Faculty Profiles - TOKUDA Yoshiyuki

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

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

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

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

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

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

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

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

DOI： 10.1007/s00595-021-02415-1

Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement. Reviewed International journal

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

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

Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study. Reviewed International journal Open Access

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

Scientific reports Vol. 12 ( 1 ) page： 10626 2022.6

Albuminuria predicts worsening renal function after transcatheter aortic valve replacement Reviewed International journal Open Access

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

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

Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study. Reviewed International journal Open Access

Kurihara M, Kamata K, Tokuda Y

BMJ open Vol. 12 ( 4 ) page： e054246 2022.4

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

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

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

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

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

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

Hitomi Koyanagi, Yoshinori Tsutsumi, Yoshiyuki Tokuda, Akihito Tanaka, Maki Endo, Yasushi Furukawa, Shinji Abe

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

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Japan

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 &lt
0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p &lt
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

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

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

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

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

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

Nationwide survey on Japanese residents' experience with and barriers to incident reporting. Reviewed International journal Open Access

Kurihara M, Watari T, Rohde JM, Gupta A, Tokuda Y, Nagao Y

PloS one Vol. 17 ( 12 ) page： e0278615 2022

Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting. Reviewed International journal Open Access

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

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

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

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

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

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

Incident reporting among physicians-in-training in Japan: A national survey. Reviewed International journal Open Access

Kurihara M, Nagao Y, Tokuda Y

Journal of general and family medicine Vol. 22 ( 6 ) page： 356 - 358 2021.11

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

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

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

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

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

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

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

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

Improvement in the nutritional status after transcatheter aortic valve implantation Reviewed International journal Open Access

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

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

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

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

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

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

Web of Science

Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis International journal Open Access

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

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

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

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

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

Hiroshi Banno, Masato Mutsuga, Masayuki Sugimoto, Yoshiyuki Tokuda, Akio Kodama, Akihiko Usui, Kimihiro Komori

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

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

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