研究者詳細 - 徳田　順之

論文 - 徳田　順之

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Ascorbic acid deficiency increases hepatic expression of acute phase proteins through the intestine-derived IL-6 and hepatic STAT3 pathway in ODS rats. 査読有り国際誌

Kawade N, Murai A, Suzuki W, Tokuda Y, Kobayashi M, Horio F

The Journal of nutritional biochemistry 70 巻頁： 116 - 124 2019年8月

Temporary immobile leaflet following transcatheter aortic valve replacement of a SAPIEN-XT valve. 査読有り国際誌

Aoki T, Tanaka A, Tokuda Y, Oshima H, Suzuki S, Ishii H

Cardiovascular intervention and therapeutics 34 巻 ( 3 ) 頁： 277 - 278 2019年7月

Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis. 査読有り国際誌

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

The Annals of thoracic surgery 108 巻 ( 1 ) 頁： 107 - 114 2019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：Annals of Thoracic Surgery

Background: Postoperative neurologic deficits are associated with severe morbidity in aortic arch replacement. Methods: A group of 198 consecutive patients undergoing isolated total aortic arch replacement with the use of antegrade cerebral perfusion were analyzed for the risk factors for predicting neurologic deficit. With the use of computed tomography, atherothrombotic lesions (defined as extensive intimal thickening exceeding 4 mm) were identified in the proximal aorta (the ascending aorta or aortic arch) in 26.2% of cases and in the distal aorta in 34.9% of cases. Results: Permanent neurologic deficits occurred in 11.1% (including non-disabling stroke confirmed by imaging) and transient neurologic deficits in 8.1% of patients. A univariate analysis identified proximal atherothrombotic aorta (p = 0.0057), distal atherothrombotic aorta (p = 0.032), and retrograde systemic perfusion from the femoral artery in the presence of distal atherothrombotic aorta (p = 0.0022) as risk factors for neurologic deficits. A multivariate logistic regression analysis identified atherothrombotic proximal aorta (odds ratio 2.4, p = 0.033) as the independent risk factor. The presence of carotid stenosis did not affect the rate of neurologic deficit. Intracranial hemorrhagic lesions were found in 23% of permanent neurologic deficit cases. Conclusions: Atherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphologic characteristics appear to be mandatory. Anticoagulation therapy should be performed carefully to avoid intracranial hemorrhagic changes.

DOI： 10.1016/j.athoracsur.2019.01.004

Conservative treatment of type A aortic dissection following hybrid arch repair.

Yoshizumi T, Tokuda Y, Abe T, Usui A

General thoracic and cardiovascular surgery 67 巻 ( 7 ) 頁： 602 - 607 2019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：General Thoracic and Cardiovascular Surgery

Objective: Type A aortic dissection (TAAD) following hybrid arch repair (HAR) is a lethal complication. Open surgical repair is the ideal treatment, but this can be difficult, as most candidates have complications and are unsuitable for the conventional open aortic repair. We herein report three cases of TAAD after HAR and assess the treatment options. Methods: Of 261 aortic arch repair cases between April 2010 and March 2018, 38 underwent HAR using debranching of all the arch vessels followed by stent graft implantation landing proximally in zone 0 (type 1 HAR). Three cases suffered from TAAD, and their background characteristics and post-operative outcomes were studied retrospectively. Results: The three TAAD cases were elderly with a high risk of mortality due to comorbidities. TAAD for Cases 1, 2, and 3 was detected on post-operative day (POD) 11, POD11, and during the procedure, respectively. Case 1 was complicated with both respiratory and renal failures, and Case 3 suffered from severe neurological impairment when TAAD was detected. No additional open aortic repair was performed in any cases. Case 3 died on POD5 due to aortic rupture. Cases 1 and 2 have survived for more than 50 months since their initial surgeries. Conclusions: TAAD following HAR can be detected with post-operative imaging despite a lack of signs noted during the intra- and post-operative periods. Conservative therapy might, therefore, be an acceptable option for subacute-onset TAAD following HAR with stable hemodynamics, even though such patients do required a very careful follow-up.

DOI： 10.1007/s11748-019-01075-w

Fungal endocarditis after transcatheter aortic valve replacement (TAVR): Case report and review of literature. 査読有り国際誌

Morioka H, Tokuda Y, Oshima H, Iguchi M, Tomita Y, Usui A, Yagi T

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 巻 ( 3 ) 頁： 215 - 217 2019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 Infection and Chemotherapy

The reported number of transcatheter aortic valve replacement-associated infective endocarditis (TAVR-IE) cases has been increasing worldwide, but information about the incidence and clinical features of fungal TAVR-IE is quite limited. We present a patient who acquired TAVR-IE caused by Candida parapsilosis four month after TAVR, who was successfully treated redo-aortic valve replacement and prolonged antifungal therapy.

DOI： 10.1016/j.jiac.2018.08.017

Dementia and Cognitive Impairment on Coronary Artery Bypass Grafting Patients in Aging Society 国際誌

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

Journal of Coronary Artery Disease 25 巻 ( 3 ) 頁： 66 - 71 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：The Japanese Coronary Association

Coronary artery bypass grafting (CABG) is strategy for complex coronary artery disease (CAD) practiced worldwide that has become to be performed in relatively elderly patients in recent years, regarding to the development of off-pump CABG. As the population of elderly patients with cognitive disorders increases, a certain proportion of CABG candidates are likely to have some degree of cognitive impairment, especially dementia. The discussions about the CABG candidates with dementia are still insufficient, although several reports have suggested that 9.6%&ndash20% of CABG candidates may have preoperative dementia. An analysis indicated higher rate of hospital mortality and delirium in dementia patients, but ideal strategies for managing such patients remain controversial. An estimated 20%&ndash35% of CABG patients may have preoperative mild cognitive impairment (MCI), which is associated with an increased risk of morbidity and poor physical recovery after CABG. This preoperative cognitive decline was identified as a predictive factor for post-operative cognitive decline (POCD). Several randomized control trial have compared the cognitive outcomes between elderly high-risk patients after CABG with or without cardiopulmonary bypass, finding no significant cognitive differences between on- and off-pump treatments at 3 to 12 months after CABG. In addition, any late cognitive decline is likely associated with the progression of underlying cerebrovascular disease rather than surgical procedure itself or cardiopulmonary bypass. Preoperative evaluations of the cognitive function may contribute to appropriate postoperative management, reduce the incidence of delirium and improve the overall surgical outcome.

DOI： 10.7793/jcad.25.010

CiNii Research

The oral administration of clarithromycin prevents the progression and rupture of aortic aneurysm. 査読有り国際誌

Uchida W, Narita Y, Yamawaki-Ogata A, Tokuda Y, Mutsuga M, Lee Fujimoto K, Abe T, Oshima H, Usui A

Journal of vascular surgery 68 巻 ( 6S ) 頁： 82S - 92S.e2 2018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：Journal of Vascular Surgery

Objective: The pathogenesis of aortic aneurysm (AA) is associated with chronic inflammation in the aortic wall with increased levels of matrix metalloproteinases (MMPs). Clarithromycin (CAM) has been reported to suppresses MMP activity. In this study, we investigated whether CAM could prevent the formation and rupture of AA. Methods: Male apolipoprotein E-deficient mice (28-30 weeks of age) were infused with angiotensin II for 28 days. CAM (100 mg/kg/d) or saline (as a control) was administered orally to the mice every day (CAM group, n = 13; control group, n = 13). After the administration period, the aortic diameter, elastin content, macrophage infiltration, MMP levels, and levels of inflammatory cytokines, including nuclear factor κB (NF-κB), were measured. Results: The aortic diameter was significantly suppressed in the CAM group (P <.001). No rupture death was observed in the CAM group in contrast to five deaths (38%) in the control group (P <.01). CAM significantly suppressed the degradation of aortic elastin (56.3% vs 16.5%; P <.001) and decreased the infiltration of inflammatory macrophages (0.05 vs 0.16; P <.01). Compared with the controls, the enzymatic activity of MMP-2 and MMP-9 was significantly reduced in the CAM group (MMP-2, 0.15 vs 0.56 [P <.01]; MMP-9, 0.12 vs 0.60 [P <.01]), and the levels of interleukin 1β (346.6 vs 1066.0; P <.05), interleukin 6 (128.4 vs 346.2; P <.05), and phosphorylation of NF-κB were also decreased (0.3 vs 2.0; P <.01). Conclusions: CAM suppressed the progression and rupture of AA through the suppression of inflammatory macrophage infiltration, a reduction in MMP-2 and MMP-9 activity, and the inhibition of elastin degradation associated with the suppression of NF-κB phosphorylation. Clinical Relevance: This article shows that high-dose clarithromycin (CAM) suppressed aortic aneurysm formation and rupture. Fortunately, no mice had adverse effects of CAM in the laboratory test. For clinical relevance, we will try a low dose of CAM for the same model of mice, such as 10 mg/kg/d or less. Although we think we need to try bigger animals, such as a pig, we have no study design of an aortic aneurysm model for big animals.

DOI： 10.1016/j.jvs.2017.12.047

Strategy of Cardiovascular Surgery for Patients With Dementia as Evaluated by Mini-Mental State Examination. 国際誌

Terazawa S, Oshima H, Narita Y, Fujimoto K, Mutsuga M, Tokuda Y, Yoshizumi T, Ito H, Uchida W, Usui A

Circulation journal : official journal of the Japanese Circulation Society 82 巻 ( 12 ) 頁： 2998-3004 - 3004 2018年11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: The strategy for cardiovascular surgery in dementia patients is controversial, so we aimed to investigate whether preoperative dementia and its severity might affect the outcomes of cardiovascular surgery by evaluating with the Mini-Mental State Examination (MMSE). Methods and Results: The study group comprised 490 patients undergoing cardiovascular surgery. Their preoperative cognitive status was evaluated using the MMSE, and analysis was performed to compare the patients with MMSE score <24 (dementia group, n=51) or MMSE score 24–30 (non-dementia group, n=439). Furthermore, the effect of the severity of dementia was analyzed with a cut-off MMSE score of 19/20. Risk factors for surgical outcomes were explored using multivariate logistic regression analysis. Hospital mortality was 11.8% in the dementia group and 2.1% in the non-dementia group (P=0.002). Regarding the postoperative morbidities, the incidence of cerebrovascular disorder (P=0.001), pneumonia (P=0.039), delirium (P=0.004), and infection (P=0.006) was more frequent in dementia group. Among the patients with MMSE <20, hospital mortality was as high as 25%, and the rate of delirium was 58%. Multivariate logistic regression analysis revealed that MMSE score <24 (P=0.003), lower serum albumin (P=0.023) and aortic surgery (P=0.036) were independent risk factors for hospital death. Conclusions: Preoperative dementia affects the outcomes of cardiovascular surgery with regard to hospital death and delirium. The surgical indication for patients with MMSE <20 might be difficult, but surgery with an appropriate strategy should be considered for patients with MMSE <24.

DOI： 10.1253/circj.CJ-18-0312

The Possibility of Clarithromycin for the Treatment of Type B Aortic Dissection.

Uchida Wataru, Yamawaki-Ogata Aika, Hideki Ito, Sachie Tarazawa, Tokuda Yoshiyuki, Mutsuga Masato, Fujimoto Kazuro L., Yuji Narita, Usui Akihiko

CIRCULATION 138 巻 2018年11月

Aortic sarcoidosis complicated by a pulmonary artery aneurysm. 査読有り国際誌

Uchida W, Tokuda Y, Mutsuga M, Usui A

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 54 巻 ( 4 ) 頁： 786 - 788 2018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 76-year-old woman, who had a history of ocular sarcoidosis, was incidentally found to have a huge pulmonary artery aneurysm, along with aortic, mitral and tricuspid valve insufficiency. She underwent pulmonary artery plication along with surgeries for 3 valves. A specimen of the slightly enlarged ascending aorta revealed the involvement of sarcoidosis in the aortic wall. The systemic granulomatous inflammation process of sarcoidosis possibly affected the valvular and vascular pathology. Herein, we report a rare case of aortic sarcoidosis complicated by a pulmonary artery aneurysm.

DOI： 10.1093/ejcts/ezy131

Placebo-Controlled, Double-Blinded Phase III Study Comparing Dexamethasone on Day 1 With Dexamethasone on Days 1 to 3 With Combined Neurokinin-1 Receptor Antagonist and Palonosetron in High-Emetogenic Chemotherapy. 査読有り国際誌

Ito Y, Tsuda T, Minatogawa H, Kano S, Sakamaki K, Ando M, Tsugawa K, Kojima Y, Furuya N, Matsuzaki K, Fukuda M, Sugae S, Ohta I, Arioka H, Tokuda Y, Narui K, Tsuboya A, Suda T, Morita S, Boku N, Yamanaka T, Nakajima TE

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 36 巻 ( 10 ) 頁： 1000 - 1006 2018年4月

Clinical outcomes and quality of life after surgery for dilated ascending aorta at the time of aortic valve replacement; wrapping versus graft replacement. 査読有り国際誌

Abe T, Terazawa S, Ito H, Tokuda Y, Fujimoto K, Mutsuga M, Narita Y, Oshima H, Usui A

Nagoya journal of medical science 79 巻 ( 4 ) 頁： 443 - 451 2017年11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：Nagoya Journal of Medical Science

Wrapping and graft replacement are two optional procedures for the treatment of dilated ascending aorta at the time of aortic valve replacement (AVR). Wrapping is considered less invasive. The aim of this study was to compare the short- and long-term clinical outcomes as well as the long-term quality of life in patients undergoing these two procedures.This study enrolled 40 consecutive patients with dilated ascending aorta who had undergone either wrapping (WAA group, n=20) or replacement (RAA group, n=20) of the ascending aorta at the time of AVR. Short-term outcomes, long-term deaths, and aortic events were evaluated, as was quality of life using the SF-36 Short Form. Long-term maximal proximal aortic diameter was also obtained.There were no early deaths in either group. Pump time was shorter, and transfusion (55% vs. 95%, p=0.035) and postoperative atrial fibrillation (5% vs. 30%, p=0.036) rates were lower, in the WAA than in the RAA group. At a mean follow-up of 4.9 years, the overall 5 year survival rates in the WAA and RAA groups were 78.1% and 87.5%, respectively. There were no significant between group differences in SF-36 scores in any subcategory of this survey. Long-term maximal aortic diameter remained stable in both groups. Both surgical interventions for dilated ascending aorta at the time of AVR yield favorable and comparable results in patients with suitable anatomy. Furthermore, we found no differences in quality of life between these procedures.

DOI： 10.18999/nagjms.79.4.443

Entire Circumferential Reconstruction of the Right Atrium Surrounded by Angiosarcoma. 査読有り国際誌

Hibino M, Abe T, Oshima H, Narita Y, Mutsuga M, Fujimoto KL, Tokuda Y, Yamana K, Kuroda T, Usui A

The Annals of thoracic surgery 103 巻 ( 6 ) 頁： e483 - e485 2017年6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

Primary cardiac angiosarcomas are frequently found at a large size with infiltration into the adjacent heart structure owing to their asymptomatic characteristics until an advanced stage. Therefore, extensive resection is often required to achieve a good prognosis. We herein report a case of entire circumferential resection of the right atrium surrounded by angiosarcoma and excellent three-dimensional reconstruction of the right atrium.

DOI： 10.1016/j.athoracsur.2016.11.032

Total Arch Replacement Using Manufactured Frozen Elephant Trunk after Acute Type-A Dissection Repair

Hibino M., Mutsuga M., Oshima H., Narita Y., Abe T., Fujimoto K., Tokuda Y., Usui A.

Kyobu geka. The Japanese journal of thoracic surgery 70 巻 ( 4 ) 頁： 281 - 285 2017年4月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Kyobu geka. The Japanese journal of thoracic surgery

The purpose of this study is to assess the result of total arch replacement(TAR) using manufactured frozen elephant trunk(FET) for chronic aortic dissection after initial repair including the effect of aortic remodeling by the FET. Between 2003 and 2015, we performed 11 TAR using manufactured FET. Initial repairs before were 9 ascending aortic replacements and 2 Bentall operations. The entry of residual dissection was located at arch in 7 and at distal anastomosis site in 4. There was no hospital death. The operative complication included 2 surgical site infection, 1 interstitial pneumonia and 1 paraplegia with almost full recovery. Postoperative computed tomography 2.1 months after operation showed distal end of the FET was located at aortic valve level in 7 and at pulmonary bifurcation level in 4. There was no entry in thoracic aorta. Thrombosis of descending aorta was achieved in 7 patients. Significant midterm aortic remodeling (increased diameter of true lumen and decreased diameter of false lumen) was achieved, although the total diameter of aorta was increased. TAR using manufactured FET after type-A dissection repair promoted entry closure and thrombosis of false lumen. It requires long-term observation to judge the effect for aortic remodeling.

Scopus

[Total Arch Replacement Using Manufactured Frozen Elephant Trunk after Acute Type-A Dissection Repair]. 査読有り国際誌

Hibino M, Mutsuga M, Oshima H, Narita Y, Abe T, Fujimoto K, Tokuda Y, Usui A

Kyobu geka. The Japanese journal of thoracic surgery 70 巻 ( 4 ) 頁： 281 - 285 2017年4月

Early and Late Outcomes of Thoracic Aortic Surgery in Hemodialysis Patients (vol 102, pg 1282, 2016) 国際誌

M. Hibino, H. Oshima, Y. Narita, T. Abe, M. Mutsuga, K. L. Fujimoto, Y. Tokuda, S. Terazawa, H. Ito, A. Usui

ANNALS OF THORACIC SURGERY 103 巻 ( 1 ) 頁： 366 - 366 2017年1月

Increased expression of the adipocytokine omentin in the epicardial adipose tissue of coronary artery disease patients 査読有り

251 巻頁： 299-304 2016年7月

Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch. 査読有り

Tokuda Y, Oshima H, Narita Y, Abe T, Mutsuga M, Fujimoto K, Terazawa S, Ito H, Hibino M, Uchida W, Komori K, Usui A

Interact Cardiovasc Thorac Surg 22 巻 ( 6 ) 頁： 750-755 2016年6月

A 'through-and-through bowing technique' for antegrade thoracic endovascular aneurysm repair with total arch debranching: a technical note and the initial results 査読有り

49 巻頁： 1264-1269 2015年9月

Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. 査読有り

Tokuda Y, Oshima H, Narita Y, Abe T, Araki Y, Mutsuga M, Fujimoto K, Terazawa S, Yagami K, Ito H, Yamamoto K, Komori K, Usui A

Eur J Cardiothorac Surg. 頁： ezv063. [Epub ahead of print] 2015年

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