研究者詳細 - 徳田　順之

Impact of Early Ambulation on the Prognosis of Coronary Artery Bypass Grafting Patients.

Tsuchikawa Y, Tokuda Y, Ito H, Shimizu M, Tanaka S, Nishida K, Takagi D, Fukuta A, Takeda N, Yamamoto H, Hori M, Nishida Y, Mutsuga M

Circulation journal : official journal of the Japanese Circulation Society 87 巻 ( 2 ) 頁： 306 - 311 2023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: The effect of delayed ambulation on the outcome of coronary artery bypass grafting (CABG) remains to be clarified. Methods and Results: The long-term and in-hospital outcomes of 887 patients who underwent isolated CABG (455 off-pump cases, 135 urgent cases) were evaluated, with a focus on the timing of first ambulation. In-hospital mortality cases were excluded. Early ambulation (first ambulation within 3 days after operation) was achieved in 339 (38%) patients. In the multivariable logistic regression analysis, longer operation time and urgent case, EuroSCORE II, re-thoracotomy, and respiratory time were associated with delayed (≥4 days) ambulation. Delayed ambulation was associated with a high incidence of postoperative complications, such as pneumonia, and stroke (P<0.01). Following discharge, 22.2% of patients experienced major cardiac events and 13.8% died during the follow-up period (median follow-up 60 months). Cox hazards analysis revealed that delayed ambulation was associated with long-term adverse events (hazard ratio 1.04 per day, P<0.001). With adjustment for preoperative factors, the estimated future risk of adverse events was found to be increased day-by-day during the delay until initial ambulation. Conclusions: In isolated CABG patients, delayed ambulation was associated with poor outcomes, even in the long-term period. The results support the current guideline recommending early ambulation protocol after cardiac surgery.

DOI： 10.1253/circj.CJ-22-0416

Impact of Albuminuria on the Prognosis After Transcatheter Aortic Valve Implantation. 査読有り国際誌

Tobe A, Tanaka A, Tokuda Y, Shirai Y, Miyazaki T, Yuhara S, Akita S, Furusawa K, Ishii H, Mutsuga M, Murohara T

The American journal of cardiology 186 巻頁： 156 - 162 2023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：American Journal of Cardiology

The impact of preoperative albuminuria on the prognosis after transcatheter aortic valve implantation (TAVI) has not been studied. A total of 228 patients who underwent TAVI for severe aortic stenosis (AS) and for whom preoperative urinary data was available were retrospectively investigated. Patients were divided into two groups according to the urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). The urinary total protein-to-creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was the composite outcome of all-cause death and readmission for heart failure. In total, 117 patients had a high ACR and 111 patients had a low ACR. During the median follow-up period of 467 days, patients with a high ACR had a higher incidence of the primary outcome than those with a low ACR (p<0.001). Patients with a high PCR or positive dipstick proteinuria were also at a higher risk for the primary outcome (p<0.001 and p=0.008, respectively). Multivariable Cox proportional hazards analysis showed a high ACR was independently associated with a primary outcome (hazard ratio, 4.98; 95% confidence interval, 1.84–13.49; p=0.002). In conclusion, preoperative albuminuria is an independent predictor of cardiac events in patients with severe AS undergoing TAVI.

DOI： 10.1016/j.amjcard.2022.09.020

Higher F-wave frequency associates with poor procedural success rate after Maze procedure. 査読有り国際誌

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

General thoracic and cardiovascular surgery 70 巻 ( 12 ) 頁： 997 - 1004 2022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

Objectives: Persistent atrial fibrillation (AF) causes atrial remodeling, which causes myocardial fibrosis and micro-reentry. Fibrosis may reduce wave voltage and micro-reentry may enhance the dominant frequency (DF) of the F-wave. We investigated whether the DF predicts procedural success by the Maze procedure. Methods: In 138 consecutive patients who underwent mitral valve surgery and a modified Cox-Maze III procedure for persistent AF in Nagoya University in 2002–2018, 96 (70%) were successfully cardioverted (group S); 42 had persistent or relapsed AF after surgery (group F). Patient data were compared between the groups. Cut-off values were determined by an ROC analysis and predictors of procedural success were evaluated. The DF was obtained from the F-wave of V1 by a high-speed Fourier analysis using the CEPAS software program. Results: Group F showed a significantly larger LA diameter, better LVEF, lower F-wave voltage, higher DF, and longer duration of AF. The cut-off values were as follows: LA diameter, 56 mm; EF, 64.5%; F-wave voltage, 0.13 mV; DF, 7.3 Hz; and duration of AF, 44 months. Each factor showed statistical significance in a univariate analysis; DF lost significance in the multivariate analysis. The higher (DF ≥ 7.3 Hz) and lower voltage group (≤ 0.13 mV) showed the worst procedural success rate (36%), while the lower DF (< 7.3 Hz) and higher voltage group (> 0.13 mV) showed a good rate (86%). Conclusions: The DF of the F-wave is a useful predictor of procedural success after the Maze procedure in addition to the voltage of F-wave.

DOI： 10.1007/s11748-022-01836-0

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

Web of Science

Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis. 国際誌

Tobe A, Tanaka A, Tokuda Y, Akita S, Fujii T, Miki Y, Furusawa K, Ishii H, Usui A, Murohara T

Circulation journal : official journal of the Japanese Circulation Society 85 巻 ( 7 ) 頁： 1093 - 1098 2021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：一般社団法人日本循環器学会

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. 査読有り国際誌

Banno H, Mutsuga M, Sugimoto M, Tokuda Y, Kodama A, Usui A, Komori K

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 61 巻 ( 6 ) 頁： 938 - 944 2021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：European Journal of Vascular and Endovascular Surgery

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

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

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

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

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

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

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

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.