THORACIC AND CARDIOVASCULAR SURGERY   Vol. 67 ( 7 ) page: 602 - 607   2019.7

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    OBJECTIVE: Type A aortic dissection (TAAD) following hybrid arch repair (HAR) is a lethal complication. Open surgical repair is the ideal treatment, but this can be difficult, as most candidates have complications and are unsuitable for the conventional open aortic repair. We herein report three cases of TAAD after HAR and assess the treatment options. METHODS: Of 261 aortic arch repair cases between April 2010 and March 2018, 38 underwent HAR using debranching of all the arch vessels followed by stent graft implantation landing proximally in zone 0 (type 1 HAR). Three cases suffered from TAAD, and their background characteristics and post-operative outcomes were studied retrospectively. RESULTS: The three TAAD cases were elderly with a high risk of mortality due to comorbidities. TAAD for Cases 1, 2, and 3 was detected on post-operative day (POD) 11, POD11, and during the procedure, respectively. Case 1 was complicated with both respiratory and renal failures, and Case 3 suffered from severe neurological impairment when TAAD was detected. No additional open aortic repair was performed in any cases. Case 3 died on POD5 due to aortic rupture. Cases 1 and 2 have survived for more than 50 months since their initial surgeries. CONCLUSIONS: TAAD following HAR can be detected with post-operative imaging despite a lack of signs noted during the intra- and post-operative periods. Conservative therapy might, therefore, be an acceptable option for subacute-onset TAAD following HAR with stable hemodynamics, even though such patients do required a very careful follow-up.

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  39. Dementia and Cognitive Impairment on Coronary Artery Bypass Grafting Patients in Aging Society International journal

    Terazawa Sachie, Narita Yuji, Fujimoto Kazuro, Mutsuga Masato, Tokuda Yoshiyuki, Ito Hideki, Uchida Wataru, Usui Akihiko

    Journal of Coronary Artery Disease   Vol. 25 ( 3 ) page: 66 - 71   2019

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    Coronary artery bypass grafting (CABG) is strategy for complex coronary artery disease (CAD) practiced worldwide that has become to be performed in relatively elderly patients in recent years, regarding to the development of off-pump CABG. As the population of elderly patients with cognitive disorders increases, a certain proportion of CABG candidates are likely to have some degree of cognitive impairment, especially dementia. The discussions about the CABG candidates with dementia are still insufficient, although several reports have suggested that 9.6%&ndash20% of CABG candidates may have preoperative dementia. An analysis indicated higher rate of hospital mortality and delirium in dementia patients, but ideal strategies for managing such patients remain controversial. An estimated 20%&ndash35% of CABG patients may have preoperative mild cognitive impairment (MCI), which is associated with an increased risk of morbidity and poor physical recovery after CABG. This preoperative cognitive decline was identified as a predictive factor for post-operative cognitive decline (POCD). Several randomized control trial have compared the cognitive outcomes between elderly high-risk patients after CABG with or without cardiopulmonary bypass, finding no significant cognitive differences between on- and off-pump treatments at 3 to 12 months after CABG. In addition, any late cognitive decline is likely associated with the progression of underlying cerebrovascular disease rather than surgical procedure itself or cardiopulmonary bypass. Preoperative evaluations of the cognitive function may contribute to appropriate postoperative management, reduce the incidence of delirium and improve the overall surgical outcome.

    DOI: 10.7793/jcad.25.010

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  40. The oral administration of clarithromycin prevents the progression and rupture of aortic aneurysm. International journal

    Uchida W, Narita Y, Yamawaki-Ogata A, Tokuda Y, Mutsuga M, Lee Fujimoto K, Abe T, Oshima H, Usui A

    Journal of vascular surgery   Vol. 68 ( 6S ) page: 82S-92S.e2 - 92S.e2   2018.12

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    OBJECTIVE: The pathogenesis of aortic aneurysm (AA) is associated with chronic inflammation in the aortic wall with increased levels of matrix metalloproteinases (MMPs). Clarithromycin (CAM) has been reported to suppresses MMP activity. In this study, we investigated whether CAM could prevent the formation and rupture of AA. METHODS: Male apolipoprotein E-deficient mice (28-30 weeks of age) were infused with angiotensin II for 28 days. CAM (100 mg/kg/d) or saline (as a control) was administered orally to the mice every day (CAM group, n = 13; control group, n = 13). After the administration period, the aortic diameter, elastin content, macrophage infiltration, MMP levels, and levels of inflammatory cytokines, including nuclear factor κB (NF-κB), were measured. RESULTS: The aortic diameter was significantly suppressed in the CAM group (P < .001). No rupture death was observed in the CAM group in contrast to five deaths (38%) in the control group (P < .01). CAM significantly suppressed the degradation of aortic elastin (56.3% vs 16.5%; P < .001) and decreased the infiltration of inflammatory macrophages (0.05 vs 0.16; P < .01). Compared with the controls, the enzymatic activity of MMP-2 and MMP-9 was significantly reduced in the CAM group (MMP-2, 0.15 vs 0.56 [P < .01]; MMP-9, 0.12 vs 0.60 [P < .01]), and the levels of interleukin 1β (346.6 vs 1066.0; P < .05), interleukin 6 (128.4 vs 346.2; P < .05), and phosphorylation of NF-κB were also decreased (0.3 vs 2.0; P < .01). CONCLUSIONS: CAM suppressed the progression and rupture of AA through the suppression of inflammatory macrophage infiltration, a reduction in MMP-2 and MMP-9 activity, and the inhibition of elastin degradation associated with the suppression of NF-κB phosphorylation.

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  41. Strategy of Cardiovascular Surgery for Patients With Dementia as Evaluated by Mini-Mental State Examination. International journal

    Terazawa S, Oshima H, Narita Y, Fujimoto K, Mutsuga M, Tokuda Y, Yoshizumi T, Ito H, Uchida W, Usui A

    Circulation journal : official journal of the Japanese Circulation Society   Vol. 82 ( 12 ) page: 2998-3004 - 3004   2018.11

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    <p><b><i>Background: </i></b>The strategy for cardiovascular surgery in dementia patients is controversial, so we aimed to investigate whether preoperative dementia and its severity might affect the outcomes of cardiovascular surgery by evaluating with the Mini-Mental State Examination (MMSE). </p><p><b><i>Methods and Results: </i></b>The study group comprised 490 patients undergoing cardiovascular surgery. Their preoperative cognitive status was evaluated using the MMSE, and analysis was performed to compare the patients with MMSE score <24 (dementia group, n=51) or MMSE score 24–30 (non-dementia group, n=439). Furthermore, the effect of the severity of dementia was analyzed with a cut-off MMSE score of 19/20. Risk factors for surgical outcomes were explored using multivariate logistic regression analysis. Hospital mortality was 11.8% in the dementia group and 2.1% in the non-dementia group (P=0.002). Regarding the postoperative morbidities, the incidence of cerebrovascular disorder (P=0.001), pneumonia (P=0.039), delirium (P=0.004), and infection (P=0.006) was more frequent in dementia group. Among the patients with MMSE <20, hospital mortality was as high as 25%, and the rate of delirium was 58%. Multivariate logistic regression analysis revealed that MMSE score <24 (P=0.003), lower serum albumin (P=0.023) and aortic surgery (P=0.036) were independent risk factors for hospital death. </p><p><b><i>Conclusions: </i></b>Preoperative dementia affects the outcomes of cardiovascular surgery with regard to hospital death and delirium. The surgical indication for patients with MMSE <20 might be difficult, but surgery with an appropriate strategy should be considered for patients with MMSE <24. </p>

    DOI: 10.1253/circj.CJ-18-0312

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  42. The Possibility of Clarithromycin for the Treatment of Type B Aortic Dissection.

    Uchida Wataru, Yamawaki-Ogata Aika, Hideki Ito, Sachie Tarazawa, Tokuda Yoshiyuki, Mutsuga Masato, Fujimoto Kazuro L., Yuji Narita, Usui Akihiko

    CIRCULATION   Vol. 138   2018.11

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  43. Aortic sarcoidosis complicated by a pulmonary artery aneurysm. Reviewed International journal

    Uchida W, Tokuda Y, Mutsuga M, Usui A

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   Vol. 54 ( 4 ) page: 786 - 788   2018.10

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    DOI: 10.1093/ejcts/ezy131

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  44. Fungal endocarditis after transcatheter aortic valve replacement (TAVR): Case report and review of literature. International journal

    Morioka H, Tokuda Y, Oshima H, Iguchi M, Tomita Y, Usui A, Yagi T

    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy   Vol. 25 ( 3 ) page: 215 - 217   2018.9

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    The reported number of transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) cases has been increasing worldwide, but information about the incidence and clinical features of fungal TAVR-IE is quite limited. We present a patient who acquired TAVR-IE caused by Candida parapsilosis four month after TAVR, who was successfully treated redo-aortic valve replacement and prolonged antifungal therapy.

    DOI: 10.1016/j.jiac.2018.08.017

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  45. Clinical outcomes and quality of life after surgery for dilated ascending aorta at the time of aortic valve replacement; wrapping versus graft replacement Reviewed International journal

    Tomonobu Abe, Sachie Terazawa, Hideki Ito, Yoshiyuki Tokuda, Kazuro Fujimoto, Masato Mutsuga, Yuji Narita, Hideki Oshima, Akihiko Usui

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 79 ( 4 ) page: 443 - 451   2017.11

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    Wrapping and graft replacement are two optional procedures for the treatment of dilated ascending aorta at the time of aortic valve replacement (AVR). Wrapping is considered less invasive. The aim of this study was to compare the short-and long-term clinical outcomes as well as the long-term quality of life in patients undergoing these two procedures. This study enrolled 40 consecutive patients with dilated ascending aorta who had undergone either wrapping (WAA group, n=20) or replacement (RAA group, n=20) of the ascending aorta at the time of AVR. Short-term outcomes, long-term deaths, and aortic events were evaluated, as was quality of life using the SF-36 Short Form. Long-term maximal proximal aortic diameter was also obtained. There were no early deaths in either group. Pump time was shorter, and transfusion (55% vs. 95%, p=0.035) and postoperative atrial fibrillation (5% vs. 30%, p=0.036) rates were lower, in the WAA than in the RAA group. At a mean follow-up of 4.9 years, the overall 5 year survival rates in the WAA and RAA groups were 78.1% and 87.5%, respectively. There were no significant between group differences in SF-36 scores in any subcategory of this survey. Long-term maximal aortic diameter remained stable in both groups. Both surgical interventions for dilated ascending aorta at the time of AVR yield favorable and comparable results in patients with suitable anatomy. Furthermore, we found no differences in quality of life between these procedures.

    DOI: 10.18999/nagjms.79.4.443

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  46. Entire Circumferential Reconstruction of the Right Atrium Surrounded by Angiosarcoma Reviewed International journal

    Makoto Hibino, Tomonobu Abe, Hideki Oshima, Yuji Narita, Masato Mutsuga, Kazuro L. Fujimoto, Yoshiyuki Tokuda, Koji Yamana, Taiyo Kuroda, Akihiko Usui

    ANNALS OF THORACIC SURGERY   Vol. 103 ( 6 ) page: e483 - e485   2017.6

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    Primary cardiac angiosarcomas are frequently found at a large size with infiltration into the adjacent heart structure owing to their asymptomatic characteristics until an advanced stage. Therefore, extensive resection is often required to achieve a good prognosis. We herein report a case of entire circumferential resection of the right atrium surrounded by angiosarcoma and excellent three-dimensional reconstruction of the right atrium. (C) 2017 by The Society of Thoracic Surgeons.

    DOI: 10.1016/j.athoracsur.2016.11.032

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  47. Total Arch Replacement Using Manufactured Frozen Elephant Trunk after Acute Type-A Dissection Repair

    Hibino M., Mutsuga M., Oshima H., Narita Y., Abe T., Fujimoto K., Tokuda Y., Usui A.

    Kyobu geka. The Japanese journal of thoracic surgery   Vol. 70 ( 4 ) page: 281 - 285   2017.4

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    The purpose of this study is to assess the result of total arch replacement(TAR) using manufactured frozen elephant trunk(FET) for chronic aortic dissection after initial repair including the effect of aortic remodeling by the FET. Between 2003 and 2015, we performed 11 TAR using manufactured FET. Initial repairs before were 9 ascending aortic replacements and 2 Bentall operations. The entry of residual dissection was located at arch in 7 and at distal anastomosis site in 4. There was no hospital death. The operative complication included 2 surgical site infection, 1 interstitial pneumonia and 1 paraplegia with almost full recovery. Postoperative computed tomography 2.1 months after operation showed distal end of the FET was located at aortic valve level in 7 and at pulmonary bifurcation level in 4. There was no entry in thoracic aorta. Thrombosis of descending aorta was achieved in 7 patients. Significant midterm aortic remodeling (increased diameter of true lumen and decreased diameter of false lumen) was achieved, although the total diameter of aorta was increased. TAR using manufactured FET after type-A dissection repair promoted entry closure and thrombosis of false lumen. It requires long-term observation to judge the effect for aortic remodeling.

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  48. [Total Arch Replacement Using Manufactured Frozen Elephant Trunk after Acute Type-A Dissection Repair]. International journal

    Hibino M, Mutsuga M, Oshima H, Narita Y, Abe T, Fujimoto K, Tokuda Y, Usui A

    Kyobu geka. The Japanese journal of thoracic surgery   Vol. 70 ( 4 ) page: 281-285   2017.4

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  49. Early and Late Outcomes of Thoracic Aortic Surgery in Hemodialysis Patients (vol 102, pg 1282, 2016) International journal

    M. Hibino, H. Oshima, Y. Narita, T. Abe, M. Mutsuga, K. L. Fujimoto, Y. Tokuda, S. Terazawa, H. Ito, A. Usui

    ANNALS OF THORACIC SURGERY   Vol. 103 ( 1 ) page: 366 - 366   2017.1

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  50. Increased expression of the adipocytokine omentin in the epicardial adipose tissue of coronary artery disease patients Reviewed

      Vol. 251   page: 299-304   2016.7

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    DOI: 10.1016/j.atherosclerosis

  51. Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch. Reviewed

    Tokuda Y, Oshima H, Narita Y, Abe T, Mutsuga M, Fujimoto K, Terazawa S, Ito H, Hibino M, Uchida W, Komori K, Usui A

    Interact Cardiovasc Thorac Surg   Vol. 22 ( 6 ) page: 750-755   2016.6

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    DOI: 10.1093

  52. A 'through-and-through bowing technique' for antegrade thoracic endovascular aneurysm repair with total arch debranching: a technical note and the initial results Reviewed

      Vol. 49   page: 1264-1269   2015.9

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    DOI: 10.1093/ejcts/ezv313

  53. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Reviewed

    Tokuda Y, Oshima H, Narita Y, Abe T, Araki Y, Mutsuga M, Fujimoto K, Terazawa S, Yagami K, Ito H, Yamamoto K, Komori K, Usui A

    Eur J Cardiothorac Surg.     page: ezv063. [Epub ahead of print]   2015

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  54. Brain protection during ascending aortic repair for Stanford type A acute aortic dissection surgery: A nationwide analysis in Japan Reviewed

    Yoshiyuki Tokuda, Hiroaki Miyata, Noboru Motomura, Hideki Oshima1, Akihiko Usui1, Shinichi Takamoto, The Japan Adult Cardiovascular Database Organization

    Circ J.   Vol. 78 ( 10 ) page: 2431-8.   2014.9

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  55. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Reviewed

    Tokuda Y, Miyata H, Motomura N, Araki Y, Oshima H, Usui A, Takamoto S;

      Vol. 96 ( 2 ) page: 571-6   2013.8

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  56. Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Reviewed

    Tokuda Y, Oshima H, Araki Y, Narita Y, Mutsuga M, Kato K, Usui A.

    Tokuda Y, Oshima H, Araki Y, Narita Y, Mutsuga M, Kato K, Usui A.   Vol. 43 ( 6 ) page: 1183-1187   2013.6

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  57. Recurrence of cardiac myxoma in the left atrial after 28 years; report of a case. Reviewed

    Takanohashi A, Usui A, Mutsuga M, Tokuda Y, Araki Y, Narita Y, Oshima H, Ueda Y.

    Kyobu Geka.   Vol. 65 ( 12 ) page: 1089-92.   2012.11

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  58. Association of a matrix metallopeptidase 1 gene polymorphism with long-term outcome of thoracic aortic aneurysm. Reviewed

    Kimihiko Kato, Yoshiyuki Tokuda, Naohiko Inagaki, Tetsuro Yoshida, Tetsuo Fujimaki, Mitsutoshi Oguri, Takeshi Hibino, Kiyoshi Yokoi, Toyoaki Murohara, Yoshiji Yamada.

    NTERNATIONAL JOURNAL OF MOLECULAR MEDICINE   Vol. 29 ( 1 ) page: 125-32.   2012.1

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  59. Cardiac 64-Multislice Computed Tomography Reveals Increased Epicardial Fat Volume in Patients With Acute Coronary Syndrome. Reviewed

    Harada K, Amano T, Uetani T, Tokuda Y, Kitagawa K, Shimbo Y, Kunimura A, Kumagai S, Yoshida T, Kato B, Kato M, Marui N, Ishii H, Matsubara T, Murohara T

    Am J Cardiol.   Vol. 108 ( 8 ) page: 1119-23   2011.10

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  60. Pneumopericardial Tamponade in a Patient With Partial Sternal Dehiscence

    Yoshiyuki Tokuda, Katsuhito Teranishi, Shin Morita, Kazuo Yamaguchi, Eiji Takeuchi.

    Ann Thorac Surg.   Vol. 89 ( 4 ) page: 1291-92   2010

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  61. Intraoperative heart rate variability of a cardiac surgeon himself in coronary artery bypass grafting surgery. Reviewed

    Min-Ho Song, Yoshiyuki Tokuda, Tomohiro Nakayama, Masami Sato, Keisuke Hattori

    Interact Cardiovasc Thorac Surg   Vol. 8 ( 6 ) page: 639-41   2009

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  62. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement. Reviewed

    Yoshiyuki Tokuda, Min-Ho Song, Hideki Oshima, Akihiko Usui, Yuichi Ueda

      Vol. 86 ( 2 ) page: 532-536.   2008

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  63. Three-dimensional numerical simulation of blood flow in the aortic arch during cardiopulmonary bypass.

    Yoshiyuki Tokuda, Min-Ho Song, Yuichi Ueda, Akihiko Usui, Toshiaki Akita, Shigeru Yoneyama, Shigeru Maruyama.

    Eur J Cardiothorac Surg   Vol. 33 ( 2 ) page: 164-167   2008

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  64. Aortic root aneurysm in Takayasu arteritis syndrome: exploration in active phase and repair in inactive phase. Reviewed

    Song MH, Nakayama T, Hattori K, Tokuda Y, Mabuchi Y, Ueda Y.

    J Thorac Cardiovasc Surg.   Vol. 136 ( 4 ) page: 1084-5   2008

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  65. Internal thoracic artery grafts and upper extremity arteriovenous fistula Reviewed

    Yoshiyuki Tokuda, Min-Ho Song.

    Ann Thorac Surg   Vol. 84 ( 6 ) page: 2138   2007

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  66. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. Invited Reviewed

    Yoshiyuki Tokuda, Min-Ho Song, Yuichi Ueda, Akihiko Usui, Toshiaki Akita.

    Ann Thorac Surg.   Vol. 84 ( 6 ) page: 1928-1933   2007

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    DOI: 10.1016/j.athoracsur.2007.07.040

  67. Right ventricular end-diastolic volume in the postoperative care of cardiac surgery patients: a marker of the hemodynamic response to a fluid challenge. Reviewed

    Yoshiyuki Tokuda, Min-Ho Song, Norifumi Mabuchi, Akihiko Usui, Yuichi Ueda

      Vol. 71 ( 9 ) page: 1408-1411   2007

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  68. Revival of the side-to-side approach for distal coronary anastomosis Reviewed

    Song MH, Tokuda Y, Ito T.

    Journal of Cardiothoracic Surgery   Vol. 6 ( 2 ) page: 2   2007

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  69. A simple training model for coronary artery anastomoses Reviewed

    Yoshiyuki Tokuda, Min-Ho Song.

    Heart Surgery Forum   Vol. 9 ( 6 ) page: E880-2   2006

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  70. Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery. Reviewed

    Yoshiyuki Tokuda, Peter W Grant, Hugh D Wolfenden, Con Manganas, William J Lyon, John S K Murala.

    Interact Cardiovasc Thorac Surg.   Vol. 5   page: 322-326   2006

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  71. A Simple Method of Stabilizing a Coronary Graft onto a Suction Stabilizer in Coronary Surgery. Reviewed

    Song MH, Tokuda Y, Ito T, Hirai M.

    Heart Surgery Forum   Vol. 9 ( 3 ) page: E612-13   2006

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  72. Nasal Mask Bi-level Positive Airway Pressure (BiPAP) Ventilation for Diaphragmatic Paralysis after Pediatric Open Heart Surgery. Reviewed

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa

    Pediatr Cardiol   Vol. 25 ( 5 ) page: 552-3   2005

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  73. Gastrointestinal complications in patients undergoing coronary artery bypass grafting. Reviewed

    Yoshida K, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, Matsuo T.

    Ann Thorac Cardiovasc Surg   Vol. 11 ( 1 ) page: 25-8   2005

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  74. Successful Repair of an Aortoesophageal Fistula due to a Thoracic Aortic Aneurysm Reviewed

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa, Katsuhiko Matsuyama, Kazunori Yoshida, Takehiko Matsuo.

    Surg Today   Vol. 34 ( 4 ) page: 357-9   2004

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  75. Management for type A acute dissection Reviewed

    Sugita T, Matsumoto M, Nishizawa J, Matsuyama K, Kawanishi Y, Tokuda Y, Yoshida K, Uehara K, Matsuo T.

    Kyobu Geka   Vol. 57 ( 3 ) page: 201-6   2004

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  76. Early and late results of combined valvular and coronary artery surgery Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Yoshida K, Tokuda Y, Matsuo T.

    Kyobu Geka   Vol. 57 ( 6 ) page: 353-7   2004

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  77. Surgical treatment of five patients with aortobronchial fistula in the aortic arch. Reviewed

    Nishizawa J, Matsumoto M, Sugita T, Matsuyama K, Tokuda Y, Yoshida K, Matsuo T.

    Ann Thorac Surg   Vol. 77 ( 5 ) page: 1821-3   2004

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  78. Intravenous leiomyomatosis extending into the right ventricle associated with pulmonary metastasis and extensive arteriovenous fistula. Reviewed

    Nishizawa J, Matsumoto M, Sugita T, Matsuyama K, Tokuda Y, Yoshida K, Matsuo T, Okayama S, Fujimoto S, Saito Y.

    J Am Coll Surg   Vol. 198 ( 5 ) page: 842-3   2004

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  79. Bilateral Diaphragmatic Paralysis after Aortic Surgery with Topical Hypothermia: Ventilatory Assistance by Nasal Mask Bi-level Positive Pressure. Reviewed

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa, Katsuhiko Matsuyama, Kazunori Yoshida, Takehiko Matsuo.

    J Thorac Cardiovasc Surg.   Vol. 125 ( 5 ) page: 1158-9   2003

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  80. Vascular Surgery Using Argatroban in a Patient with a History of Heparin-Induced Thrombocytopenia. Reviewed

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa, Katsuhiko Matsuyama, Kazunori Yoshida, Takehiko Matsuo

    Circ J.   Vol. 67 ( 10 ) page: 889 – 890   2003

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  81. Predictors of residual tricuspid regurgitation after mitral valve surgery. Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T.

    Ann Thorac Surg   Vol. 75 ( 6 ) page: 1826-8   2003

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  82. Management of asymptomatic aortic stenosis in patients undergoing coronary artery bypass grafting. Reviewed

    Yoshida K, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, Matsuo T.

    Circ J   Vol. 67 ( 3 ) page: 199-202   2003

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  83. Two contributions concerning mild to moderate aortic stenosis in patients undergoing coronary bypass grafting. Reviewed

    Yoshida K, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, Matsuo T.

    J Heart Valve Dis   Vol. 12 ( 2 ) page: 270-1   2003

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  84. Treatment of persistent chylothorax with somatostatin. Reviewed

    Matsuo T, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Tokuda Y, Yoshida K.

    Ann Thorac Surg   Vol. 76 ( 1 ) page: 340-1   2003

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  85. Methicillin-resistant Staphylococcus aureus endocarditis following repair of tetralogy of Fallot. Reviewed

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Shinichiro Yoshimura.

    Pediatr Cardiol.   Vol. 23 ( 5 ) page: 564-5   2002

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  86. Mitral Valve Repair for Severe Mitral Regurgitation Caused by Endomyocardial Biopsy. Reviewed

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa, Katsuhiko Matsuyama, Kazunori Yoshida, Takehiko Matsuo.

    J Heart Valve Dis.   Vol. 11   page: 837-838   2002

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  87. Anticoagulant therapy in Japanese patients with mechanical mitral valves. Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Yoshida K, Tokuda Y, Matsuo T.

    Circ J   Vol. 66 ( 7 ) page: 668-70.   2002

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  88. Anticoagulant therapy in Japanese patients with mechanical mitral valves. Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Yoshida K, Tokuda Y, Matsuo T.

    Circ J   Vol. 66 ( 7 ) page: 668-70   2002

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  89. The Optimal Treatment for Adult Patent Ductus Arteriosus. Reviewed

    Tokuda Yoshiyuki, Matsumoto Masahiko, Sugita Takaaki.

    Ann Thorac Surg.   Vol. 72 ( 6 ) page: 2186   2001

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  90. Mini-Incision Midline Approach for Infrarenal Abdominal Aortic Aneurysms. Reviewed

    Hitoshi Ogino, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa, Katsuhiko Matsuyama, Tatsuya Yoshioka, Yoshiyuki Tokuda,

    Asian Cardiovasc Thorac Ann.   Vol. 9   page: 347-348   2001

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  91. Coronary artery bypass grafting for patients with an atherosclerotic ascending aorta. Reviewed

    Ogino H, Ueda Y, Tahata T, Sugita T, Nishizawa J, Matsuyama K, Yoshimura S, Yoshioka T, Tokuda Y.

    Jpn J Thorac Cardiovasc Surg   Vol. 49 ( 4 ) page: 195-200   2001

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  92. Emergent surgical treatment of type A acute aortic dissection in an elderly patient. Reviewed

    Nishizawa J, Matsumoto M, Sugita T, Matsuyama K, Morimoto Y, Yoshimura S, Yoshioka T, Tokuda Y, Ogino H.

    Kyobu Geka   Vol. 54 ( 13 ) page: 1115-7   2001

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    Language:Japanese   Publishing type:Research paper (scientific journal)  

  93. De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation. Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T, Ueda Y.

    J Heart Valve Dis   Vol. 10 ( 4 ) page: 520-4   2001

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    Language:English   Publishing type:Research paper (scientific journal)  

  94. Clinical characteristics of patients with constrictive pericarditis after coronary bypass surgery. Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Yoshioka T, Tokuda Y, Ueda Y.

    Jpn Circ J   Vol. 65 ( 6 ) page: 480-2   2001

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    Language:English   Publishing type:Research paper (scientific journal)  

  95. Clinical characteristics of patients with constrictive pericarditis after coronary bypass surgery. Reviewed

    Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Yoshioka T, Tokuda Y, Ueda Y.

    Jpn Circ J   Vol. 65 ( 6 ) page: 480-2   2001

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    Language:English   Publishing type:Research paper (scientific journal)  

  96. Transcatheter coil closure of large patent ductus arteriosus in 70-year-old woman with 0.052-inch Gianturco coils using Bioptome. Reviewed

    Tokuda Yoshiyuki, Matsumoto Masahiko, Suda Kenji, Matsumura Masahiko.

    Jpn J Thorac Cardiovasc Surg.   Vol. 49 ( 6 ) page: 381-383   2001

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  97. Long-term effect of polystan monocusp ventricular outflow patch after right ventricular outflow tract reconstruction. Reviewed

    Sugita T, Matsumoto M, Ogino H, Nishizawa J, Matsuyama K, Yoshimura S, Yoshioka T, Tokuda Y, Matsumura M, Suda K, Ueda Y.

    Kyobu Geka   Vol. 53 ( 10 ) page: 853-6   2000

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  98. Long-term results of right ventricular outflow reconstruction with valved conduit. Reviewed

    Sugita T, Matsumoto M, Ogino H, Matsuyama K, Yoshimura S, Yoshioka T, Tokuda Y, Ueda Y.

    Kyobu Geka   Vol. 53 ( 12 ) page: 1025-7   2000

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  99. Combined cardiac surgery and total thyroidectomy: a case report. Reviewed

    Matsuyama K, Ueda Y, Ogino H, Sugita T, Nishizawa J, Matsubayashi K, Yoshimura S, Yoshioka T, Tokuda Y.

    Jpn Circ J   Vol. 63 ( 12 ) page: 1004-6   1999

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Books 5

  1. 心臓血管外科手術エクセレンス4 大動脈疾患の手術

    徳田順之 碓氷章彦( Role: Joint author ,  人工血管感染症の診断)

    中山書店  2020.12  ( ISBN:978-4-521-74480-3

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    Total pages:233   Responsible for pages:178−185   Language:Japanese Book type:Scholarly book

  2. 別冊日本臨床 領域別症候群シリーズNo.5循環器症候群 滲出性収縮性心膜炎

    徳田順之( Role: Joint author)

    日本臨床  2019 

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    Responsible for pages:565-567   Language:Japanese Book type:Textbook, survey, introduction

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  3. 循環器ナーシング 高齢者の心臓大血管手術とフレイル・サルコペニア

    徳田順之( Role: Joint author)

    医学出版  2017.7 

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    Language:Japanese Book type:General book, introductory book for general audience

  4. 最新人工心肺

    徳田順之( Role: Joint author ,  特殊な体外循環(TAVR))

    名古屋大学出版会  2017 

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    Language:Japanese Book type:Textbook, survey, introduction

  5. 女性総合診療マニュアル 女性外来の実践から 下肢静脈瘤

    徳田順之( Role: Joint author)

    保健文化社  2010 

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    Language:Japanese

MISC 9

  1. Transcatheter aortic valve replacement for bicuspid aortic stenosis with a severely calcified raphe using an under-sized SAPIEN 3 valve: Sizing by the circle method and deployment by the pressure-regulated method.

    Tobe A, Tanaka A, Tokuda Y, Shirai Y, Miyazaki T, Yuhara S, Akita S, Furusawa K, Ishii H, Mutsuga M, Murohara T

    Cardiovascular revascularization medicine : including molecular interventions     2022.8

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    Language:English   Publisher:Cardiovascular Revascularization Medicine  

    Transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve stenosis is challenging, and the absence of established methods for sizing the bicuspid aortic valve (BAV) complicates TAVR. We report a case of successful TAVR for bicuspid aortic stenosis with a severely calcified raphe. We used an undersized SAPIEN 3 valve, with three safety measures based on assessment of structural characteristics, sizing by the circle method, and deployment of the valve by the pressure-regulated method.

    DOI: 10.1016/j.carrev.2022.08.025

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  2. Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement

    Shirai Y, Tanaka A, Tokuda Y, Tobe A, Furusawa K, Usui A, Murohara T

    Journal of cardiac surgery   Vol. 37 ( 7 ) page: 2103 - 2104   2022.7

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    An interventricular membranous septal aneurysm, though rare, can coexist with aortic valve stenosis. In this report, we present an unsuitable anatomy for transcatheter aortic valve replacement (TAVR) due to large interventricular membranous septal aneurysm. This case suggests that the feasibility of TAVR would depend on the location and size of the aneurysm and its relationship with the aortic root.

    DOI: 10.1111/jocs.16504

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  3. Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting.

    Fujii T, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Yuhara S, Usui A

    SAGE open medical case reports   Vol. 10   page: 2050313X221116681   2022

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    A 73-year-old man presented with multiple giant coronary artery aneurysms. Twelve years prior to the presentation, he had undergone coronary artery bypass grafting. At that time, he exhibited small aneurysms (16 mm diameter) in the right coronary artery and a single aneurysm (10 mm diameter) in the left circumflex artery. During follow-up, the aneurysms gradually increased in size (to 45 and 30 mm, respectively, at 12 years after surgery). We resected all of the aneurysms and performed coronary artery bypass grafting of the left circumflex artery through re-sternotomy.

    DOI: 10.1177/2050313X221116681

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  4. The oral administration of clarithromycin prevents the progression and rupture of aortic aneurysm. International journal

    Uchida W, Narita Y, Yamawaki-Ogata A, Tokuda Y, Mutsuga M, Lee Fujimoto K, Abe T, Oshima H, Usui A

    Journal of vascular surgery   Vol. 68 ( 6S ) page: 82S-92S.e2   2018.12

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    OBJECTIVE: The pathogenesis of aortic aneurysm (AA) is associated with chronic inflammation in the aortic wall with increased levels of matrix metalloproteinases (MMPs). Clarithromycin (CAM) has been reported to suppresses MMP activity. In this study, we investigated whether CAM could prevent the formation and rupture of AA. METHODS: Male apolipoprotein E-deficient mice (28-30 weeks of age) were infused with angiotensin II for 28 days. CAM (100 mg/kg/d) or saline (as a control) was administered orally to the mice every day (CAM group, n = 13; control group, n = 13). After the administration period, the aortic diameter, elastin content, macrophage infiltration, MMP levels, and levels of inflammatory cytokines, including nuclear factor κB (NF-κB), were measured. RESULTS: The aortic diameter was significantly suppressed in the CAM group (P < .001). No rupture death was observed in the CAM group in contrast to five deaths (38%) in the control group (P < .01). CAM significantly suppressed the degradation of aortic elastin (56.3% vs 16.5%; P < .001) and decreased the infiltration of inflammatory macrophages (0.05 vs 0.16; P < .01). Compared with the controls, the enzymatic activity of MMP-2 and MMP-9 was significantly reduced in the CAM group (MMP-2, 0.15 vs 0.56 [P < .01]; MMP-9, 0.12 vs 0.60 [P < .01]), and the levels of interleukin 1β (346.6 vs 1066.0; P < .05), interleukin 6 (128.4 vs 346.2; P < .05), and phosphorylation of NF-κB were also decreased (0.3 vs 2.0; P < .01). CONCLUSIONS: CAM suppressed the progression and rupture of AA through the suppression of inflammatory macrophage infiltration, a reduction in MMP-2 and MMP-9 activity, and the inhibition of elastin degradation associated with the suppression of NF-κB phosphorylation.

    DOI: 10.1016/j.jvs.2017.12.047

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  5. Strategy of Cardiovascular Surgery for Patients With Dementia as Evaluated by Mini-Mental State Examination.

    Terazawa S, Oshima H, Narita Y, Fujimoto K, Mutsuga M, Tokuda Y, Yoshizumi T, Ito H, Uchida W, Usui A

    Circulation journal : official journal of the Japanese Circulation Society   Vol. 82 ( 12 ) page: 2998-3004   2018.11

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    DOI: 10.1253/circj.CJ-18-0312

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  6. Fungal endocarditis after transcatheter aortic valve replacement (TAVR): Case report and review of literature. International journal

    Morioka H, Tokuda Y, Oshima H, Iguchi M, Tomita Y, Usui A, Yagi T

    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy   Vol. 25 ( 3 ) page: 215 - 217   2018.9

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    The reported number of transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) cases has been increasing worldwide, but information about the incidence and clinical features of fungal TAVR-IE is quite limited. We present a patient who acquired TAVR-IE caused by Candida parapsilosis four month after TAVR, who was successfully treated redo-aortic valve replacement and prolonged antifungal therapy.

    DOI: 10.1016/j.jiac.2018.08.017

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  7. Temporary immobile leaflet following transcatheter aortic valve replacement of a SAPIEN-XT valve.

    Aoki T, Tanaka A, Tokuda Y, Oshima H, Suzuki S, Ishii H

    Cardiovascular intervention and therapeutics     2018.7

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    DOI: 10.1007/s12928-018-0536-7

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  8. Clinical outcomes and quality of life after surgery for dilated ascending aorta at the time of aortic valve replacement; wrapping versus graft replacement

    Tomonobu Abe, Sachie Terazawa, Hideki Ito, Yoshiyuki Tokuda, Kazuro Fujimoto, Masato Mutsuga, Yuji Narita, Hideki Oshima, Akihiko Usui

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 79 ( 4 ) page: 443 - 451   2017.11

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    Language:English   Publishing type:Rapid communication, short report, research note, etc. (scientific journal)   Publisher:NAGOYA UNIV, SCH MED  

    Wrapping and graft replacement are two optional procedures for the treatment of dilated ascending aorta at the time of aortic valve replacement (AVR). Wrapping is considered less invasive. The aim of this study was to compare the short-and long-term clinical outcomes as well as the long-term quality of life in patients undergoing these two procedures. This study enrolled 40 consecutive patients with dilated ascending aorta who had undergone either wrapping (WAA group, n=20) or replacement (RAA group, n=20) of the ascending aorta at the time of AVR. Short-term outcomes, long-term deaths, and aortic events were evaluated, as was quality of life using the SF-36 Short Form. Long-term maximal proximal aortic diameter was also obtained. There were no early deaths in either group. Pump time was shorter, and transfusion (55% vs. 95%, p=0.035) and postoperative atrial fibrillation (5% vs. 30%, p=0.036) rates were lower, in the WAA than in the RAA group. At a mean follow-up of 4.9 years, the overall 5 year survival rates in the WAA and RAA groups were 78.1% and 87.5%, respectively. There were no significant between group differences in SF-36 scores in any subcategory of this survey. Long-term maximal aortic diameter remained stable in both groups. Both surgical interventions for dilated ascending aorta at the time of AVR yield favorable and comparable results in patients with suitable anatomy. Furthermore, we found no differences in quality of life between these procedures.

    DOI: 10.18999/nagjms.79.4.443

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  9. Entire Circumferential Reconstruction of the Right Atrium Surrounded by Angiosarcoma

    Makoto Hibino, Tomonobu Abe, Hideki Oshima, Yuji Narita, Masato Mutsuga, Kazuro L. Fujimoto, Yoshiyuki Tokuda, Koji Yamana, Taiyo Kuroda, Akihiko Usui

    ANNALS OF THORACIC SURGERY   Vol. 103 ( 6 ) page: E483 - E485   2017.6

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    Primary cardiac angiosarcomas are frequently found at a large size with infiltration into the adjacent heart structure owing to their asymptomatic characteristics until an advanced stage. Therefore, extensive resection is often required to achieve a good prognosis. We herein report a case of entire circumferential resection of the right atrium surrounded by angiosarcoma and excellent three-dimensional reconstruction of the right atrium. (C) 2017 by The Society of Thoracic Surgeons.

    DOI: 10.1016/j.athoracsur.2016.11.032

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Research Project for Joint Research, Competitive Funding, etc. 1

  1. JSTREAM Study - 0 (Japanese Study of Optimal Treatment Strategy for Infective Endocarditis-0: Timing for Surgery

    2014.3 - 2015.9

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    Authorship:Coinvestigator(s) 

    Grant amount:\122324

KAKENHI (Grants-in-Aid for Scientific Research) 4

  1. Safe and Stable Transseptal Access for Trans-catheter Mitral Valve Replacement

    Grant number:22K08955  2022.4 - 2025.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Authorship:Principal investigator 

    Grant amount:\3900000 ( Direct Cost: \3000000 、 Indirect Cost:\900000 )

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  2. 心筋梗塞後急性炎症に対する炎症制御因子介入による心筋サルベージ療法

    Grant number:20K09145  2020.4 - 2021.3

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    藤本 和朗, 碓氷 章彦, 徳田 順之, 成田 裕司, 緒方 藍歌

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    Authorship:Coinvestigator(s) 

    広範囲心筋梗塞では、壊死心筋の激しい炎症の後、線維化組織に置換され心腔拡大や収縮障害、最終的に重症心不全を引き起こす。梗塞部位では、集積した炎症性マクロファージ (M1MF)による過剰な炎症状態と、抗炎症性マクロファージ (M2MF)による血管新生・線維化組織の誘導が観察されるが、炎症/抗炎症バランスが改善されず梗塞後リモデリングが進行して心機能がさらに低下する。本研究では、心筋梗塞後急性炎症に対する抗炎症作用・組織修復に関わるProgranulin(PGRN)およびSecretory leukocyte proteinase inhibitor (SLPI)による心筋サルベージ療法を試みる。
    広範囲心筋梗塞では、壊死心筋の激しい炎症の後、線維化組織に置換され、時間とともにリモデリングが進行し、心腔拡大や収縮障害、最終的に重症心不全を引き起こす。心筋梗塞部位では過剰な炎症状態と血管新生・線維化組織の誘導が観察されるが、炎症/抗炎症バランスが改善されず梗塞後リモデリングが進行して心機能がさらに低下する。近年、研究代表者らは、慢性炎症を呈する動脈硬化性大動脈瘤モデルにおいて間葉系幹細胞(MSC)療法の有効性を示し、MSC産生因子に抗炎症作用・組織修復に関わるProgranulin(PGRN)およびセリンプロテアーゼ阻害因子 Secretory leukocyte proteinase inhibitor (SLPI)が含まれていることを見出した。この知見から、PGRN, SLPIは心筋梗塞における炎症/抗炎症バランスを改善し、梗塞後リモデリングを抑制しうる仮説を立てた。本研究では、PGRN, SLPIによる心筋梗塞治療効果を検証するため、In vitroにて培養マクロファージに対するrPGRN, SLPIの作用について調べた。LPSまたはTNF-α/INF-γで24時間炎症刺激した炎症性M1マクロファージ(M1MF)に対し、rPGRN, rSLPIを添加して24時間培養後にM1MFからRNA抽出して遺伝子発現の定量比較を行った(PGRN群、SLPI群、各n=5)。比較対象群には何も添加しない無添加群(n=5)を用いた。無添加群に比べ、PGRN群とSLPI群でIL-1β, IL-6, MCP-1, iNOS遺伝子発現量が有意に低下した。さらにSLPI群は、TNF-α遺伝子発現量が有意に低下した一方で、IL-10, TGF-β1遺伝子発現量が有意に上昇した。これらの結果から、SLPIは炎症/抗炎症バランスを改善させる可能性が示唆された。

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  3. Medical Economics in Transcatheter Aortic Valve Implantation

    Grant number:19K08513  2019.4 - 2023.3

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Scientific Research (C)

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    Grant amount:\4420000 ( Direct Cost: \3400000 、 Indirect Cost:\1020000 )

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  4. 感染抵抗性人工血管の開発

    2012.4 - 2014.3

    科学研究費補助金  若手研究(B)

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    Authorship:Principal investigator 

 

Teaching Experience (On-campus) 2

  1. 弁膜症 体外循環

    2021

  2. 体外循環

    2020

 

Social Contribution 8

  1. カンボジア医療支援 

    特定非営利活動法人ジャパンハート  2019.12 - 2020.1

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    Type:Other

    医療支援活動

  2. カンボジア医療支援

    特定非営利活動法人ジャパンハート  2019.12 - 2020.1

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    Type:Other

    医療支援活動

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  3. 市民公開講座

    Role(s):Lecturer

    中日新聞社  東建ホール  2019.9

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    Audience: General

    Type:Lecture

  4. 市民公開講座

    Role(s):Lecturer

    中日新聞社  東建ホール  2019.9

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    Audience: General

    Type:Lecture

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  5. 平成30年名古屋大学附属病院 地域医療連携講演会

    Role(s):Lecturer

    名古屋大学附属病院  2018.11

  6. 平成30年名古屋大学附属病院 地域医療連携講演会

    Role(s):Lecturer

    名古屋大学附属病院  2018.11

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  7. 市民公開講座

    Role(s):Commentator, Media coverage

    読売新聞社  2018.1

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    Audience: General

    Type:Lecture

  8. 市民公開講座

    Role(s):Commentator, Media coverage

    読売新聞社  2018.1

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    Audience: General

    Type:Lecture

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Media Coverage 4

  1. 心臓弁膜症 あなたの頑張っている心臓のおはなし Newspaper, magazine

    中日新聞社  中日新聞  中日新聞紙面  2022.10

  2. With コロナ時代に知っておきたい 心臓疾患

    中日新聞社   中日新聞紙面  2020.12

  3. 知っておきたい心臓の病気 Newspaper, magazine

    中日新聞社  中日新聞紙面  2019.10

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    Author:Other 

  4. 知って見逃さない心臓弁膜症 Newspaper, magazine

    読売新聞  読売新聞紙面  2018.3

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    Author:Other 

Academic Activities 3

  1. 2021年度日本体外循環技術医学会教育セミナー 心臓血管外科の血管内治療と体外循環技士の役割

    Role(s):Planning, management, etc.

    ( 教育講演 及び同内容での教育目的冊子書籍の執筆 ) 2021.5

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    Type:Academic society, research group, etc. 

    (体外循環技士向けの教育)
    今日、心臓血管外科領域の手術方法は非常に多様化 し、多くの低侵襲治療技術が導入されつつある。僧帽 弁形成(MVP)などを小さい切開で視野を得て行う いわゆる MICS は今後増加が予想されるが、そうい ったアプローチ以外に、血管内治療の役割も増してい る。具体的には弁膜症領域で AS に対する経カテーテ ル大動脈弁置換(TAVI)、動脈瘤では胸部大動脈ス テントグラフト内挿術(TEVAR)、腹部大動脈ステ ントグラフト内挿術(EVAR)などが普及しつつある。 Stanford B 型大動脈解離の TEVAR によるエントリ ー閉鎖が注目されており、MR に対する Mitraclip ® 治療は開心術による僧帽弁形成に形成の質として及ば ないものの重症心不全における機能性 MR への効果 が期待されている。これらの血管内治療のサポートに は体外循環技士、臨床工学技士が関与する機会が増加 しているが、開心術とは異なるコンセプトと知識が必 要となる。本稿で介助に必要な基礎知識の入り口一 部だけを述べた血管内治 療の手技の種類はいろいろあるが、例として一部を挙 げ、施術目線で基本的機材の用語や取扱についてここ に記した。手技の TIPS を把握しておいたほうが良い 介助サポートが可能だろうと考えるからである。

  2. 名古屋心エコーセミナー講演演者 僧帽弁閉鎖不全を理解するための僧帽弁解剖学

    ( 名古屋国際会議場 ) 2020.8

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  3. 名古屋心エコーセミナー講演演者 僧帽弁複合体の解剖と僧帽弁閉鎖不全の機序

    ( 名古屋国際会議場 ) 2018.5

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    Type:Academic society, research group, etc.