研究者詳細 - 徳田　順之

Albuminuria Predicts Short-Term Worsening Renal Function After Transcatheter Aortic Valve Replacement. 査読有り国際誌

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

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

Multidisciplinary surgical approach for renal cell carcinoma with inferior vena cava tumor thrombus. 査読有り国際誌

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

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

Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement. 査読有り国際誌

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

Journal of cardiac surgery 37 巻 ( 7 ) 頁： 2103 - 2104 2022年7月

Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study. 査読有り国際誌

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 12 巻 ( 1 ) 頁： 10626 2022年6月

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

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

Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study. 査読有り国際誌

Kurihara M, Kamata K, Tokuda Y

BMJ open 12 巻 ( 4 ) 頁： e054246 2022年4月

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

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

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

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

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

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

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

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

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

Nationwide survey on Japanese residents' experience with and barriers to incident reporting. 査読有り国際誌

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

PloS one 17 巻 ( 12 ) 頁： e0278615 2022年

Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting. 査読有り国際誌

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

SAGE open medical case reports 10 巻頁： 2050313X221116681 2022年

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

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

Incident reporting among physicians-in-training in Japan: A national survey. 査読有り国際誌

Kurihara M, Nagao Y, Tokuda Y

Journal of general and family medicine 22 巻 ( 6 ) 頁： 356 - 358 2021年11月

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

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

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

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

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

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

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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