研究者詳細 - 徳田　順之

論文 - 徳田　順之

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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

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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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

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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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

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.

DOI： 10.1111/jocs.15282

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

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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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

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

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.

DOI： 10.1007/s11748-020-01387-2

その他リンク： http://link.springer.com/article/10.1007/s11748-020-01387-2/fulltext.html

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

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement. 国際誌

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

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査読有り国際誌

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 73回巻頁： CLO7 - 7 2020年10月

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

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

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.

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. 査読有り

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

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

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

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

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

その他リンク： http://link.springer.com/article/10.1007/s11748-019-01254-9/fulltext.html

Management of Patients With Aortic Stenosis Requiring Non-Cardiac Surgery. 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

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

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.

DOI： 10.1093/ejcts/ezz323

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

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

その他リンク： http://link.springer.com/article/10.1007/s11748-019-01201-8/fulltext.html

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中期成績の検討査読有り国際誌

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 50回巻頁： O11 - 3 2020年3月

Spinal cord injury following aortic arch replacement. 査読有り国際誌

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

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.

DOI： 10.1007/s00595-019-01853-2

その他リンク： http://link.springer.com/article/10.1007/s00595-019-01853-2/fulltext.html

Contemporary Outcomes of Surgical Aortic Valve Replacement in Japan.

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

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本循環器学会

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. 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

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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