Faculty Profiles - TOKUDA Yoshiyuki

Papers - TOKUDA Yoshiyuki

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

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

Heart Lung and Circulation Vol. 30 ( 5 ) page： 765 - 772 2021.5

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

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

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

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

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

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

DOI： 10.1016/j.athoracsur.2020.07.031

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Sutures on the Anterior Mitral Leaflet to Prevent Systolic Anterior Motion Reviewed International journal Open Access

Yoshiyuki Tokuda, Kazuro Fujimoto, Yuji Narita, Masato Mutsuga, Akihiko Usui

Annals of Thoracic Surgery Vol. 111 ( 3 ) page： e213 - e215 2021.3

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

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

Masato Mutsuga, Hiroshi Banno, Yoshiyuki Tokuda, Akihiko Usui

Journal of Cardiac Surgery Vol. 36 ( 3 ) page： 1126 - 1129 2021.3

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

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.

DOI： 10.1111/jocs.15282

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

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

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

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

Hideki Ito, Masato Mutsuga, Yoshiyuki Tokuda, Akihiko Usui

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

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

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

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

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement International journal Open Access

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

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

大動脈手術後後の急性腎機能障害の危険因子に対する検討 Reviewed International journal

大野司, 秋田利明, 成田裕司, 六鹿雅登, 藤本和朗, 徳田順之, 寺澤幸枝, 伊藤英樹, 内田亘, 松村泰基, 宗像寿祥, 芦田真一, 西俊彦, 秋田翔, 矢野大介, 阿部知伸, 碓氷章彦

日本胸部外科学会定期学術集会 Vol. 73回 page： CLO7 - 7 2020.10

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

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

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

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

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.

DOI： 10.1007/s10047-020-01160-5

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

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

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

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

Hideki Ito, Masato Mutsuga, Yoshiyuki Tokuda, Akihiko Usui

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

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press (OUP)

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

DOI： 10.1093/ejcts/ezaa032

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

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

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

Management of Patients With Aortic Stenosis Requiring Non-Cardiac Surgery International journal Open Access

Tokuda Yoshiyuki, Usui Akihiko

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

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

Background:Patients with severe aortic stenosis (AS) might be at high risk for adverse cardiovascular events at the time of non-cardiac surgery.Methods and Results:The current study population included 348 patients who underwent elective non-cardiac surgery under general or spinal anesthesia during the follow up of 3,815 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry. There were 187 patients with untreated severe AS at time of surgery (untreated severe AS group) and 161 patients who had undergone aortic valve replacement (AVR) before surgery (prior AVR group), including 23 patients with prophylactic AVR. The primary outcome measure was 30-day mortality after non-cardiac surgery. At 30 days after non-cardiac surgery, 8 patients (4.3%) died in the untreated severe AS group, while no patients died in the prior AVR group (P=0.008). The causes of death were cardiovascular in 6 out of 8 patients. Mortality at 30 days was higher in untreated severe AS patients with AS-related symptoms before surgery than in those without AS-related symptoms (7.2% vs. 3.1%). Higher surgical risk estimates of the non-cardiac surgery incrementally increased the risk of 30-day mortality in patients with untreated severe AS, though the difference was not statistically significant (low-risk: 0%, intermediate-risk: 4.3%, and high-risk: 6.6 %, P=0.46).Conclusions:Symptomatic and asymptomatic severe AS might be associated with higher risk of 30-day mortality if untreated before elective intermediate- and high-risk non-cardiac surgery, while no patient with prior AVR died after elective non-cardiac surgery.

DOI： 10.1253/circj.CJ-20-0437

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

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

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

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

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.

DOI： 10.1093/ejcts/ezz323

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

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

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

肺高血圧治療部門新規開設施設におけるCTEPHに対するPEA/BPA中期成績の検討 Reviewed International journal

寺澤幸枝, 安藤太三, 足立史郎, 近藤隆久, 石田真一, 矢野大介, 秋田翔, 西俊彦, 芦田真一, 宗像寿祥, 内田亘, 松村泰基, 伊藤英樹, 徳田順之, 六鹿雅登, 藤本和朗, 成田裕司, 碓氷章彦

日本心臓血管外科学会学術総会抄録集 Vol. 50回 page： O11 - 3 2020.3

Spinal cord injury following aortic arch replacement Reviewed International journal

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

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

Contemporary Outcomes of Surgical Aortic Valve Replacement in Japan Open Access

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

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

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

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.

DOI： 10.1253/circj.CJ-19-0674

Mechanical haemolytic anaemia assessed with four-dimensional flow cardiac magnetic resonance International journal Open Access

Uchida Wataru, Tokuda Yoshiyuki, Takehara Yasuo, Usui Akihiko

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

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

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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Papers - TOKUDA Yoshiyuki