2022/11/08 更新

写真a

トクダ ヨシユキ
徳田 順之
TOKUDA Yoshiyuki
所属
医学部附属病院 心臓外科 病院講師
職名
病院講師
連絡先
メールアドレス
外部リンク

学位 2

  1. 医学博士 ( 2008年1月   名古屋大学 ) 

  2. 医学士 医師 ( 1997年3月   北海道大学 ) 

研究キーワード 4

  1. 心臓弁膜症の外科治療 僧帽弁閉鎖不全 大動脈弁狭窄症 三尖弁閉鎖不全症 カテーテル弁置換 僧帽弁形成

  2. ステントグラフト内挿術 ハイブリッド治療

  3. 大動脈の外科治療 胸部大動脈瘤 腹部大動脈瘤 胸腹部大動脈瘤 大動脈解離

  4. 医療経済 大規模データベース研究

研究分野 3

  1. ライフサイエンス / 心臓血管外科学

  2. ライフサイエンス / 外科学一般、小児外科学

  3. ライフサイエンス / 医療技術評価学

現在の研究課題と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. 医療経済から見た 高齢者高額医療(特に心臓血管外科手術)の妥当性の検討

  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. 専門外科医の途上国医療との関わり 

▼全件表示

経歴 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年8月 - 2011年1月

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    国名:日本国

  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年4月 - 2009年7月

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    国名:日本国

  3. 名古屋大学附属病院 心臓外科医員

    2007年9月 - 2008年3月

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    国名:日本国

  4. 岐阜県立多治見病院 心臓血管外科医員

    2005年10月 - 2007年8月

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    国名:日本国

  5. Prince of Wales Hospital Cardiothracic surgery Registrar

    2004年6月 - 2005年8月

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    国名:オーストラリア連邦

  6. Wellington hospital Cardiothracic surgery Registrar

    2002年12月 - 2004年6月

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    国名:ニュージーランド

  7. 天理よろづ相談所病院レジデント

    1997年5月 - 2002年11月

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    国名:日本国

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学歴 2

  1. 名古屋大学   医学系研究科

    - 2008年1月

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    国名: 日本国

  2. 北海道大学   医学部

    1991年4月 - 1997年3月

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    国名: 日本国

所属学協会 11

  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. 日本外科学会

  8. 日本経カテーテル心臓弁治療学会(JTVT)

  9. 関西胸部外科学会   評議員

  10. European association of cardiothoracic surgery

  11. 日本血管外科学会

▼全件表示

受賞 3

  1. Best Reviewers Awards for 2020, Circulation Journal

    2021年4月   日本循環器学会   Best Reviewers Awards for 2020, Circulation Journal

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    受賞区分:学会誌・学術雑誌による顕彰 

  2. 優秀論文賞 Best Papers Focus Session

    2017年10月   欧州心臓胸部外科学会  

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    受賞区分:国際学会・会議・シンポジウム等の賞 

  3. 第64回 胸部外科学会優秀演題賞

    2011年10月   日本胸部外科学会  

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    受賞区分:国内学会・会議・シンポジウム等の賞  受賞国:日本国

 

論文 96

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

    Mutsuga M, Okumura T, Morimoto R, Kondo T, Ito H, Terazawa S, Tokuda Y, Narita Y, Nishida K, Murohara T, Usui A

    Artificial organs     2022年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1111/aor.14426

    PubMed

  2. 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     2022年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元: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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  3. Albuminuria Predicts Short-Term Worsening Renal Function After Transcatheter Aortic Valve Replacement. 国際誌

    Tobe A, Tanaka A, Tokuda Y, Shirai Y, Otsuka S, Yamamoto T, Tokoro M, Furusawa K, Ishii H, Usui A, Murohara T

    Cardiovascular revascularization medicine : including molecular interventions   42 巻   頁: 178 - 181   2022年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Cardiovascular Revascularization Medicine  

    Albuminuria is a major risk factor of cardiovascular events, however, the impact of albuminuria on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) has not been fully investigated. This retrospective study included 206 patients who underwent TAVR for severe aortic stenosis. Patients were divided into two groups according to the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥ 30 mg/g) and low (ACR < 30 mg/g). The incidence of 1-month worsening renal function (WRF), defined as a decrease in estimated glomerular filtration rate (eGFR) ≥10% from baseline after TAVR, was investigated. Patients with high ACR had acute kidney injury (8.5% vs. 1.0%, p = 0.01) and 1-month WRF (29.2% vs. 12.0%, p = 0.002) more frequently than those with low ACR. High ACR was independently associated with 1-month WRF (odds ratio, 3.72; 95% confidence interval, 1.72–8.08; p < 0.001). Albuminuria can be a useful predictor of deterioration of renal function at various time points after TAVR.

    DOI: 10.1016/j.carrev.2022.03.014

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  4. Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus. 国際誌

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

    Surgery today   52 巻 ( 7 ) 頁: 1016 - 1022   2022年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元: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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  5. 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     2022年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:General Thoracic and Cardiovascular Surgery  

    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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  6. Albuminuria predicts worsening renal function after transcatheter aortic valve replacement. 査読有り 国際誌

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

    Journal of cardiology   79 巻 ( 5 ) 頁: 648 - 654   2022年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Cardiology  

    Background: The impact of albuminuria on worsening renal function (WRF) and clinical outcomes after transcatheter aortic valve replacement (TAVR) is unknown. Methods: Overall, 142 patients who underwent TAVR for severe aortic stenosis were divided into two groups based on the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥30 mg/g) and low (ACR <30 mg/g). The incidence of WRF (an absolute increase in serum creatinine level of ≥0.3 mg/dL or ≥1.5-fold from baseline or dialysis initiation) at 6 months after TAVR and the incidence of all-cause death and heart failure readmission during follow-up were investigated. Results: Half of the examined patients [n=71/142 (50.0%)] had a high ACR. Patients with a high ACR more frequently had WRF at 6 months than those with a low ACR (17.6% vs. 2.9%, p=0.004). Multivariate analysis showed a high ACR was independently associated with WRF (odds ratio, 7.76; 95% confidence interval, 1.62–37.30; p=0.01), whereas baseline estimated glomerular filtration rate <60 mL/min/1.73m² was not (odds ratio, 0.34; 95% confidence interval, 0.08–1.50; p=0.15). Patients with a high ACR had a higher risk of composite outcomes of all-cause death and heart failure readmission (p=0.002). Conclusions: Preoperative albuminuria (ACR ≥30 mg/g) was independently associated with WRF at 6 months after TAVR. Furthermore, patients with an ACR ≥30 mg/g had higher risks of all-cause death and heart failure readmission than those with an ACR <30 mg/g.

    DOI: 10.1016/j.jjcc.2021.11.014

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  7. Predictors of Failure of Mitral Valve Repair Using Artificial Chordae. 査読有り 国際誌

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

    The Annals of thoracic surgery   113 巻 ( 4 ) 頁: 1136 - 1143   2022年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Annals of Thoracic Surgery  

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

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

    Heart and vessels   37 巻 ( 1 ) 頁: 132 - 141   2022年1月

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    担当区分:責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元: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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    PubMed

  9. Alternative therapeutic strategy for existing aortic aneurysms using mesenchymal stem cell-derived exosomes. 査読有り

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

    Expert opinion on biological therapy   22 巻 ( 1 ) 頁: 95 - 104   2022年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Expert Opinion on Biological Therapy  

    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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    PubMed

  10. Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients. 査読有り 国際誌

    Tobe A, Tanaka A, Tokuda Y, Miki Y, Furusawa K, Akita S, Fujii T, Tsutsumi Y, Ishii H, Iwano S, Naganawa S, Usui A, Murohara T

    Heart and vessels   36 巻 ( 12 ) 頁: 1911 - 1922   2021年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Heart and Vessels  

    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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  11. 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   7 巻 ( 1 ) 頁: 223   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1186/s40792-021-01296-3

    PubMed

  12. Hypofibrinogenemia can be estimated by the predictive formula in aortic surgery. 査読有り

    Nishi T, Mutsuga M, Akita T, Narita Y, Fujimoto K, Tokuda Y, Nishida K, Matsui S, Nishiwaki K, Usui A

    General thoracic and cardiovascular surgery   69 巻 ( 10 ) 頁: 1376 - 1382   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:General Thoracic and Cardiovascular Surgery  

    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

    Web of Science

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  13. Improvement in the nutritional status after transcatheter aortic valve implantation. 査読有り 国際誌

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

    Journal of cardiology   78 巻 ( 3 ) 頁: 250 - 254   2021年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Cardiology  

    Background: A poor nutritional status of patients before transcatheter aortic valve implantation (TAVI) has been reported to be associated with poor clinical outcomes. However, changes in the nutritional status following TAVI have not been fully elucidated. Methods: In this single-center retrospective observational study, 129 patients whose nutritional status at baseline and 6 months after TAVI were available were investigated. The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) were used to assess the nutritional status of the patients at baseline and at 6 months. We further assessed changes in the nutritional status of patients in the subgroups stratified according to the baseline levels as low and high. Results: The PNI and GNRI values at 6 months were significantly better than at baseline [PNI, baseline: 44.5 (41.0–48.0), 6 months: 46.0 (41.9–48.3), p = 0.02; GNRI, baseline: 95.3 (89.0–100.3), 6 months: 97.8 (91.5–101.4), p = 0.006]. Both PNI and GNRI values at 6 months were significantly better in the patients with a low baseline nutritional status, while no significant change was observed in those with high baseline levels [PNI, low; baseline: 36.8 (36.1–39.4), 6 months: 40.8 (39.0–43.4), p = 0.002, high; baseline: 47.0 (43.0–49.5), 6 months: 46.5 (43.5–50.5), p = 0.44 and GNRI, low; baseline: 86.4 (81.7–88.7), 6 months: 88.6 (83.4–95.3), p = 0.001, high; baseline: 99.8 (95.3–102.8), 6 months: 100.7 (96.8–103.4), p = 0.34]. Conclusion: Nutritional status of patients might improve during the chronic phase after TAVI, especially in those with poor baseline levels.

    DOI: 10.1016/j.jjcc.2021.04.006

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  14. Worsening renal function after transcatheter aortic valve replacement and surgical aortic valve replacement. 査読有り 国際誌

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

    Heart and vessels   36 巻 ( 7 ) 頁: 1080 - 1087   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Heart and Vessels  

    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.

    DOI: 10.1007/s00380-021-01778-2

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  15. Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis. 査読有り 国際誌

    Tobe A, Tanaka A, Tokuda Y, Akita S, Fujii T, Miki Y, Furusawa K, Ishii H, Usui A, Murohara T

    Circulation journal : official journal of the Japanese Circulation Society   85 巻 ( 7 ) 頁: 1093 - 1098   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Circulation Journal  

    Background: The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated. Methods and Results: 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. Conclusions: Regression of ECG-LVH was observed between 1 and 6 months after TAVI.

    DOI: 10.1253/circj.CJ-21-0354

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  16. Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair. 査読有り 国際誌

    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   61 巻 ( 6 ) 頁: 938 - 944   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:European Journal of Vascular and Endovascular Surgery  

    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.

    DOI: 10.1016/j.ejvs.2021.02.044

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  17. Is Hybrid Repair for an Entire Shaggy Aorta Feasible? 査読有り 国際誌

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

    Heart, lung & circulation   30 巻 ( 5 ) 頁: 765 - 772   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Heart Lung and Circulation  

    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.

    DOI: 10.1016/j.hlc.2020.09.923

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  18. Surgery for Anomalous Papillary Muscle Directly Into the Anterior Mitral Leaflet. 査読有り 国際誌

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

    The Annals of thoracic surgery   111 巻 ( 5 ) 頁: 1512 - 1518   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Annals of Thoracic Surgery  

    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 subvalvular apparatus. Methods: Among 38 patients who underwent septal myectomy from 2007 to 2020, 4 had an anomalous mitral subvalvular 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 papillary muscles, concomitant with septal myectomy. In another 34 patients, 20 cases needed mitral valve repair with regard to systolic anterior motion by hypertrophic cardiomyopathy. The comparison study was conducted between the anomalous papillary muscle group (group A) and the others (group B). Results: There was no early or late death in group A, and there were 3 early deaths and 2 late deaths 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, and from 2 to 0.6 in group B. Six patients needed mitral valve replacement because of 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.

    DOI: 10.1016/j.athoracsur.2020.07.031

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  19. Beating-heart total arch replacement for an octogenarian patient with severe heart failure. 査読有り 国際誌

    Mutsuga M, Banno H, Tokuda Y, Usui A

    Journal of cardiac surgery   36 巻 ( 3 ) 頁: 1126 - 1129   2021年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Cardiac Surgery  

    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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  20. Sutures on the Anterior Mitral Leaflet to Prevent Systolic Anterior Motion. 査読有り 国際誌

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

    The Annals of thoracic surgery   111 巻 ( 3 ) 頁: e213 - e215   2021年3月

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Annals of Thoracic Surgery  

    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.

    DOI: 10.1016/j.athoracsur.2020.07.057

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  21. Perioperative D-dimer levels after transcatheter aortic valve replacement: Comparison of patients with and without anticoagulant therapy. 査読有り 国際誌

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

    Cardiology journal   28 巻 ( 1 ) 頁: 170 - 172   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Cardiology Journal  

    DOI: 10.5603/CJ.a2020.0143

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  22. Upper thoracoabdominal aortic repair through partial posterior incision of the diaphragm via left thoracotomy. 査読有り 国際誌

    Ito H, Mutsuga M, Tokuda Y, Usui A

    General thoracic and cardiovascular surgery   68 巻 ( 12 ) 頁: 1594 - 1595   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:General Thoracic and Cardiovascular Surgery  

    During surgical repair of a thoracoabdominal aortic aneurysm, division of the diaphragm should be minimized to avoid pulmonary complications. We herein describe a modified exposure technique that avoids ordinary circumferential division of the diaphragm. The diaphragm was detached from the aneurysm at the level of the aortic hiatus via a modified anterior lateral thoracotomy incision through the pleural space. The diaphragmatic incision around the aneurysm was extended posteriorly. This partial division of the diaphragm provided sufficient exposure of the distal anastomosis site for thoracoabdominal aneurysms that do not extend below the upper part of the abdomen.

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  23. Serial Images of Aortic Plaque Rupture During Transfemoral Transcatheter Aortic Valve Replacement. 査読有り 国際誌

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

    JACC. Cardiovascular interventions   13 巻 ( 22 ) 頁: e203 - e204   2020年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JACC: Cardiovascular Interventions  

    DOI: 10.1016/j.jcin.2020.09.007

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  24. Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement.

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

    Circulation reports   2 巻 ( 11 ) 頁: 701 - 702   2020年10月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1253/circrep.CR-20-0060

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  25. 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. 査読有り 国際誌

    Mashiko Y, Abe T, Tokuda Y, Oshima H, Usui A

    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs   23 巻 ( 3 ) 頁: 225 - 232   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Artificial Organs  

    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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  26. 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.

    Mashiko Y, Abe T, Tokuda Y, Oshima H, Usui A

    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs   23 巻 ( 3 ) 頁: 233 - 233   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Artificial Organs  

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

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  27. Modified sutureless repair using left atrial appendage flap for acquired left-sided pulmonary vein stenosis. 査読有り 国際誌

    Ito H, Mutsuga M, Tokuda Y, Usui A

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   58 巻 ( 2 ) 頁: 395 - 397   2020年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:European Journal of Cardio-thoracic Surgery  

    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.

    DOI: 10.1093/ejcts/ezaa032

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  28. Bilateral versus single internal thoracic artery grafting in hemodialysis patients. 査読有り 国際誌

    Munakata H, Tajima K, Kato W, Tanaka K, Tokuda Y, Mutsuga M, Usui A

    General thoracic and cardiovascular surgery   68 巻 ( 8 ) 頁: 768 - 773   2020年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:General Thoracic and Cardiovascular Surgery  

    Background: The use of the bilateral internal thoracic arteries (BITAs) during myocardial revascularization reportedly provides a survival benefit over using a single internal thoracic artery (SITA). However, the advantages in chronic hemodialysis patients, who generally have multiple comorbidities, is unclear. Methods: Outcomes of chronic hemodialysis patients who underwent isolated coronary artery bypass grafting (CABG) using a SITA with additional saphenous vein grafts (SVGs) (n = 33) or BITAs (n = 30) for left-side revascularization were retrospectively reviewed. Results: With the exception of the rate of diabetes mellitus (SITA vs. BITA: 84.8% vs. 50.0%; p = 0.003), the two groups showed similar patient characteristics. Using the off-pump technique, revascularization was completed without manipulation of the ascending aorta in 45.7% of patients in the BITA group, whereas all patients in the SITA group required aortic manipulation (p < 0.001). Of note, the incidence of extensive aortic calcification (>50% of ascending aorta circumference) was not uncommon (14.3%). The in-hospital mortality (3.0% vs. 0%, p = 0.336) and complication rates (including deep wound infection, re-exploration and stroke) were similar in both groups. The 5-year estimated survival rates for freedom from overall death in the SITA and BITA groups were 42.4% and. 57.4%, respectively (p = 0.202). Conclusions: BITA grafting was able to achieve revascularization with minimal manipulation of the diseased ascending aorta without increasing the complication rate. The long-term survival benefit of BITA grafting, however, was unclear in dialysis patients, especially because such patients have a relatively short life expectancy.

    DOI: 10.1007/s11748-019-01254-9

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  29. Management of Patients With Aortic Stenosis Requiring Non-Cardiac Surgery. 査読有り 国際誌

    Tokuda Y, Usui A

    Circulation journal : official journal of the Japanese Circulation Society   84 巻 ( 7 ) 頁: 1064 - 1066   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Circulation Journal  

    DOI: 10.1253/circj.CJ-20-0437

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  30. 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. 査読有り 国際誌

    Abe T, Yamamoto H, Miyata H, Motomura N, Tokuda Y, Tanemoto K, Usui A, Takamoto S

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   57 巻 ( 4 ) 頁: 660 - 667   2020年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:European Journal of Cardio-thoracic Surgery  

    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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  31. The incidence and risk factors of hypofibrinogenemia in cardiovascular surgery. 査読有り 国際誌

    Nishi T, Mutsuga M, Akita T, Narita Y, Fujimoto K, Tokuda Y, Terazawa S, Ito H, Nishiwaki K, Usui A

    General thoracic and cardiovascular surgery   68 巻 ( 4 ) 頁: 335 - 341   2020年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:General Thoracic and Cardiovascular Surgery  

    Objective: Cardiovascular surgery often causes massive bleeding due to coagulopathy, with hypofibrinogenemia being a major causative factor. We assessed the intraoperative incidence of hypofibrinogenemia and explored predictors of hypofibrinogenemia. Methods: The intraoperative serum fibrinogen level (SFL) was routinely measured in 872 consecutive patients [mean age: 66.9 ± 13.3 years; 598 men (68.6%)] undergoing cardiovascular surgery from July 2013 to November 2016 at Nagoya University Hospital. There were 275 aortic surgeries, 200 cases of coronary artery bypass grafting (CABG), 334 valvular surgeries and 63 other surgeries. We estimated hypofibrinogenemia incidence (intraoperative lowest SFL ≤ 150 mg/dL) and identified its predictors by a logistic regression analysis. Results: The average intraoperative lowest SFL of all cases, aortic surgery, CABG and valvular surgery was 185 ± 71, 156 ± 65, 198 ± 69 and 198 ± 68 mg/dL, respectively. Aortic surgery had a significantly lower intraoperative lowest SFL than CABG (p < 0.001) and valvular surgery (p < 0.001). The incidence of hypofibrinogenemia was 32.8%, 50.2%, 26.5% and 22.8% in all cases, aortic surgery, CABG and valvular surgery, respectively. The predictors of hypofibrinogenemia were the preoperative SFL, re-do surgery and perfusion time. A receiver operating characteristics curve analysis showed that the best preoperative SFL cutoff value for predicting hypofibrinogenemia was 308.5 mg/dL. Assuming preoperative SFL 300 mg/dL as the cutoff, the odds ratio for hypofibrinogenemia was 7.22 (95% confidence interval 5.26–9.92, p < 0.001). Conclusions: The incidence of hypofibrinogenemia in aortic surgery was high. The preoperative SFL, re-do surgery and perfusion time were identified as predictors for hypofibrinogenemia. Intraoperative measurement of SFL is important for detecting hypofibrinogenemia and applying appropriate and prompt transfusion treatment.

    DOI: 10.1007/s11748-019-01201-8

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  32. Spinal cord injury following aortic arch replacement. 国際誌

    Tokuda Y, Fujimoto K, Narita Y, Mutsuga M, Terazawa S, Ito H, Matsumura Y, Uchida W, Munakata H, Ashida S, Ono T, Nishi T, Yano D, Ishida S, Kuwabara F, Akita T, Usui A

    Surgery today   50 巻 ( 2 ) 頁: 106 - 113   2020年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Surgery Today  

    Purpose: Postoperative spinal cord injury is a devastating complication after aortic arch replacement. The purpose of this study was to determine the predictors of this complication. Methods: A group of 254 consecutive patients undergoing aortic arch replacement via median sternotomy, with (n = 78) or without (n = 176) extended replacement of the upper descending aorta, were included in a risk analysis. The frozen elephant trunk technique was used in 46 patients. The patients’ atherothrombotic lesions (extensive intimal thickening of > 4 mm) were identified from computed tomography images. Results: Complete paraplegia (n = 7) and incomplete paraparesis (n = 4) occurred immediately after the operation (permanent spinal cord injury rate, 1.97%; transient spinal cord injury rate, 2.36%). A multivariable logistic regression analysis identified the use of the frozen elephant trunk technique (odds ratio 36.3), previous repair of thoracoabdominal aorta or descending aorta (odds ratio 29.4), proximal atherothrombotic aorta (odds ratio 9.6), chronic obstructive lung disease (odds ratio 7.1) and old age (odds ratio 1.1) as predictors of spinal cord injury (p < 0.0001, area under curve 0.93). Conclusions: Spinal cord injury occurs with a non-negligible incidence following aortic arch replacement. The full objective assessment of the morphology of the whole aorta and the recognition of the risk factors are mandatory.

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  33. Contemporary Outcomes of Surgical Aortic Valve Replacement in Japan. 査読有り 国際誌

    Tokuda Y, Yamamoto H, Miyata H, Usui A, Motomura N, Japan Cardiovascular Surgery Database Organization.

    Circulation journal : official journal of the Japanese Circulation Society   84 巻 ( 2 ) 頁: 277 - 282   2020年1月

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Circulation Journal  

    Background: 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. Methods and Results: 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. Conclusions: 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.

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  34. Mechanical haemolytic anaemia assessed with four-dimensional flow cardiac magnetic resonance. 査読有り 国際誌

    Uchida W, Tokuda Y, Takehara Y, Usui A

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   56 巻 ( 4 ) 頁: 813 - 814   2019年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:European Journal of Cardio-thoracic Surgery  

    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.

    DOI: 10.1093/ejcts/ezz031

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  35. 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   34 巻 ( 3 ) 頁: 277 - 278   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Cardiovascular Intervention and Therapeutics  

    DOI: 10.1007/s12928-018-0536-7

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  36. Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis. 査読有り 国際誌

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

    The Annals of thoracic surgery   108 巻 ( 1 ) 頁: 107 - 114   2019年7月

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Annals of Thoracic Surgery  

    Background: Postoperative neurologic deficits are associated with severe morbidity in aortic arch replacement. Methods: A group of 198 consecutive patients undergoing isolated total aortic arch replacement with the use of antegrade cerebral perfusion were analyzed for the risk factors for predicting neurologic deficit. With the use of computed tomography, atherothrombotic lesions (defined as extensive intimal thickening exceeding 4 mm) were identified in the proximal aorta (the ascending aorta or aortic arch) in 26.2% of cases and in the distal aorta in 34.9% of cases. Results: Permanent neurologic deficits occurred in 11.1% (including non-disabling stroke confirmed by imaging) and transient neurologic deficits in 8.1% of patients. A univariate analysis identified proximal atherothrombotic aorta (p = 0.0057), distal atherothrombotic aorta (p = 0.032), and retrograde systemic perfusion from the femoral artery in the presence of distal atherothrombotic aorta (p = 0.0022) as risk factors for neurologic deficits. A multivariate logistic regression analysis identified atherothrombotic proximal aorta (odds ratio 2.4, p = 0.033) as the independent risk factor. The presence of carotid stenosis did not affect the rate of neurologic deficit. Intracranial hemorrhagic lesions were found in 23% of permanent neurologic deficit cases. Conclusions: Atherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphologic characteristics appear to be mandatory. Anticoagulation therapy should be performed carefully to avoid intracranial hemorrhagic changes.

    DOI: 10.1016/j.athoracsur.2019.01.004

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  37. Conservative treatment of type A aortic dissection following hybrid arch repair. 査読有り 国際誌

    Yoshizumi T, Tokuda Y, Abe T, Usui A

    General thoracic and cardiovascular surgery   67 巻 ( 7 ) 頁: 602 - 607   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:General Thoracic and Cardiovascular Surgery  

    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.

    DOI: 10.1007/s11748-019-01075-w

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

    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   25 巻 ( 3 ) 頁: 215 - 217   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Infection and Chemotherapy  

    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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  39. The oral administration of clarithromycin prevents the progression and rupture of aortic aneurysm.

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

    Journal of vascular surgery   68 巻 ( 6S ) 頁: 82S - 92S.e2   2018年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Journal of Vascular Surgery  

    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. Clinical Relevance: This article shows that high-dose clarithromycin (CAM) suppressed aortic aneurysm formation and rupture. Fortunately, no mice had adverse effects of CAM in the laboratory test. For clinical relevance, we will try a low dose of CAM for the same model of mice, such as 10 mg/kg/d or less. Although we think we need to try bigger animals, such as a pig, we have no study design of an aortic aneurysm model for big animals.

    DOI: 10.1016/j.jvs.2017.12.047

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  40. 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   82 巻 ( 12 ) 頁: 2998 - 3004   2018年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Circulation Journal  

    Background: 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). Methods and Results: 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. Conclusions: 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.

    DOI: 10.1253/circj.CJ-18-0312

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  41. 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   138 巻   2018年11月

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    掲載種別:研究論文(学術雑誌)  

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  42. Aortic sarcoidosis complicated by a pulmonary artery aneurysm.

    Uchida W, Tokuda Y, Mutsuga M, Usui A

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery   54 巻 ( 4 ) 頁: 786 - 788   2018年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:European Journal of Cardio-thoracic Surgery  

    A 76-year-old woman, who had a history of ocular sarcoidosis, was incidentally found to have a huge pulmonary artery aneurysm, along with aortic, mitral and tricuspid valve insufficiency. She underwent pulmonary artery plication along with surgeries for 3 valves. A specimen of the slightly enlarged ascending aorta revealed the involvement of sarcoidosis in the aortic wall. The systemic granulomatous inflammation process of sarcoidosis possibly affected the valvular and vascular pathology. Herein, we report a rare case of aortic sarcoidosis complicated by a pulmonary artery aneurysm.

    DOI: 10.1093/ejcts/ezy131

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

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

    Nagoya journal of medical science   79 巻 ( 4 ) 頁: 443 - 451   2017年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Nagoya Journal of Medical Science  

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

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

    The Annals of thoracic surgery   103 巻 ( 6 ) 頁: e483 - e485   2017年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Annals of Thoracic Surgery  

    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.

    DOI: 10.1016/j.athoracsur.2016.11.032

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  45. 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   70 巻 ( 4 ) 頁: 281 - 285   2017年4月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Kyobu geka. The Japanese journal of thoracic surgery  

    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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  46. [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   70 巻 ( 4 ) 頁: 281-285   2017年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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  47. Increased expression of the adipocytokine omentin in the epicardial adipose tissue of coronary artery disease patients 査読有り

      251 巻   頁: 299-304   2016年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.atherosclerosis

  48. Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch. 査読有り

    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   22 巻 ( 6 ) 頁: 750-755   2016年6月

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1093

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

      49 巻   頁: 1264-1269   2015年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1093/ejcts/ezv313

  50. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. 査読有り

    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.     頁: ezv063. [Epub ahead of print]   2015年

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  51. Brain protection during ascending aortic repair for Stanford type A acute aortic dissection surgery: A nationwide analysis in Japan 査読有り

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

    Circ J.   78 巻 ( 10 ) 頁: 2431-8.   2014年9月

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    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  52. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. 査読有り

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

      96 巻 ( 2 ) 頁: 571-6   2013年8月

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  53. Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography. 査読有り

    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.   43 巻 ( 6 ) 頁: 1183-1187   2013年6月

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  54. Recurrence of cardiac myxoma in the left atrial after 28 years; report of a case. 査読有り

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

    Kyobu Geka.   65 巻 ( 12 ) 頁: 1089-92.   2012年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

  55. Association of a matrix metallopeptidase 1 gene polymorphism with long-term outcome of thoracic aortic aneurysm. 査読有り

    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   29 巻 ( 1 ) 頁: 125-32.   2012年1月

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  56. Cardiac 64-Multislice Computed Tomography Reveals Increased Epicardial Fat Volume in Patients With Acute Coronary Syndrome. 査読有り

    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.   108 巻 ( 8 ) 頁: 1119-23   2011年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  57. Pneumopericardial Tamponade in a Patient With Partial Sternal Dehiscence

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

    Ann Thorac Surg.   89 巻 ( 4 ) 頁: 1291-92   2010年

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  58. Intraoperative heart rate variability of a cardiac surgeon himself in coronary artery bypass grafting surgery. 査読有り

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

    Interact Cardiovasc Thorac Surg   8 巻 ( 6 ) 頁: 639-41   2009年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  59. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement. 査読有り

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

      86 巻 ( 2 ) 頁: 532-536.   2008年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  60. 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   33 巻 ( 2 ) 頁: 164-167   2008年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  61. Aortic root aneurysm in Takayasu arteritis syndrome: exploration in active phase and repair in inactive phase. 査読有り

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

    J Thorac Cardiovasc Surg.   136 巻 ( 4 ) 頁: 1084-5   2008年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  62. Internal thoracic artery grafts and upper extremity arteriovenous fistula 査読有り

    Yoshiyuki Tokuda, Min-Ho Song.

    Ann Thorac Surg   84 巻 ( 6 ) 頁: 2138   2007年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  63. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. 招待有り 査読有り

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

    Ann Thorac Surg.   84 巻 ( 6 ) 頁: 1928-1933   2007年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.athoracsur.2007.07.040

  64. Right ventricular end-diastolic volume in the postoperative care of cardiac surgery patients: a marker of the hemodynamic response to a fluid challenge. 査読有り

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

      71 巻 ( 9 ) 頁: 1408-1411   2007年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  65. Revival of the side-to-side approach for distal coronary anastomosis 査読有り

    Song MH, Tokuda Y, Ito T.

    Journal of Cardiothoracic Surgery   6 巻 ( 2 ) 頁: 2   2007年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  66. A simple training model for coronary artery anastomoses 査読有り

    Yoshiyuki Tokuda, Min-Ho Song.

    Heart Surgery Forum   9 巻 ( 6 ) 頁: E880-2   2006年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  67. Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery. 査読有り

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

    Interact Cardiovasc Thorac Surg.   5 巻   頁: 322-326   2006年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  68. A Simple Method of Stabilizing a Coronary Graft onto a Suction Stabilizer in Coronary Surgery. 査読有り

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

    Heart Surgery Forum   9 巻 ( 3 ) 頁: E612-13   2006年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  69. Nasal Mask Bi-level Positive Airway Pressure (BiPAP) Ventilation for Diaphragmatic Paralysis after Pediatric Open Heart Surgery. 査読有り

    Yoshiyuki Tokuda, Masahiko Matsumoto, Takaaki Sugita, Junichiro Nishizawa

    Pediatr Cardiol   25 巻 ( 5 ) 頁: 552-3   2005年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  70. Gastrointestinal complications in patients undergoing coronary artery bypass grafting. 査読有り

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

    Ann Thorac Cardiovasc Surg   11 巻 ( 1 ) 頁: 25-8   2005年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  71. Successful Repair of an Aortoesophageal Fistula due to a Thoracic Aortic Aneurysm 査読有り

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

    Surg Today   34 巻 ( 4 ) 頁: 357-9   2004年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  72. Management for type A acute dissection 査読有り

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

    Kyobu Geka   57 巻 ( 3 ) 頁: 201-6   2004年

     詳細を見る

    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

  73. Early and late results of combined valvular and coronary artery surgery 査読有り

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

    Kyobu Geka   57 巻 ( 6 ) 頁: 353-7   2004年

     詳細を見る

    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

  74. Surgical treatment of five patients with aortobronchial fistula in the aortic arch. 査読有り

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

    Ann Thorac Surg   77 巻 ( 5 ) 頁: 1821-3   2004年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  75. Intravenous leiomyomatosis extending into the right ventricle associated with pulmonary metastasis and extensive arteriovenous fistula. 査読有り

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

    J Am Coll Surg   198 巻 ( 5 ) 頁: 842-3   2004年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  76. Bilateral Diaphragmatic Paralysis after Aortic Surgery with Topical Hypothermia: Ventilatory Assistance by Nasal Mask Bi-level Positive Pressure. 査読有り

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

    J Thorac Cardiovasc Surg.   125 巻 ( 5 ) 頁: 1158-9   2003年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  77. Vascular Surgery Using Argatroban in a Patient with a History of Heparin-Induced Thrombocytopenia. 査読有り

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

    Circ J.   67 巻 ( 10 ) 頁: 889 – 890   2003年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  78. Predictors of residual tricuspid regurgitation after mitral valve surgery. 査読有り

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

    Ann Thorac Surg   75 巻 ( 6 ) 頁: 1826-8   2003年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  79. Management of asymptomatic aortic stenosis in patients undergoing coronary artery bypass grafting. 査読有り

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

    Circ J   67 巻 ( 3 ) 頁: 199-202   2003年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  80. Two contributions concerning mild to moderate aortic stenosis in patients undergoing coronary bypass grafting. 査読有り

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

    J Heart Valve Dis   12 巻 ( 2 ) 頁: 270-1   2003年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  81. Treatment of persistent chylothorax with somatostatin. 査読有り

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

    Ann Thorac Surg   76 巻 ( 1 ) 頁: 340-1   2003年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  82. Methicillin-resistant Staphylococcus aureus endocarditis following repair of tetralogy of Fallot. 査読有り

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

    Pediatr Cardiol.   23 巻 ( 5 ) 頁: 564-5   2002年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  83. Mitral Valve Repair for Severe Mitral Regurgitation Caused by Endomyocardial Biopsy. 査読有り

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

    J Heart Valve Dis.   11 巻   頁: 837-838   2002年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  84. Anticoagulant therapy in Japanese patients with mechanical mitral valves. 査読有り

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

    Circ J   66 巻 ( 7 ) 頁: 668-70.   2002年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  85. Anticoagulant therapy in Japanese patients with mechanical mitral valves. 査読有り

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

    Circ J   66 巻 ( 7 ) 頁: 668-70   2002年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  86. The Optimal Treatment for Adult Patent Ductus Arteriosus. 査読有り

    Tokuda Yoshiyuki, Matsumoto Masahiko, Sugita Takaaki.

    Ann Thorac Surg.   72 巻 ( 6 ) 頁: 2186   2001年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  87. Mini-Incision Midline Approach for Infrarenal Abdominal Aortic Aneurysms. 査読有り

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

    Asian Cardiovasc Thorac Ann.   9 巻   頁: 347-348   2001年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  88. Coronary artery bypass grafting for patients with an atherosclerotic ascending aorta. 査読有り

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

    Jpn J Thorac Cardiovasc Surg   49 巻 ( 4 ) 頁: 195-200   2001年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  89. Emergent surgical treatment of type A acute aortic dissection in an elderly patient. 査読有り

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

    Kyobu Geka   54 巻 ( 13 ) 頁: 1115-7   2001年

     詳細を見る

    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

  90. De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation. 査読有り

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

    J Heart Valve Dis   10 巻 ( 4 ) 頁: 520-4   2001年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  91. Clinical characteristics of patients with constrictive pericarditis after coronary bypass surgery. 査読有り

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

    Jpn Circ J   65 巻 ( 6 ) 頁: 480-2   2001年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  92. Clinical characteristics of patients with constrictive pericarditis after coronary bypass surgery. 査読有り

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

    Jpn Circ J   65 巻 ( 6 ) 頁: 480-2   2001年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

  93. Transcatheter coil closure of large patent ductus arteriosus in 70-year-old woman with 0.052-inch Gianturco coils using Bioptome. 査読有り

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

    Jpn J Thorac Cardiovasc Surg.   49 巻 ( 6 ) 頁: 381-383   2001年

     詳細を見る

    担当区分:筆頭著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

  94. Long-term effect of polystan monocusp ventricular outflow patch after right ventricular outflow tract reconstruction. 査読有り

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

    Kyobu Geka   53 巻 ( 10 ) 頁: 853-6   2000年

     詳細を見る

    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

  95. Long-term results of right ventricular outflow reconstruction with valved conduit. 査読有り

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

    Kyobu Geka   53 巻 ( 12 ) 頁: 1025-7   2000年

     詳細を見る

    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

  96. Combined cardiac surgery and total thyroidectomy: a case report. 査読有り

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

    Jpn Circ J   63 巻 ( 12 ) 頁: 1004-6   1999年

     詳細を見る

    記述言語:英語   掲載種別:研究論文(学術雑誌)  

▼全件表示

書籍等出版物 4

  1. 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( 担当: 共著)

    日本臨床  2019年 

     詳細を見る

    記述言語:日本語 著書種別:教科書・概説・概論

  2. 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( 担当: 共著)

    医学出版  2017年7月 

     詳細を見る

    記述言語:日本語 著書種別:一般書・啓蒙書

  3. 最新人工心肺

    徳田順之( 担当: 共著 ,  範囲: 特殊な体外循環(TAVR))

    名古屋大学出版会  2017年 

     詳細を見る

    記述言語:日本語 著書種別:教科書・概説・概論

  4. 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( 担当: 共著)

    保健文化社  2010年 

     詳細を見る

    記述言語:日本語

MISC 3

  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年8月

     詳細を見る

    記述言語:英語   出版者・発行元: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

    Scopus

    PubMed

  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 surgery37 巻 ( 7 ) 頁: 2103 - 2104   2022年7月

     詳細を見る

    記述言語:英語   出版者・発行元:Journal of Cardiac Surgery  

    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

    Scopus

    PubMed

  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 reports10 巻   頁: 2050313X221116681   2022年

     詳細を見る

    記述言語:英語   出版者・発行元:SAGE Open Medical Case Reports  

    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

    Scopus

    PubMed

共同研究・競争的資金等の研究課題 1

  1. 感染性心内膜炎における至適手術時期に関する多施設共同後ろ向き研究

    2014年3月 - 2015年9月

      詳細を見る

    担当区分:研究分担者 

    配分額:122324円

科研費 4

  1. 経カテーテル僧帽弁置換のための安定した経心房中隔アクセス法の確立

    研究課題/研究課題番号:22K08955  2022年4月 - 2025年3月

    科学研究費助成事業  基盤研究(C)

    徳田 順之, 古澤 健司, 成田 裕司, 田中 哲人, 六鹿 雅登

      詳細を見る

    担当区分:研究代表者 

    配分額:3900000円 ( 直接経費:3000000円 、 間接経費:900000円 )

    経カテーテル僧帽弁置換(TMVR)の目的に叶う経中隔アクセスを安定して得るにはどうすればよいのかを学術的問いとして設定した。
    1)大口径可変シースのプロトタイプ作成
    2)従来の 下大静脈 経由以外に頸静脈/鎖骨下静脈から 上大静脈 を介した頭側からのアプローチの検証
    3)心房中隔至適穿刺位置の再検証 <従来提唱されてきた穿刺点の見直し>
    4)delivery ガイドワイヤー法の再検討<渦巻ワイヤー以外のプルスルー法はどうか>など

  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

    研究課題/研究課題番号:20K09145  2020年4月 - 2021年3月

    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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    担当区分:研究分担者 

    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。

  3. 医療経済からみた経カテーテル大動脈弁置換術の適応限界の検証

    研究課題/研究課題番号:19K08513  2019年4月 - 2022年3月

    科学研究費助成事業  基盤研究(C)

    徳田 順之, 碓氷 章彦, 伊藤 英樹, 藤本 和朗, 田中 哲人

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    担当区分:研究代表者 

    配分額:4420000円 ( 直接経費:3400000円 、 間接経費:1020000円 )

    限られた財源で医療を最適化するには費用対効果の客観的評価を行うことが必要である。我が国ではその任を担う医療技術評価(HTA)機関が存在せず、特に侵襲的医療の費用対効果は検証されていない。本研究は、高齢者が対象となる高額医療の代表格の大動脈弁狭窄症(AS)に対する経カテーテル的大動脈弁置換(TAVI)の医療経済視点からの介入限界を明らかにするものである。多数のQOL曲線を得て費用対効果の評価プロセスを標準化し介入限界を明らかにする。HTA設立の足がかりとしたい。
    大動脈弁狭窄症(AS)に対する経カテーテル的大動脈弁置換(TAVI)の医療経済視点からの介入限界を明らするためステップを構築した。QALY(Quality-adjusted life year) (生活の質指標である効用値と生存年数の積分値である)の曲線算出が必要となる。1QALYを得るのに必要な医療費および関連コスト(の増)がICER(Incremental cost-effectiveness ratio=増分費用効果比)である。
    1.正確なQALY曲線を得るため、情報収集記録手段を確立した。データサーバーの構築をIRB了承を得て行った。セキュリティーの十分確保されたサーバーは稼動し外科手術情報データベースとしても日常使用している。2.QALY把握に術前のFrailty+ADL 評価方法を確立し記録した。理学療法士による周術期リハビリテーション時に継続的評価を行った(項目=MMSE EQ-5D,握力 Katz ADL) 3.さらに質問紙でも効用値が算出できるように情報収集系を確立した。具体的にはEQ-5D質問回答を効用値に変換する変換プログラムを作成した。効用値はQALY曲線の縦軸でありEQ-5D質問紙でこれが直ちに得られる体系を構築したことは費用対効果解析の上では意義深い。4.術前、周術期、術後退院前の作業療法士による評価に加えて予後調査とともににEQ-5D質問紙送付を行い経時的な効用値の追跡、予後追跡を行った。
    TAVI後の生存曲線2年生存82.9% 2年MACE free生存77.8%であり、前述のMACE freeを達成した例の効用値下行は顕著でなかった。Historical cohortでの自然予後との比較で一連のAS治療による良好なaverage QALY gainを確認した。
    現時点で得られた知見の概要を記する。TAVI後の生存曲線2年生存82.9% 2年MACE free生存77.8%であり、前述のMACE freeを達成した例の効用値下行は顕著でなかった。Historical cohortの自然予後との比較で一連のAS治療による良好なaverage QALY gainを確認した。曲線がまだ継続しており数値を提示しきれないが>2QALYは確実と考えられる。対する社会コストは保険請求点数のTAVI入院費用550万円+その後の各種医療費+社会コストである。TAVIはコストも大きいが獲得QALYも大きい。なお、ICER算出上の対照アームの薬物治療単体でも160万円以上は必要と見込まれた。
    ICER閾値(社会が1QALYを得るのに支出しうるコスト)をどこに置くかは議論があるが、WHOの基準等を参考にすると日本の場合1人あたりのGDP比約1.2倍の500万円と考えられる。この基準に基づけば、当施設で実施しているTAVIは医療経済上の効果は良好といえる。
    重症ASの高齢者に対して、現在の国内一般基準に基づくTAVI治療(いわゆるintermediate-high risk candidateに対する治療)は医学的および医療経済的に妥当な範囲にある。TAVIはコストも大きいが獲得QALYも大きい。
    ここまでが明らかとなり順調な進捗である。
    ICER閾値(社会が1QALYを得るのに支出しうるコスト)をどこに置くかは議論があるが、WHOの基準等を参考に日本の場合1人あたりのGDP比約1.2倍の500万円と考えられる。この基準に基づけば、当施設で実施しているTAVIは医療経済上の効果は良好といえる。
    重症ASの高齢者に対して、現在の国内一般基準に基づくTAVI治療(いわゆるintermediate-high risk candidateに対する治療)は医学的および医療経済的に妥当な範囲にある。(保存的治療に比して)TAVIはコストも大きいが獲得QALYも大きいことは明らかとなったが、今後の課題は外科的AVRとTAVIの医療経済比較解析である。外科的AVRは入院保険点数は若年例では450万円とやや低いがそれでも入院期間が長い高齢者で併発症を有すると入院コストは激増する。Propensity matchを行った上、コスト比較解析を実施する。
    本研究の過程で作成された、パーソナルコンピュータもしくはスマートフォンに実装可能なEQ-5D質問紙-効用値変換計算プログラムについては、要請に応じた各研究期間への公開を視野にいれている。医療経済解析を行う研究者に有用と考えられる。

  4. 感染抵抗性人工血管の開発

    2012年4月 - 2014年3月

    科学研究費補助金  若手研究(B)

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    担当区分:研究代表者 

 

担当経験のある科目 (本学) 2

  1. 弁膜症 体外循環

    2021

  2. 体外循環

    2020

 

社会貢献活動 4

  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年12月 - 2020年1月

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    種別:その他

    医療支援活動

  2. 市民公開講座

    役割:講師

    中日新聞社  東建ホール  2019年9月

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    対象: 社会人・一般

    種別:講演会

  3. 平成30年名古屋大学附属病院 地域医療連携講演会

    役割:講師

    名古屋大学附属病院  2018年11月

  4. 市民公開講座

    役割:コメンテーター, 取材協力

    読売新聞社  2018年1月

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    対象: 社会人・一般

    種別:講演会

メディア報道 4

  1. 心臓弁膜症 あなたの頑張っている心臓のおはなし 新聞・雑誌

    中日新聞社  中日新聞  中日新聞紙面  2022年10月

  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年12月

  3. 知っておきたい心臓の病気 新聞・雑誌

    中日新聞社  中日新聞紙面  2019年10月

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    執筆者:本人以外 

  4. 知って見逃さない心臓弁膜症 新聞・雑誌

    読売新聞  読売新聞紙面  2018年3月

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    執筆者:本人以外 

学術貢献活動 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

    役割:企画立案・運営等

    ( 教育講演 及び同内容での教育目的冊子書籍の執筆 ) 2021年5月

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    種別:学会・研究会等 

    (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年8月

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    種別:学会・研究会等 

  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年5月

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    種別:学会・研究会等