Faculty Profiles - TOKUDA Yoshiyuki

Papers - TOKUDA Yoshiyuki

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Risk factors for distal stent graft-induced new entry after frozen elephant trunk procedure in chronic aortic dissection. Reviewed International journal

Akita S, Tokuda Y, Narita Y, Terazawa S, Yoshizumi T, Ito H, Mutsuga M

General thoracic and cardiovascular surgery 2025.2

Impact of direct mesenteric perfusion on malperfusion in acute type A aortic dissection repair. Reviewed International journal

Yamamoto R, Kato W, Tokuda Y, Yamaki K, Morita K, Uemura T, Yamamoto T, Ito H, Yoshizumi T, Terazawa S, Narita Y, Mutsuga M

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Vol. 67 ( 1 ) 2024.12

The Incidence and Influencing Factors of In-hospital Frailty Progression following Transcatheter Aortic Valve Implantation

Miyazaki Tatsuya, Tanaka Akihito, Tokuda Yoshiyuki, Shirai Yoshinori, Mizutani Koji, Furusawa Kenji, Akita Sho, Ozeki Takahiro, Kobayashi Kiyonori, Ishii Hideki, Mutsuga Masato, Murohara Toyoaki

Internal Medicine Vol. 63 ( 24 ) page： 3283 - 3289 2024.12

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Internal Medicine

Objective Patients undergoing transcatheter aortic valve implantation (TAVI) are generally older and frailty is therefore an important clinical issue. The baseline degree of frailty is associated with the prognosis in patients undergoing TAVI; however, the incidence of in-hospital frailty progression and its influencing factors have not yet been elucidated. Methods This observational, single-center study retrospectively evaluated 281 patients who underwent TAVI. The degree of frailty at baseline and discharge was evaluated using the Clinical Frailty Scale (CFS). In-hospital frailty progression was defined as an increase of at least one level in the CFS score at discharge from baseline, and predictors of frailty progression were assessed. Results The median baseline CFS score was 4.0 (interquartile range: 3.0-4.0). In-hospital frailty progression was observed in 49 patients (17.4%). No significant differences were observed in age, sex, comorbidities, or surgical risk scores between patients with and without frailty progression. Patients with frailty progression experienced stroke more frequently during hospitalization than those without (12.2% vs. 1.3%, p=0.001). A multivariable logistic analysis showed that in-hospital stroke was a significant predictor of frailty progression (odds ratio, 10.7; 95% confidence interval: 2.34-49.2, p=0.002). Patients with frailty progression had a longer hospital stay than those without frailty progression [7.0 (4.0-17.0) vs. 4.0 (4.0-8.0) days, p=0.001]. Conclusion In-hospital frailty progression was not uncommon in patients undergoing TAVI. Stroke incidence was a significant influencing factor in frailty progression, whereas baseline comorbidities and surgical risks were not.

DOI： 10.2169/internalmedicine.3146-23

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Clinical Features and Postoperative Mobilization following Total Aortic Arch Replacement

Shirai Yuya, Tokuda Yoshiyuki, Tsuchikawa Yohei, Kobayashi Kiyonori, Tanaka Shinya, Yoshito Natsumi, Hori Yuto, Takagi Daichi, Nishida Yoshihiro, Mutsuga Masato

International Heart Journal Vol. 65 ( 6 ) page： 1075 - 1078 2024.11

Language：English Publishing type：Research paper (scientific journal) Publisher：International Heart Journal Association

Open thoracic aortic surgery is believed to necessitate more intensive rehabilitation. This study aimed to compare the progress of postoperative rehabilitation between standard and delayed mobilization. A retrospective review was conducted on 199 patients who underwent isolated total aortic arch replacement via median sternotomy. Cases of in-hospital mortality and postoperative stroke were excluded. Based on the current guidelines for cardiovascular rehabilitation of the Japanese Circulation Society, patients were categorized into standard mobilization (could sit on the edge of bed within 2 days) and delayed mobilization (could not do so) groups. Rehabilitation progress was compared among both groups. Initial mobilization was delayed in 100 patients (delayed mobilization group), primarily because of respiratory failure (46.0%). Preoperative risk characteristics, including EuroSCORE II (median, 2.9 versus 3.5), were similar between the standard and delayed mobilization groups. The delayed mobilization group had longer operation (median, 6.1 versus 8.0 hours, P < 0.001) and cardiopulmonary bypass (median, 3.2 versus 4.1 hours, P < 0.001) times. Independent ambulation occurred earlier in the standard mobilization group (median, 6.0 versus 8.0 days, P < 0.001).In conclusion, early initiation of sitting on the edge of the bed within 2 days was associated with earlier independent ambulation during postoperative rehabilitation, which supports the current guidelines. Longer operation and cardiopulmonary bypass times were associated with delayed mobilization initiation, suggesting the need for more tailored approaches in such cases.

DOI： 10.1536/ihj.24-261

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Risk factors for proximal and distal aortic events after type A acute aortic dissection. Reviewed International journal

Akita S, Tokuda Y, Kato W, Tanaka K, Mutsuga M

General thoracic and cardiovascular surgery 2024.9

HeartMate 3 driveline damage by gradual corrosion due to liquid infiltration: a case report. Reviewed International journal

Yoshizumi T, Ito H, Terazawa S, Tokuda Y, Sakurai H, Narita Y, Mutsuga M

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2024.8

Bronchial occlusion with endobronchial Watanabe spigots using a two-scope technique for massive haemoptysis. Reviewed International journal

Baba T, Ito T, Sato Y, Hayai S, Koyama J, Nakamura S, Tokuda Y, Chen-Yoshikawa TF, Ishii M

Respirology case reports Vol. 12 ( 6 ) page： e01405 2024.6

Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study. Reviewed International journal Open Access

Nagasaki K, Kobayashi H, Nishizaki Y, Kurihara M, Watari T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Katayama K, Tokuda Y

Scientific reports Vol. 14 ( 1 ) page： 1481 2024.1

Surgical reconstruction after resection of cardiac metastasis from oropharyngeal carcinoma: a case report. Reviewed International journal

Nishi T, Fujimoto KL, Hiramatsu M, Okada T, Suzuki Y, Shimoyama Y, Terazawa S, Tokuda Y, Mutsuga M, Usui A

Nagoya journal of medical science Vol. 85 ( 4 ) page： 875 - 879 2023.11

Safety culture survey among medical residents in Japan: a nationwide cross-sectional study. Reviewed International journal Open Access

Watari T, Kurihara M, Nishizaki Y, Tokuda Y, Nagao Y

BMJ open quality Vol. 12 ( 4 ) 2023.10

Phase II trial of biweekly administration with eribulin after three cycles of induction therapy in hormone receptor-positive, HER2-negative metastatic breast cancer (JACCRO BC-03). Reviewed International journal

Kobayashi K, Masuda N, Mizuno T, Miura K, Tokuda Y, Yoshinami T, Kawaguchi H, Ohtani S, Saeki T, Toi M, Takeuchi M, Ito Y

Breast cancer research and treatment Vol. 201 ( 3 ) page： 409 - 415 2023.10

Association between prolonged weekly duty hours and self-study time among residents: a cross-sectional study. Reviewed International journal

Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Katayama K, Kobayashi H, Tokuda Y

Postgraduate medical journal Vol. 99 ( 1176 ) page： 1080 - 1087 2023.9

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. Reviewed International journal

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 Vol. 53S page： S149 - S152 2023.8

Hybrid Repair of Extensive Aortic Arch Aneurysms: Outcomes of Isolated Frozen Elephant Trunk Repair and of Elephant Trunk with Second Stage Thoracic Endovascular Aortic Repair. Reviewed International journal

Tokuda Y, Terazawa S, Yoshizumi T, Ito H, Banno H, Mutsuga M

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Vol. 66 ( 2 ) page： 284 - 285 2023.8

Clinical implications of the cardio-ankle vascular index before and after transcatheter aortic valve implantation. Reviewed International journal

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

Journal of cardiovascular medicine (Hagerstown, Md.) Vol. 24 ( 5 ) page： 302 - 307 2023.5

Incidence and clinical impact of silent pancreatitis after aortic arch surgery. Reviewed International journal

Tsukasa Ohno, Masato Mutsuga, Shunei Saito, Yoshiyuki Tokuda, Keiichi Nagai, Norio Umemoto, Tomonobu Abe, Akihiko Usui

Asian cardiovascular & thoracic annals Vol. 31 ( 4 ) page： 303 - 311 2023.5

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

BACKGROUND: This study was designed to investigate the incidence and types of pancreatic injury, risk factors, and time-course changes in computed tomographic findings following total aortic arch replacement with moderate hypothermic circulatory arrest. METHODS: Medical records of patients who underwent total arch replacement between January 2006 and August 2021 were retrospectively reviewed. A comparison study between the patients with (group P) and without pancreatic injury (group N) was conducted to elucidate the impact of pancreatic injury. Follow-up computed tomography of the patients in group P was reviewed to investigate time-course changes of the pancreatic injury. RESULTS: Of 353 patients, 14 (4.0%) had subclinical pancreatic injury. Computed tomographic findings were consistent with acute pancreatitis in all patients, of whom eight patients had interstitial edematous pancreatitis, whereas six patients had necrotizing pancreatitis. Although walled-off necrosis occurred in three patients, none of them required drainage. In-hospital mortality was 7.1% and 4.4% in groups P and N, respectively (p = 0.98). The 5-year actuarial survival rates were 77.9% and 81.0% in groups P and N, respectively (p = 0.51). Multivariate analysis revealed that pancreatic injury was associated with chronic obstructive pulmonary disease (p = 0.03). CONCLUSIONS: This study highlighted that silent pancreatic injury after aortic arch surgery is underrecognized. Potential arterial sclerosis of the pancreatic circulation seems to be related to pancreatic injury.

DOI： 10.1177/02184923231158581

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冠動脈バイパス手術患者における早期歩行が長期予後に与える影響 Reviewed International journal

土川洋平, 徳田順之, 伊藤英樹, 清水美帆, 田中伸弥, 西田一貴, 高木大地, 福田章真, 武田夏季, 山本浩正, 堀将也, 西田佳弘, 六鹿雅登

日本循環器学会学術集会抄録集 Vol. 87回 page： CA1 - 5 2023.3

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

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

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

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

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

DOI： 10.1111/aor.14426

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Impact of Early Ambulation on the Prognosis of Coronary Artery Bypass Grafting Patients Open Access

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

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

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

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

DOI： 10.1253/circj.CJ-22-0416

Impact of Albuminuria on the Prognosis After Transcatheter Aortic Valve Implantation. Reviewed International journal

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

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

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

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

DOI： 10.1016/j.amjcard.2022.09.020

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Papers - TOKUDA Yoshiyuki