Language：Japanese   Publisher：The Japanese Society for Cardiovascular Surgery  

DOI： 10.4326/jjcvs.54.1.i

CiNii Research

Language：English   Publisher：Advanced Healthcare Materials  

Multiple hydrogels are developed for injection therapy after myocardial infarction, with some incorporating substances promoting tissue regeneration and others emphasizing mechanical effects. In this study, porosity and extracellular matrix-derived digest (ECM) are incorporated, into a mechanically optimized, thermoresponsive, degradable hydrogel (poly(N-isopropylacrylamide-co-N-vinylpyrrolidone-co-MAPLA)) and evaluate whether this biomaterial injectate can abrogate adverse remodeling in rat ischemic cardiomyopathy. After myocardial infarction, rats are divided into four groups: NP (non-porous hydrogel) without either ECM or porosity, PM (porous hydrogel) from the same synthetic copolymer with mannitol beads as porogens, and PME with porosity and ECM digest added to the synthetic copolymer. PBS injection alone is a control group. Intramyocardial injections occurred 3 days after myocardial infarction followed by serial echocardiography and histological assessments 8 weeks after infarction. Echocardiographic function and neovascularization improved in the PME group compared to the other hydrogels and PBS injection. The PME group also demonstrated improved LV geometry and macrophage polarization (toward M2) compared to PBS, whereas differences are not observed in the NP or PM groups versus control. These results demonstrate further functional improvement may be achieved in hydrogel injection therapy for ischemic cardiomyopathy by incorporating porosity and ECM digest, representing combined mechanical and biological effects.

DOI： 10.1002/adhm.202402757

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：European Journal of Cardio-thoracic Surgery  

OBJECTIVES: Mesenteric malperfusion in acute aortic dissection remains a life-threatening complication with no standardized treatment strategy. This study aimed to describe and evaluate the outcomes of our integrated approach combining exploratory laparotomy, immediate mesenteric reperfusion, and central aortic repair. METHODS: We retrospectively reviewed patients with acute aortic dissection with a preoperative diagnosis of mesenteric malperfusion who were treated between August 2011 and November 2022. Our surgical approach was to establish cardiopulmonary bypass, followed by exploratory laparotomy with mesenteric artery flow assessment using Doppler ultrasound and direct perfusion if needed, central aortic repair, and subsequent mesenteric artery reconstruction. The primary end-point was the 30-day operative mortality. RESULTS: Among 217 patients with acute aortic dissection, 12 (5.5%) had mesenteric malperfusion on preoperative computed tomography. Ten patients underwent exploratory laparotomy, where Doppler ultrasonography revealed reduced mesenteric blood flow in five patients (2.3% of the total 217 patients). These patients underwent direct perfusion of the mesenteric artery via a side branch of the cardiopulmonary bypass circuit. Doppler ultrasound confirmed the restoration of mesenteric blood flow in all perfused patients. No bowel resections were required. The operative mortality in patients with mesenteric malperfusion was 20%. The causes of death were stroke (n = 1) and acute myocardial infarction (n = 1). CONCLUSIONS: Our integrated surgical strategy combining central aortic repair with concurrent exploratory laparotomy and immediate mesenteric perfusion demonstrated technical feasibility in managing mesenteric malperfusion during aortic repair. Further prospective studies with larger cohorts are warranted to validate these findings.

DOI： 10.1093/ejcts/ezae452

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Scopus

PubMed

Language：English   Publisher：ACS Omega  

Bacterial infections on material surfaces are a serious public health concern worldwide. Although poly(vinyl alcohol) (PVA)-based materials have great potential as medical devices, they lack antibacterial properties on their surfaces and pose bacterial infection risks during implantation surgery. Copolymers containing antibacterial [2-(methacryloyloxy)ethyl]trimethylammonium chloride (METAC) units were used to modify the surfaces of chemically cross-linked water-insoluble PVA-based microfibers. The copolymers also had carboxy units that were used to react with the hydroxy group of the PVA-based microfibers via a simple thermal treatment at 135 °C. PVA-based materials containing METAC units exhibit significant swelling due to electrostatic repulsions. Because the copolymers were modified on the extreme surface of the microfibers, no difference in the diameters between unmodified microfibers (PM-fiber) and copolymers with METAC unit-modified microfibers (PM-METAC-fiber), in both the dry and swollen states, was observed. The viable bacterial cell numbers, which were evaluated by colony counting, decreased by exposure to the poly(METAC-co-methacrylic acid (MAAc)) aqueous solution or PM-METAC-fibers. The value of CFU/mL decreased to 0.1% (against B. subtilis) and 3.9% (against E. coli) after contact with the PM-METAC-fibers compared to the PM-fibers. The percentage of hemolysis against rabbit red blood cells was equivalent to that of the negative control, suggesting that PM-METAC-fibers can selectively exhibit antibacterial properties. This modification method can be applied to various PVA-based materials if hydroxy groups are present on their surface. This study provides a facile, cost-effective, and promising strategy to impart antibacterial properties to the surface of PVA-based materials without significantly affecting their physicochemical properties.

DOI： 10.1021/acsomega.4c05637

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：General Thoracic and Cardiovascular Surgery  

Objectives: Type A acute aortic dissection (TAAAD) is a life-threatening condition often requiring emergency surgery, with approximately 30% of patients needing reoperation. This study aimed to identify predictors of long-term aortic events from early postoperative computed tomography (CT) examinations. Methods: A total of 336 cases underwent TAAAD surgery at two institutions between 2002 and 2018. Of these, 302 patients received CT examinations immediately after initial TAAAD surgery. Predictors of aortic events were evaluated from these early postoperative CT exams. Aortic events were defined as any events involving aortic-related death, open surgery, reoperation, endovascular stenting, or thoracic aorta diameter enlargement to ≥ 55 mm. Results: Excluding 34 in-hospital deaths (10.1%; 34/336), the 1-, 5-, and 10-year actuarial survival rates after primary TAAAD surgery were 98.2%, 88.6%, and 81.7%, respectively. Over a mean follow-up period of 7.4 ± 5.1 years, 67 aortic events (proximal: 19, distal: 45, both: 3) were observed. Freedom from proximal aortic events was 98.6%, 93.9%, and 85.2% at 1, 5, and 10 years, respectively. Proximal anastomosis new entry was identified as a significant risk factor for aortic events, with a 92% vs. 42% incidence at 10 years (p < 0.001). Freedom from distal aortic events was 99.6%, 84.5%, and 67.2% at 1, 5, and 10 years, respectively. A false/true area ratio greater than 1 and distal anastomosis new entry were significant risk factors for aortic events (low-risk group: 83.3% vs. high-risk group: 42.3% at 10 years, p < 0.001). Conclusions: Detailed analysis of early postoperative CT scans following primary TAAAD surgery may help identify predictors of subsequent aortic events, potentially improving long-term patient management and outcomes.

DOI： 10.1007/s11748-024-02077-z

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Scopus

PubMed

Language：Japanese  

PubMed

Language：English   Publisher：Journal of Artificial Organs  

A 31-year-old man with a HeartMate 3 was admitted with a “Driveline Communication Fault” alarm due to liquid infiltration. Eleven months earlier, the connector between the modular and pump cables had gotten wet when he was taking a shower. The cable connector was dried immediately, and no alarm had been observed during follow-up. Subsequently, the modular cable and system controller were replaced, with corrosion found on the modular cable connector. The “Communication Fault” alarm recurred, and complete damage to the communication cables was discovered. The pump was replaced, and the removed pump cable connector showed corrosion as well. If the driveline connector gets wet, the multidisciplinary team should discuss if it should be immediately disconnected and dried, averting the need for future pump replacements due to corrosion.

DOI： 10.1007/s10047-024-01464-w

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Scopus

PubMed

Language：English   Publisher：Scientific Reports  

Apoptosis inhibitor of macrophage (AIM) is known to induce apoptosis resistance in macrophages and to exacerbate chronic inflammation, leading to arteriosclerosis. The role of AIM in aortic aneurysm (AA) remains unknown. This study examined the effects of an anti-AIM antibody in preventing AA formation and progression. In apolipoprotein E-deficient mice, AA was induced by subcutaneous angiotensin II infusion. Mice were randomly divided into two groups: (i) AIM group; weekly anti-murine AIM monoclonal antibody injection (n = 10), and (ii) IgG group; anti-murine IgG antibody injection as control (n = 14). The AIM group, compared with the IgG group, exhibited reduced AA enlargement (aortic diameter at 4 weeks: 2.1 vs. 2.7 mm, respectively, p = 0.012); decreased loss of elastic lamellae construction; reduced expression levels of IL-6, TNF-α, and MCP-1; decreased numbers of AIM-positive cells and inflammatory M1 macrophages (AIM: 1.4 vs. 8.0%, respectively, p = 0.004; M1 macrophages: 24.5 vs. 55.7%, respectively, p = 0.017); and higher expression of caspase-3 in the aortic wall (22.8 vs. 10.5%, respectively, p = 0.019). Our results suggest that administration of an anti-AIM antibody mitigated AA progression by alleviating inflammation and promoting M1 macrophage apoptosis.

DOI： 10.1038/s41598-024-66791-7

Open Access

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Scopus

PubMed

Language：English  

DOI： 10.1007/s10047-024-01441-3

PubMed

Language：English  

DOI： 10.1007/s11748-023-01941-8

Web of Science

PubMed

Language：English   Publisher：Japan Transcatheter Valve Therapies  

<p>The treatment of functional mitral regurgitation (FMR) has evolved dramatically in recent years and remains dynamic. Generally, the treatment of FMR involves a combination of medication optimization and surgical or transcatheter interventions. The use of transcatheter edge-to-edge repair has been increasing for FMR. This less invasive approach allows for transcatheter mitral valve repair, avoiding open heart surgery. On the other hand, surgical mitral valve repair techniques, such as annuloplasty, still play a crucial role in managing FMR. Simultaneous surgical ablation for atrial fibrillation or left atrial appendage closure can be performed. Surgical interventions also encompass concomitant operations, including addressing commonly coexisting secondary tricuspid valve pathology or performing coronary artery bypass grafting, which is relevant, especially in the case of ischemic mitral regurgitation. The management of FMR involves a multidisciplinary heart team consisting of cardiologists, cardiac surgeons, and other specialists. This collaborative approach aims to tailor treatment strategies to individual patients, considering survival and the quality of life.</p>

DOI： 10.33290/jtvt.ra.24-0008

CiNii Research

Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.55.1195

CiNii Research

Language：English  

DOI： 10.1093/ejcts/ezad408

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PubMed

Language：English  

DOI： 10.1093/icvts/ivad170

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PubMed

Language：English  

DOI： 10.18999/nagjms.85.4.875

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PubMed

Language：English  

DOI： 10.1053/j.jvca.2023.06.023

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PubMed

Language：English  

DOI： 10.1016/j.xjtc.2023.07.026

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PubMed

DOI： 10.1016/j.polymer.2023.126236

Web of Science

Publisher：南江堂  

DOI： 10.15106/j_kyobu76_824

CiNii Research

Language：Japanese  

PubMed

Language：English  

DOI： 10.1186/s41232-023-00280-8

Web of Science

PubMed

Language：English  

DOI： 10.1016/j.carrev.2022.08.025

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PubMed

Language：English  

DOI： 10.1016/j.ejvs.2023.05.009

Web of Science

PubMed

Language：English  

DOI： 10.18999/nagjms.85.3.626

Web of Science

PubMed

Language：Japanese   Publisher：特定非営利活動法人 日本心臓血管外科学会  

DOI： 10.4326/jjcvs.52.i

CiNii Research

Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao.52.62

CiNii Research

Language：English  

DOI： 10.1177/02184923231158581

Web of Science

PubMed

Language：English  

DOI： 10.2459/JCM.0000000000001456

Web of Science

PubMed

Language：English  

DOI： 10.1016/j.jccase.2023.01.005

PubMed

Language：English  

DOI： 10.1007/s10047-022-01337-0

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PubMed

Language：English  

DOI： 10.1038/s41598-023-27412-x

Web of Science

PubMed

Language：English  

DOI： 10.1016/j.amjcard.2022.09.020

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PubMed

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>近年の心臓移植レシピエント候補の増加とわが国の深刻なドナー不足により、心臓移植待機期間は1,700日を超えるに至った。移植前状態のほぼ100%は非拍動型植込型VAD装着状態にある。J-MACSデータによれば、術後1年のVAD関連合併症として、感染(36％)、神経機能障害(24％)、大量出血(21％)、右心不全(7％)、除細動を要する不整脈(8%)があり、3年生存は85％とされる。現在当院では、心臓移植適応承認84名中12名(14%)に心臓移植を施行しえたが、待機中に16名(19%)が死亡しており、原因として多臓器不全、脳血管障害、感染が多い。また、緊急入院では、心室頻拍や心室細動等の不整脈、右室不全、ドライブライン断線、感染が多い。待機中のこれらの状態を考慮した、わが国独自のスコアリングシステムの開発、allocation systemが望まれる。不整脈や右心不全にて繰り返し入退院を余儀なくされる症例、BiVADサポート症例、後遺症のない待機中脳血管障害症例、繰り返す溶血・血栓等の症例は、待機中予後の改善の観点から、優先度を再考してもよいかもしれない。しかしながら現在、これらの合併症の程度やそれに伴うStatusの変更においては客観的な検証はされておらず、各要素を組み込む際には客観的な評価システムの構築が必要となろう。当院における心臓移植待機の現状を報告し、allocation systemの現状の課題と将来的なあり方、改定への進め方を議論したい。</p>

DOI： 10.11386/jst.58.supplement_s154_1

CiNii Research

Language：English  

DOI： 10.1007/s11748-022-01836-0

Web of Science

PubMed

Language：English  

DOI： 10.1111/jocs.17002

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PubMed

Publisher：南江堂  

DOI： 10.15106/j_kyobu75_759

CiNii Research

Language：English  

DOI： 10.1007/s10047-022-01312-9

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PubMed

Language：Japanese  

PubMed

Language：English  

DOI： 10.1177/2050313X221116681

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PubMed

Language：English  

DOI： 10.1253/circrep.CR-22-0018

PubMed

Language：English  

DOI： 10.1016/j.jccase.2021.12.010

PubMed

Language：English  

DOI： 10.1007/s10047-022-01311-w

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PubMed

Language：English  

DOI： 10.1007/s12055-022-01351-0

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PubMed

Language：English  

DOI： 10.1016/j.hlc.2021.12.007

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PubMed

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Language：English  

DOI： 10.1186/s13104-022-05939-y

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PubMed

Language：English  

DOI： 10.1007/s11748-021-01738-7

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PubMed

Language：English  

DOI： 10.1080/14712598.2022.2005575

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PubMed

DOI： 10.1093/jscr/rjab602

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PubMed

Language：English  

DOI： 10.5761/atcs.ra.22-00103

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PubMed

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>症例は50歳代男性。Xー12年に心不全のためA病院入院。心筋生検にて拡張型心筋症と診断。その後入退院を繰り返し、心臓移植申請を目的にX－5年7月に名大病院紹介となった。心臓移植適応判定を得て、同年10月に植込み型補助人工心臓（HM-II)植え込み術施行。X年3月24日にドライブラインの断線疑いでHM-IIIへ入れ替え術施行。術後に尿路感染合併し4月2日より抗菌薬治療開始したところ、sCr（mg/dL）0.79-0.96から2.49へと悪化し、その後も改善しないため、4月4日腎臓内科紹介された。CTでは左胸水少量認め、IVC虚脱や水腎症を認めず、腎機能障害の原因は不明であった。ARB中止して経過観察したが4月8日sCr3.02と腎機能は改善せず，別の腎機能検査であるsCysC(mg/L)は0.91と著しい乖離を認めた。4月18日イヌリンクリアランス検査を行い実測GFR84.2（ｍL/分/1.73m2）、sCr.2.59，sCysC0.85、eGFRcreat21.3，eGFRcys88.8であり、偽性高Cr血症が疑われた。そこで酵素法（シグナスオートCRE）とHPLC法でsCrを比較したところ2.4と0.8であった。酵素法のR-Ⅱ試薬添加後に副波長の吸光度が上昇し続けており、血清に含めれる蛋白成分による混濁が疑われた。その後はsCrは希釈無し、2倍、4倍希釈で評価しており、各々3.23～4.69，0.76～1.14、0.76～0.96であった。心臓移植待機者において偽性高Cr血症を経験したため文献的考察を含め報告する。</p>

DOI： 10.11386/jst.57.supplement_s335_3

CiNii Research

Language：English  

DOI： 10.1177/03913988211040530

Web of Science

PubMed

Language：English  

DOI： 10.1186/s40792-021-01296-3

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PubMed

Language：English  

DOI： 10.1016/j.hlc.2021.05.073

PubMed

Language：English  

DOI： 10.1016/j.athoracsur.2021.04.084

PubMed

Language：English  

DOI： 10.1016/j.ijscr.2021.105962

PubMed

Language：English  

DOI： 10.1016/j.hlc.2021.04.003

PubMed

Language：English  

DOI： 10.1016/j.athoracsur.2021.04.023

PubMed

Language：English  

DOI： 10.1016/j.ejvs.2021.02.044

PubMed

Language：Japanese  

DOI： 10.1093/jscr/rjab053

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PubMed

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>【背景】脳死ドナー臓器摘出では、外科医だけでなく臨床工学技士（ME）・看護師・コーディネーター等多職種が関わる医療で、実際の手技を知っていればよりよい連携が可能かもしれない。献体されたご遺体の固定方法は進化しており、特殊な保存液で固定された状態は生体と類似しているため、手術トレーニングに用いることが可能となった。肺移植実施施設でない当院での実施施設へのとり組みの一貫として、心臓外科医・ME・医学生と合同で臓器摘出トレーニングを実行したので報告する。</p><p>【トレーニング概要】開胸・心嚢切開し臓器評価方法を全員で確認した後、心灌流液注入用と肺灌流液ドレナージ用のカテーテルを各留置し、大血管を遮断し心臓摘出、続いて肺摘出を行った。続いてバックテーブルにて肺の植え込みができる状態にまで処理を行いトレーニング終了とした。心肺摘出に際して重要となる左房の処理については、操作を止め指導医にポイントを解説してもらいつつ、心臓外科・呼吸器外科の双方の考えを伝え、解剖を確認しながら行った。また、MEと肺灌流液ドレナージ経路の方法や肺灌流のタイミングなど細やかな部分まで共有できた。</p><p>【結語】本トレーニングは多職種での手技と順序の確認に有用で、臓器摘出の際互いに心がけているポイントや考えも共有・理解できた。今後はプログラムを定型化し、実践に対応できるレベルに質を高めつつ、看護師やコーディネーターも含めて行う予定である。</p>

DOI： 10.11386/jst.56.supplement_s105

CiNii Research

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>44歳女性、Duchenne型筋ジストロフィーの保因者。頻回の入退院を繰り返し、NYHA III～IV度で推移した。最高酸素摂取量は7.7mL/min/kgまで低下し、10回の心不全増悪による入院に至った。左室駆出率は14%、左室拡張末期径は84mmであった。心臓移植適応検討に向けた精査にて、甲状腺右葉に結節影を認めた。甲状腺乳頭癌と診断され、心臓移植の適応外と判断された。年齢およびT3N1aM0からStage 1と診断され、甲状腺全摘出術および気管周囲リンパ節郭清が行われた。当時はDestination Therapy/Bridge to Decision目的の植込型補助人工心臓は装着できず、カテコラミン持続投与あるいは体外式補助人工心臓装着下に、心臓移植適応となる寛解治癒後5年を待つ方針も検討されたが、長期にわたる入院下での移植待機生活には耐えられない旨の申し出があり、その後4回の心不全増悪入院を繰り返し、翌年永眠された。現行の適応基準では、悪性腫瘍は絶対的除外条件のひとつであるが、本症例の適応外要因となった甲状腺乳頭癌Stage 1の5年生存率は99%以上であり、5年の再発・死亡回避率も90％程度に至る。実際、2016年のISHLTのlisting criteriaにおいても、癌のタイプ、治療への反応性、転移などにより、再発リスクが低い場合には心臓移植も考慮されるべきと記されている。再発リスクが低く生命予後が担保されうる悪性腫瘍合併例では、心臓移植適応に再考の余地があるのではないかと考える。</p>

DOI： 10.11386/jst.56.supplement_s504

CiNii Research

Publisher：南江堂  

DOI： 10.15106/j_kyobu73_950

CiNii Research

Language：English   Publisher：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

Publisher：南江堂  

DOI： 10.15106/j_kyobu71_37

CiNii Research

Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

The Bentall procedures using biological valved conduit is expanding owing to the increasing incidence of aortic valve disease in the aging population and usage for young generation. The long-term durability of the biological valve including the risks of structural valve deterioration(SVD) is the major concern of the bio-Bentall procedure. Bio-Bentall in our hospital are reviewed and literature review are added. Our surgical results of long-term survival in bio-Bentall patients is acceptable compare to other study and freedom from SVD and reoperation is better than other results. There was no experience of SVD complication so far. Modification using double sewing ring technique is useful to put larger valve, keep better hemostasis, easy to do reoperation for further SVD and expect for future valve in valve situation.

Scopus

Publisher：南江堂  

DOI： 10.15106/j00349.2017233269

CiNii Research

Publisher：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

Publisher：Kyobu geka. The Japanese journal of thoracic surgery  

Congenital quadricuspid aortic valve is a very rare malformation. In most cases it has been found incidentally at aortic valve surgery or at autopsy. It frequently causes aortic regurgitation, which may become manifest in adulthood and require surgical treatment. We reported 4 cases of aortic regurgitation with quadricuspid aortic valve. In all cases, aortic valve replacement was preformed with prosthetic valve, and their postoperative courses were uneventful. Two were Hurwitz's classification type b, one was type a and the last patient was type c. Although quadricuspid aortic valve is a rare anomaly, its potential for severe valve failure in adulthood should be kept in mind.

Scopus

Publisher：南江堂  

DOI： 10.15106/j00349.2014130601

CiNii Research

Publisher：南江堂  

DOI： 10.15106/j00349.2013095093

CiNii Research

Publisher：Angewandte Chemie - International Edition  

(Figure Presented) It all happened with a click: In a search for histone deacetylase (HDAC) inhibitors using in situ click chemistry, the first example of protein-Cu acceleration of the azide-alkyne cycloaddition reaction was uncovered. The copper center in the protein target HDAC8 catalyzed triazole formation between one azide-alkyne pair among 30 possibilities. These results provide a new route to HDAC inhibitors and a precedent for new types of proteinbased catalysts for click chemistry. © 2010 Wiley-VCH Verlag GmbH &. Co. KGaA, Weinheim.

DOI： 10.1002/anie.201002205

Scopus

Language：Japanese  

PubMed

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

Percutaneous mechanical circulatory support utilizing micro-axial flow pumps, such as the Impella group of devices, has become a life-saving technique in the treatment of refractory cardiogenic shock, with ever-increasing success rates. A 30-year-old man presented with acute decompensated heart failure and a severely reduced left ventricular ejection fraction (17%). Despite initial treatment with inotropic drugs and intra-aortic balloon pump support, his hemodynamic status remained unstable. Transition to Impella CP mechanical circulatory support was made on day 6 owing to persistently low systolic blood pressure. A significant decline in platelet count prompted suspicion of heparin-induced thrombocytopenia (HIT), later confirmed by positive platelet-activated anti-platelet factor 4/heparin antibody and a 4Ts score of 6 points. Argatroban was initially used as the purge solution, but owing to complications, a switch to Impella 5.0 and a bicarbonate-based purge solution (BBPS) was performed. Despite additional veno-arterial extracorporeal membrane oxygenation support on day 24, the patient, aiming for ventricular assist device treatment and heart transplantation, died from infection and multiple organ failure. Remarkably, the Impella CP continued functioning normally until the patient's demise, indicating stable Impella pump performance using BBPS. This case highlights the usefulness of BBPS as an alternative to conventional Impella heparin purge solution when HIT occurs.

DOI： 10.1007/s10047-024-01452-0

Open Access

Web of Science

Scopus

PubMed

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

AIMS: Impella has become a new option for mechanical circulatory support in patients with cardiogenic shock (CS); however, prognostic models for patients after Impella are lacking. We aimed to identify the factors that predict in-hospital mortality in patients with CS requiring Impella and develop a new risk prediction model. METHODS AND RESULTS: We utilized the J-PVAD registry, which includes all cases where Impella was implanted in Japan. Two-thirds of the patients in the J-PVAD registry were randomly assigned to the derivation cohort (n = 1701), and the other third was assigned to the validation cohort (n = 850). A backward stepwise logistic regression model was developed to identify factors associated with in-hospital mortality. In the derivation cohort, 956 patients were discharged alive, and 745 patients (43.8%) died during hospitalization. Among 29 candidate variables, 12 were independently associated with in-hospital mortality and were applied as components of the risk model, including age, sex, body mass index, fulminant myocarditis aetiology, cardiac arrest in hospital, baseline veno-arterial extracorporeal membrane oxygenation use, mean arterial pressure, lactate, lactate dehydrogenase, total bilirubin, creatinine, and albumin levels. The comparison of predicted and observed in-hospital mortality according to the 7th quantiles using the J-PVAD risk score showed good calibration. The area under the curve for the J-PVAD risk score was 0.76 (95% confidence interval 0.73-0.78). In the validation cohort, the J-PVAD risk score showed good calibration and discrimination ability. CONCLUSIONS: The J-PVAD risk score can be calculated using variables easily obtained in routine clinical practice. It helps the accurate stratification of mortality risk and facilitates clinical decision-making.

DOI： 10.1002/ejhf.3471

Open Access

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Internal Medicine  

Objective Patients undergoing transcatheter aortic valve implantation (TAVI) are generally older and frailty is therefore an important clinical issue. The baseline degree of frailty is associated with the prognosis in patients undergoing TAVI; however, the incidence of in-hospital frailty progression and its influencing factors have not yet been elucidated. Methods This observational, single-center study retrospectively evaluated 281 patients who underwent TAVI. The degree of frailty at baseline and discharge was evaluated using the Clinical Frailty Scale (CFS). In-hospital frailty progression was defined as an increase of at least one level in the CFS score at discharge from baseline, and predictors of frailty progression were assessed. Results The median baseline CFS score was 4.0 (interquartile range: 3.0-4.0). In-hospital frailty progression was observed in 49 patients (17.4%). No significant differences were observed in age, sex, comorbidities, or surgical risk scores between patients with and without frailty progression. Patients with frailty progression experienced stroke more frequently during hospitalization than those without (12.2% vs. 1.3%, p = 0.001). A multivariable logistic analysis showed that in-hospital stroke was a significant predictor of frailty progression (odds ratio, 10.7; 95% confidence interval: 2.34-49.2, p = 0.002). Patients with frailty progression had a longer hospital stay than those without frailty progression [7.0 (4.0-17.0) vs. 4.0 (4.0-8.0) days, p = 0.001]. Conclusions In-hospital frailty progression was not uncommon in patients undergoing TAVI. Stroke incidence was a significant influencing factor in frailty progression, whereas baseline comorbidities and surgical risks were not.

DOI： 10.2169/internalmedicine.3146-23

Open Access

Scopus

PubMed

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Heart Journal Association  

Open thoracic aortic surgery is believed to necessitate more intensive rehabilitation. This study aimed to compare the progress of postoperative rehabilitation between standard and delayed mobilization. A retrospective review was conducted on 199 patients who underwent isolated total aortic arch replacement via median sternotomy. Cases of in-hospital mortality and postoperative stroke were excluded. Based on the current guidelines for cardiovascular rehabilitation of the Japanese Circulation Society, patients were categorized into standard mobilization (could sit on the edge of bed within 2 days) and delayed mobilization (could not do so) groups. Rehabilitation progress was compared among both groups. Initial mobilization was delayed in 100 patients (delayed mobilization group), primarily because of respiratory failure (46.0%). Preoperative risk characteristics, including EuroSCORE II (median, 2.9 versus 3.5), were similar between the standard and delayed mobilization groups. The delayed mobilization group had longer operation (median, 6.1 versus 8.0 hours, P < 0.001) and cardiopulmonary bypass (median, 3.2 versus 4.1 hours, P < 0.001) times. Independent ambulation occurred earlier in the standard mobilization group (median, 6.0 versus 8.0 days, P < 0.001).In conclusion, early initiation of sitting on the edge of the bed within 2 days was associated with earlier independent ambulation during postoperative rehabilitation, which supports the current guidelines. Longer operation and cardiopulmonary bypass times were associated with delayed mobilization initiation, suggesting the need for more tailored approaches in such cases.

DOI： 10.1536/ihj.24-261

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Scopus

PubMed

CiNii Research

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本移植学会  

Language：Japanese   Publisher：(一社)日本移植学会  

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

OBJECTIVE: Aortic surgery is often performed in elderly patients, and these patients have a high risk of postsurgical muscle weakness. To reinforce purposeful postsurgical rehabilitation, we aimed to investigate the factors associated with postsurgical muscle weakness in patients who underwent thoracic aortic surgery. METHODS: This retrospective cohort study analyzed data of consecutive patients who underwent elective thoracic aortic surgery with cardiopulmonary bypass, and whose knee extensor isometric muscle strength (KEIS) were measured pre- and postoperatively at University Hospital between January 2012 and December 2018. The primary outcome was percent change in KEIS (% change in KEIS). Multivariate linear regression analysis was used to identify independent risk factors for % change in KEIS. RESULTS: Overall, 218 patients were included. Multivariate linear regression analysis showed that mechanical ventilation time, days from initial sitting to 100 m walking, and the number of exercises in the rehabilitation room were associated with % change in KEIS. CONCLUSIONS: This study may serve as a reference to stratify patients at risk of postsurgical muscle weakness. The preventive or alternative interventions in patients undergoing thoracic aortic surgery will be assessed in future studies.

DOI： 10.1080/09593985.2022.2068168

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PubMed

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本移植学会  

DOI： 10.18999/nagjms.85.3.62

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Impella 5.0 circulatory support via subclavian artery (SA) access may be a safe approach for patients undergoing cardiac rehabilitation (CR). In this case series, we retrospectively analyzed the demographic characteristics, physical function, and CR data of six patients who underwent Impella 5.0 implantation via the SA prior to left ventricular assist device (LVAD) implantation between October 2013 and June 2021. The median age was 48 years, and one patient was female. Grip strength was maintained or increased in all patients before LVAD implantation (pre-LVAD) compared to after Impella 5.0 implantation. The pre-LVAD knee extension isometric strength (KEIS) was less than 0.46 kgf/kg in two patients and more than 0.46 kgf/kg in three patients (unavailable KEIS data, n = 1). With Impella 5.0 implantation, two patients could ambulate, one could stand, two could sit on the edge of the bed, and one remained in bed. One patient lost consciousness during CR due to decreased Impella flow. There were no other serious adverse events. Impella 5.0 implantation via the SA allows mobilization, including ambulation, prior to LVAD implantation, and CR can be performed relatively safely.

DOI： 10.3390/jpm13040630

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PubMed

Language：Japanese   Publisher：(一社)日本移植学会  

Language：English   Publisher：(一社)日本循環器学会  

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

BACKGROUND: We evaluated the impact of a standardized driveline care strategy, including a subfascial-tunneling method and dressing protocol, on the incidence of driveline infection (DLI). METHODS: DLI data from all HeartMate II (HMII) and HeartMate 3 (HM3) patients (including exchange devices) were retrospectively collected between 2013 and 2021. The driveline subfascial-tunneling method was altered in three steps (A: right direct; B: left triple, C: right triple), and the shower protocol was changed in two steps (A: with/without cover, B: with cover). Disinfection was individually tailored after changing the shower protocol. Complications associated with morbidity and mortality were evaluated for each modification. RESULTS: During the study period, 80 devices were implanted (HMII, n = 54; HM3, n = 26). The 8-year incidence of DLI was 15% (n = 8) in HMII patients and 0% in HM3 patients (p = 0.039). DLI was not associated with hospital mortality. The modified dressing protocol and tunneling method was associated with a significantly better DLI incidence rate in comparison to the previous one: Protocol-A (n = 17), Protocol-B (n = 63), 35% vs 3% (p = 0.0009), Method-A (n = 13), Method-B (n = 42), Method-C (n = 25), 46% vs 5% vs 0% (p = 0.0001). The rete of freedom form DLI at 1, 2, and 3 years had also significant difference between groups: Protocol-A and Protocol-B, 80%, 54%, 54% vs 96%, 96%, 96%, respectively (p < 0.0001), Method-A, Method-B and Method-C, 76%, 44%, 44%, vs 94%, 94%, 94% vs 100%, 100%, respectively (p < 0.0001). CONCLUSIONS: A standardized triple driveline tunneling strategy and waterproof dressing protocol reduced driveline infection in HM3 patients to 0%.

DOI： 10.1111/aor.14426

Web of Science

PubMed

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

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

Web of Science

PubMed

Language：Japanese   Publisher：(一社)日本人工臓器学会  

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

We examined the relationship between leg extensor muscle strength (LEMS) at discharge and rehospitalization within 1 year in patients with a newly implanted ventricular assist device (VAD). This study included 28 patients who had received a VAD at our institution between October 2013 and February 2019, all of whom had been discharged for 1 year. The patients were divided into two groups according to their LEMS at discharge (higher strength [group H] and lower strength [group L]), based on the median value of the 55.2 kg-force (kgf)/body weight (BW) equation. Exercise performance parameters (e.g., grip strength, 6-min walk distance, and peak VO2) and laboratory data concerning nutritional status were also collected. Nine patients (64.3%) in group L were rehospitalized within 1 year after discharge. The rehospitalization rate was significantly higher in group L than group H (p = 0.020). Compared with discharge, patients exhibited higher grip strength (56.3 vs. 48.6 kg/BW, respectively; p = 0.011), 6-min walk distances (588 vs. 470 m, respectively; p = 0.002), and peak VO2 (15.4 vs. 11.9 mL/min/kg, respectively; p < 0.001) at 1 year after discharge. However, the LEMS (57.4 vs. 58.0 kgf/BW, respectively; p = 0.798) did not increase after discharge in VAD patients who avoided rehospitalization. LEMS at discharge was associated with rehospitalization after VAD surgery; a high LEMS improves the likelihood of avoiding rehospitalization.

DOI： 10.1038/s41598-021-04002-3

Web of Science

PubMed

Language：Japanese   Publisher：日本臨床生理学会  

Language：Japanese   Publisher：日本臨床生理学会  

DOI： 10.1186/s40792-021-01148-0

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PubMed

DOI： 10.1111/jocs.15282

Web of Science

DOI： 10.1007/s11748-020-01510-3

Web of Science

DOI： 10.1177/0391398820949888

Web of Science

DOI： 10.1016/j.athoracsur.2020.07.057

PubMed

DOI： 10.1177/0391398820942526

Web of Science

DOI： 10.1007/s11748-021-01594-5

Web of Science

DOI： 10.1111/jocs.15170

Web of Science

DOI： 10.1016/j.athoracsur.2020.09.080

PubMed

DOI： 10.1007/s10047-020-01184-x

Web of Science

DOI： 10.1007/s11748-020-01387-2

Web of Science

DOI： 10.1016/j.hlc.2020.06.016

Web of Science

DOI： 10.18999/nagjms.82.4.657

Web of Science

DOI： 10.18999/nagjms.82.4.645

Web of Science

DOI： 10.1016/j.hlc.2020.09.923

PubMed

DOI： 10.1007/s11748-020-01498-w

Web of Science

DOI： 10.1016/j.jtcvs.2020.09.110

PubMed

PubMed

DOI： 10.1016/j.cjca.2020.04.005

Web of Science

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本胸部外科学会  

Publishing type：Research paper (scientific journal)  

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

DOI： 10.1016/j.athoracsur.2020.07.031

PubMed

DOI： 10.1177/0391398820957019

Web of Science

DOI： 10.1177/0267659120957183

Web of Science

Language：Japanese   Publisher：(一社)日本集中治療医学会  

DOI： 10.1007/s11748-019-01254-9

Web of Science

DOI： 10.1093/ejcts/ezaa032

Web of Science

DOI： 10.1007/s11748-019-01201-8

Web of Science

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

DOI： 10.18999/nagjms.82.1.129

Web of Science

DOI： 10.1007/s00595-019-01853-2

Web of Science

DOI： 10.1053/j.semtcvs.2019.09.006

Web of Science

DOI： 10.1186/s13019-019-0972-1

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DOI： 10.1007/s00380-019-01348-7

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DOI： 10.1016/j.athoracsur.2019.01.004

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DOI： 10.1016/j.jvscit.2018.10.005

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Language：Japanese   Publisher：(一社)日本循環器学会  

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

DOI： 10.1016/j.jccase.2018.08.009

PubMed

DOI： 10.1007/s12055-018-0735-y

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DOI： 10.1253/circj.CJ-18-0312

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DOI： 10.1016/j.jvs.2017.12.047

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DOI： 10.1093/ejcts/ezy131

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Authorship：Last author  

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

We report the case of a 58-year-old man with dilated cardiomyopathy who was hospitalized because of worsening heart failure. As his symptoms were refractory even with the administration of inotropes, he was given peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) upon transfer to our hospital. On admission, serum creatinine was 2.62 mg/dL and total bilirubin 10.8 mg/dL. The cannulas inserted were 16-Fr for infusion and 21-Fr for drainage. When the blood flow was increased to 2.14 L/min/m2 to improve organ dysfunction, the aortic valve became continuously close with the mean arterial pressure of 85 mmHg. Therefore, we administrated vasodilators to decrease mean arterial pressure, or left ventricular afterload, which achieved opening aortic valve continuously. After the cannula sizes were scaled up to 18Fr for infusion and 24Fr for drainage to gain further blood flow, the aortic valve opened continuously and mean pulmonary pressure decreased. Our strategy to maintain adequate flow rate of VA-ECMO using vasodilator, “high-flow/vasodilation method”, achieved hemodynamic stability. Additionally, the concentration of serum creatinine and total bilirubin gradually decreased to within the normal range, although the patient succumbed 58 days after transfer to our hospital. &lt
Learning objective: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used as a first-line mechanical circulatory support in patients with severe heart failure. However, its management is difficult and not established. We discuss the efficacy and potency of our “high-flow/vasodilation method” in the management of VA-ECMO.&gt

DOI： 10.1016/j.jccase.2018.05.002

Scopus

PubMed

Language：Japanese   Publisher：(NPO)日本血管外科学会  

Language：Japanese   Publisher：(NPO)日本血管外科学会  

Language：Japanese   Publisher：(NPO)日本血管外科学会  

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

DOI： 10.1016/j.athoracsur.2017.12.005

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PubMed

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(一社)日本集中治療医学会  

PubMed

DOI： 10.2169/internalmedicine.1047-18

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

DOI： 10.1093/ejcts/ezx234

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PubMed

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

DOI： 10.18999/nagjms.79.4.443

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PubMed

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

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

DOI： 10.1016/j.athoracsur.2016.11.032

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PubMed

Language：Japanese   Publisher：(NPO)日本血管外科学会  

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

PubMed

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

DOI： 10.1093/icvts/ivw436

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PubMed

Language：Japanese   Publisher：(一社)日本外科学会  

Language：English   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本移植学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(株)南江堂  

Stanford A型大動脈解離術後の慢性解離性大動脈瘤に対してJ Graft Open Stent Graft(JOSG)を使用して弓部置換術を施行した11例(男性6名、女性5名、平均66.2±8.0歳)を対象とした。全例独歩退院した。合併症は軽度感覚障害のみ遺残した不全対麻痺を1例に認めた。ほかの合併症としては創感染2例、間質性肺炎1例を認めた。術後平均2.1±1.9ヵ月時にCTで大動脈を評価し、JOSG末梢端は7例で大動脈弁、4例で肺門部に位置した。全例で術前に認めた弓部のエントリーは、術後には末梢側吻合部を含む胸部には認めず、残存する主要エントリーは全例で、術前のリエントリーである腹部大動脈以下に限局した。腹部分枝閉塞は認めなかった。中期遠隔(平均観察9.2ヵ月、最長14ヵ月)に死亡例は認めなかったが大動脈関連合併症は4例に認めた。下行大動脈の切迫破裂2例、下行大動脈の偽腔拡大1例、下行大動脈の再解離1例で、全3例に再手術を要した。早期、中期とも死亡例は認めなかった。

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Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本循環器学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：English   Publisher：ELSEVIER SCIENCE INC  

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Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

OBJECTIVES: Aortic repair with aortic tailoring of the false lumen can preserve the true lumen and intercostal arteries naturally. It is a useful surgical strategy to prevent paraplegia. However, aortic remodelling of tailored segments in a late phase after surgery is another concern. This study investigates the destiny of aortic remodelling of tailored aorta.
METHODS: From June 2004 to April 2013, 21 consecutive patients underwent aortic tailoring operation for chronic type B aortic dissecting aneurysm. The mean age at operation was 60 +/- 10 years (range, 43-77). The tailored aortic segments were followed by serial CT scanning with the mean follow-up period of 46 +/- 32 months (range, 2-103).
RESULTS: There were no operative deaths but paraplegia in 1, stroke in 1 and reversible renal failure in 2 patients. There were two late deaths: one due to pneumonia and the other due to aneurysmal rupture of the abdominal aorta. Eighteen patients revealed a completely thrombosed false lumen and no expansion of the tailored aorta, with it remaining less than 40 mm in diameter during follow-up. However, 3 cases were associated with a patent false lumen and 2 cases revealed aortic events. The aortic event-free rate at 5 years was 95 +/- 5.1% in all patients and 66 +/- 27% in patients in the patent false lumen group.
CONCLUSIONS: Aortic tailoring is a useful surgical technique for chronic type B aortic dissection. Paraplegia and ischaemia of other visceral organs could less likely occur. Patients with a completely thrombosed false lumen revealed no aortic events; however, a patent false lumen was associated with a high risk of aortic events.

DOI： 10.1093/ejcts/ezw240

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PubMed

DOI： 10.18999/nagjms.78.4.369

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Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background. The number of cardiovascular surgeries among hemodialysis patients is increasing according to the growing population of hemodialysis patients; however, the clinical outcome has not yet been clarified, especially in thoracic aortic surgery. The purpose of this study was to assess the early and late outcomes of thoracic aortic surgery in hemodialysis patients.
Methods. We retrospectively analyzed the outcomes of 700 consecutive open thoracic aortic surgeries from 2002 to 2014. We identified 21 patients receiving preoperative hemodialysis (group HD) and 679 patients not receiving preoperative hemodialysis (group N). The patients were predominantly male, had diabetes mellitus and cardiogenic shock, and had less hyperlipidemia and elective surgery in group HD. The early and late outcomes were compared between 21 patients in each group using a propensity-score matched analysis.
Results. The hospital stay and intensive care unit stay were significantly longer in group HD even after matching. The 30-day mortality and inhospital mortality showed no significant differences, whereas the rate of postoperative pneumonia was significantly higher in group HD compared with the matched group N (p=0.0067). The 1-year, 3-year, and 7-year survival rates in group HD were 73.4%, 45.7%, and 30.5%, respectively, which were significantly poorer than that of group N both in the prematched (p &lt; 0.001) and matched analyses (p=0.0027).
Conclusions. Considering the various operative risks associated with hemodialysis patients, the early mortality rate is acceptable, even after the association with many respiratory complications. Although hemodialysis patients have a compromised prognosis after surgery, excessive hesitation to perform thoracic aortic surgery may be avoided. (C) 2016 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2016.03.073

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PubMed

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

OBJECTIVES: Total arch replacement via the L-incision approach (a combination of left anterior thoracotomy and upper median sternotomy) can be used to achieve more extensive replacement.
METHODS: In the period between 2002 and 2014, 279 total arch replacement procedures were performed. After excluding cases of acute aortic dissection and cases involving concomitant, hybrid or frozen elephant trunk procedures, patients who underwent isolated total arch replacement via an L-incision (n = 29) and via median sternotomy (n = 143) were identified and the data pertaining to their cases were analysed.
RESULTS: Operative mortality was higher in the L-incision group than in the median sternotomy group (6.9 vs 2.1%); however, the difference was not statistically significant. The L-incision group displayed a higher rate of respiratory complications, including pneumonia (28 vs 7.0%, P = 0.0034), the need for tracheostomy (17 vs 2.1%, P = 0.0038) and pulmonary haemorrhage (6.9 vs 0%, P = 0.028). The rate of paraplegia was similar between the groups (0 vs 1.4%, P = 1.00), despite the wider range replaced via the L-incision approach (7.3 +/- 1.5 vs 4.7 +/- 0.8 anatomical zones, P &lt; 0.001). The rates of other complications and functional recovery were similar. The long-term survival (73 vs 84% at 5 years) and aortic event-free rates (94 vs 96% at 5 years) were similar in both groups.
CONCLUSIONS: A combination of left anterior thoracotomy and upper median sternotomy can be applied to the single-stage repair of extended aneurysms with acceptable results in appropriately selected patients.

DOI： 10.1093/icvts/ivw034

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

PubMed

Language：Japanese   Publisher：(株)南江堂  

症例は60〜72歳の男性3例、女性1例であった。いずれも呼吸苦を主訴とした大動脈弁閉鎖不全症による心不全症状で、前医から著者らの施設へ紹介となった。術前の冠状動脈造影では全例、異常はみられなかった。1例は術前経胸壁エコーによる術前診断が可能であったが、3例は術中にはじめて大動脈四尖弁と診断された。Hurwitz分類ではtype aが1例、type bが2例、type cが1例であった。4症例とも人工弁による大動脈弁置換術が施行された。その結果、病理所見では全例で切除弁尖に粘液腫様の変性を認めた。術後経過も合併症なく経過良好で、独歩退院となった。

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

OBJECTIVES: Operative strategies for repairing aortic arch aneurysms should be re-evaluated following recent technical advances.
METHODS: Of 364 patients who underwent aortic arch repair between 2002 and 2014, 58 were high-risk subjects who received isolated hybrid arch repair (HAR) via median sternotomy (type I n = 32, type II n = 1 and type III n = 25). During this period, excluding patients with type A dissection or extensive aneurysms, 124 patients received isolated open arch repair via median sternotomy. The patients in the HAR and open arch repair groups were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors.
RESULTS: The patients in the HAR group were older (77 years +/- 6 vs 69 +/- 9, P &lt; 0.0001), exhibited a greater rate of malignancy (21 vs 4.8%, P = 0.0022) and had higher logistic EuroSCORE values (31 +/- 18 vs 20 +/- 15, P &lt; 0.0001) than those in the open arch repair group. Following propensity score matching creating 38 matched pairs, the differences in preoperative risk diminished. Operative complications, including the mortality rate (2.6 vs 0%), were similar between the groups. Apart from the lower rates of cardiopulmonary bypass (CPB) and circulatory arrest, there was no apparent superiority of HAR with respect to patient recovery. The mean follow-up duration was 52.5 months, during which the rate of freedom from aortic events in the HAR and open arch repair groups was 79 and 99% at 24 months, respectively (P &lt; 0.0001).
CONCLUSIONS: HAR achieves equivalent short-term results to standard open arch repair, with a decreased need for CPB. However, considering the inferior mid-term outcomes of this procedure, its indications should be limited to high-risk patients.

DOI： 10.1093/ejcts/ezv063

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

Publishing type：Research paper (scientific journal)   Publisher：FORUM MULTIMEDIA PUBLISHING, LLC  

An epicardial mesothelial cyst, which can be defined as a mesothelial cyst attached to the epicardium surrounding the heart and the great vessels inside the pericardial sac, is a rare condition. We herein report a case of epicardial cyst, which was attached to the ascending aorta. The patient was a 76-year-old male who underwent coronary artery bypass surgery, and the cyst was found incidentally. It was approximately 5 cm in diameter, and histological examination confirmed mesothelial cell origin. The ascending aorta has not previously been reported as the origin of an epicardial mesothelial cyst. This case gives new insight into the embryology of these cysts.

DOI： 10.1532/hsf.1293

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PubMed

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background. Thoracic aortic operations still remain associated with substantial risks of death and neurologic injury. This study investigated the impact of surgical stroke on the early and late outcomes, focusing on the physical status and quality of life (QOL).
Methods. From 1986 to 2008, 500 patients (aged 63 +/- 13 years) underwent open thoracic aortic repair for root and ascending (31%), arch (39%), extended arch (10%), and descending and thoracoabdominal (19%) aneurysms. Brain protection consisted of retrograde cerebral perfusion (52%), antegrade cerebral perfusion (29%), and simple deep hypothermic circulatory arrest (19%). Surgical stroke was defined as a neurologic deficit persisting more than 72 hours after the operation. QOL was assessed with the Short-Form 36 Health Survey Questionnaire 5.9 +/- 4.2 years after the operation.
Results. Stroke occurred in 10.3% of patients. Hospital mortality was 21% in the stroke group and 2.7% in the nonstroke group (p &lt; 0.001). At hospital discharge, 76% of survivors in the stroke group had permanent neurologic deficits (PNDs), with sustained tracheostomy in 39%, tube feeding in 46%, and gastrostomy in 14%, and 89% required transfer to other facilities. PND was an independent risk factor for late death (hazard ratio, 2.29; 95% confidence interval, 1.04 to 4.62; p = 0.041) in a multivariate analysis. The physical component of the QOL score was worse in the PND group (51% vs 100%; p = 0.039), whereas the mental component was similar in both groups (14% vs 14%).
Conclusions. Surgical stroke is associated with high hospital mortality and PNDs that decrease late survival and the physical component score of the QOL survey. (C) 2015 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2015.01.033

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s11748-014-0499-2

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PubMed

Other Link： http://link.springer.com/article/10.1007/s11748-014-0499-2/fulltext.html

Language：Japanese   Publisher：(NPO)日本血管外科学会  

DOI： 10.12945/j.aorta.2015.14-061

PubMed

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NAGOYA UNIV, SCH MED  

Thoracic aortic surgery often causes massive bleeding due to coagulopathy. Hypofibrinogenemia is one of the major causative factors, but the utility of the intraoperative administration of fibrinogen concentrate has not yet been proven. The aim of this study was to estimate incidence of hypofibrinogenemia and to evaluate efficacy of using fibrinogen concentrate intraoperatively. The perioperative serum fibrinogen levels (SFL) had routinely been measured in consecutive 216 thoracic aortic surgeries performed from 2010 to 2012. Fibrinogen concentrate was principally used for hypofibrinogenemia (&lt; 150 mg/dl of SFL) at cardiopulmonary bypass (CPB) termination. The patients who received fibrinogen concentrate (FIB group) were compared with the patients who did not received (non Fib group). There were 147 patients (68%) in FIB group at a dose of 5.5 +/- 3.5 g. The SFL were dramatically decreased with values of 164 +/- 71 mg/dl at CPB termination, compared to the preoperative SFL of 352 +/- 131 mg/dl. In the FIB group, the intraoperative and postoperative SFLs were 139 +/- 53 and 262 +/- 75 (mg/dl), respectively. Thus the SFL was recovered quickly by the administration. 110 cases (51%) showed hypofibrinogenemia at the termination of CPB. The predictors of hypofibrinogenemia were preoperative SFL &lt; 250 mg/dl, emergency surgery and thracoabdominal aortic surgery. Hypofibrinogenemia frequently was observed at the termination of CPB during thoracic aortic surgery. Administering intraoperative fibrinogen concentrate appears to be a useful option to treat coagulopathy.

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：English   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Bioabsorbable poly-l-lactide (PLLA) sternal pins are applied to reinforce sternal closure during cardiac surgery. However, these pins lack osteoconductivity. A new bioabsorbable sternal pin with osteoconductivity, made of uncalcined hydroxyapatite and poly-l-lactide (u-HA-PLLA) has been developed. This study was conducted to compare the two types of sternal pins in terms of sternal stability and healing after median sternotomy. Between October 2006 and January 2012, 105 patients underwent aortic surgery for aortic aneurysms or dissection via median sternotomy and sternal closure with sternal pins. Among these patients, 75 were followed for 12 months using serial computed tomography (CT). PLLA sternal pins were used in 30 patients (group A) and u-HA-PLLA sternal pins were used in 45 patients (group B). The incidence rates of transverse sternal dehiscence, anteroposterior displacement and complete sternal fusion were evaluated using CT. The cross-sectional cortical bone density area (CBDA) of the sternum around the sternal pins was examined to evaluate the osteoconductivity of the sternal pins. There were no significant differences between groups A and B in the sternal dehiscence rate (6.7 vs 4.4 %), sternal displacement rate (6.7 vs 2.2 %) or 12-month sternal fusion rate (63.3 vs 73.3 %). The CBDA around the sternal pins significantly increased between discharge and 12 months after surgery in group B (P &lt; 0.001) but not in group A. These results show that u-HA-PLLA sternal pins exhibit certain osteoconductivity; however, both PLLA and u-HA-PLLA sternal pins provide comparable clinical outcomes regarding sternal stability and healing.

DOI： 10.1007/s10047-013-0727-z

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PubMed

Language：Japanese   Publisher：(株)南江堂  

広範囲弓部瘤に対するL字開胸法(L群)、frozen elephant trunk法(F群)、long elephant trunk法(E群)、debranched TEVAR法(D群)を比較検討した。非解離性大動脈で待機手術を行った241例を対象とした。L群28例、F群30例、E群21例、D群10例であった。胸骨正中切開で行った弓部置換術152例(K群)を対照とした。術後合併症としては、L群では脳梗塞合併率が25.0%と高く、F群では脊髄障害の発生率が23.3%と高かった。E群は脊髄障害の発生はなかったが脳梗塞は19%で、D群では脳梗塞を40%と高率に認めた。呼吸不全はL群、E群で高率であった。入院死亡率はL群0%、F群6.7%、E群4.8%、D群20%、K群0.7%であった。

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

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

OBJECTIVES: To investigate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting thoracic aortic prosthetic graft infection. METHODS: Nine patients with clinically suspected thoracic aortic graft infection underwent FDG-PET/CT scanning. In these patients, the diagnoses could not be confirmed using conventional modalities. The patients' clinical courses were retrospectively reviewed. RESULTS: On the basis of surgical, microbiological and clinical follow-up findings, the aortic grafts were considered infected in 4 patients and not infected in 5. All 4 patients with graft infection (root: 2 cases, arch: 1 case and descending: 1 case) eventually underwent in situ re-replacement. Two of the 4 patients also had abdominal grafts
however, only the thoracic grafts were replaced because uptake was low around the abdominal grafts. The maximal standardized uptake value (SUVmax) in the perigraft area was higher in the infected group than in the non-infected group (11.4 ± 4.5 vs 6.9 ± 6.4), although the difference was not statistically significant. According to the receiver operating characteristic analysis, SUVmax &gt
8 appeared to be the cut-off value in distinguishing the two groups (sensitivity: 1.0 and specificity: 0.8). CONCLUSIONS: FDG-PET/CT is useful for confirming the presence of graft infection by detecting high uptake around grafts and excluding other causes of inflammation. An SUVmax value greater than 8 around a graft suggests the presence of graft infection. In addition, FDG-PET/CT can be used to clarify the precise extent of infection. This is especially useful if multiple separated prosthetic grafts have been implanted. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

DOI： 10.1093/ejcts/ezs693

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Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

PubMed

Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

Objective: In 2007, we introduced a policy to plan to extubate all patients after a modified Fontan procedure in the operating room. Our objective was to review the feasibility, safety, and clinical outcomes of this approach.
Methods: Patients who underwent a modified Fontan operation between May 2004 and May 2010 were reviewed.
Results: Ninety-seven patients underwent a modified Fontan operation (mean age, 3.9 +/- 2.2 years; mean weight, 15.1 +/- 5.0 kg); 46 patients (47%) were extubated in the operating room (group A). Nineteen patients were extubated in the intensive care unit within 24 hours (group B), and 32 patients had delayed extubation (group C). The 3 groups were not significantly different with respect to preoperative characteristics. Twenty-four hours postoperatively, group A had a lower mean central venous pressure compared with patients in group B or C (13 vs 14 vs 17 mm Hg, respectively, P &lt;. 001); a higher base excess (0.4 vs -1.3 vs -3.4, P &lt;. 001); a lower fluid balance (234 vs 514 vs 730 mL, P &lt;. 001); and a lower inotrope score (4.6 vs 6.7 vs 10.8, P &lt;. 001). Group C had a longer median intensive care unit length of stay (2 vs 3 vs 6 nights, P = .01), kept their chest tubes longer (8 vs 9 vs 15 days, P = .001), and had a longer median hospital length of stay (9 vs 11 vs 21 days, P = .001).
Conclusions: Extubation in the operating room after a modified Fontan procedure seems feasible. This approach is associated with improved early postoperative hemodynamics, earlier time to chest tube removal, and shorter intensive care unit and hospital lengths of stay. (J Thorac Cardiovasc Surg 2012; 144:547-52)

DOI： 10.1016/j.jtcvs.2012.05.047

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Language：English   Publishing type：Part of collection (book)   Publisher：CRC Press  

Nanotechnology will play a great role in the field of cardiovascular disease in the near future. It will be a very useful tool in drug delivery approaches to treat cardiovascular disease. Nanomedicine (medical treatment using nanotechnology) can be considered a refinement of molecular medicine and integrates advances in genomics and proteomics to facilitate the development of personalized medicine. Nanomedicine for cardiovascular disease has focused on materials at super-molecular levels to deliver increased therapeutic efficacy and diminish adverse effects, which have ultimately resulted in their clinical application. All the aforementioned developments have revolutionized the application of nanotechnologies and have led to improved understanding of the possibilities for drug delivery to diseased tissues and organs. In this chapter we introduce a novel drug delivery system (DDS) using biodegradable nano-scaled fiber for use in cardiovascular medicine. Occasionally, systemic administration of the drug for cardiovascular diseases not only fails to work sufficiently, but also causes adverse side effects due to the limited effective threshold of the drug. Therefore, these medicines may need to be released locally and gradually. Our newly developed DDS applied biodegradable polymer mixed with a drug used for surgical treatment of cardiovascular diseases, to achieve sustained release. The mechanisms of sustained release of a drug are quite simple
the drug is released with diffusion, hydrolysis of the biodegradable polymer and/or degradation of polymer by enzymatic or phagocytotic effects in vivo. An electrospinning procedure is used to fabricate the nanofiber configurations for these materials. In this chapter, we review the DDS scaffold using electrospinning nanofiber technology, and also highlight our recent results using our new DDS with biodegradable nano-scaled fiber for cardiovascular diseases to prevent anastomotic stricture and treat aortic aneurysm.

Scopus

Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

This study evaluated the clinical advantage of a novel technique to reconstruct a true lumen with aortic wall tailoring for aortic repair (aortic tailoring) or the reimplantation of intercostal arteries (vascular tube) in a chronic type B aortic dissection. Thirty-three consecutive extended thoracoabdominal aortic repairs have been performed for chronic type B dissection since 2000. The novel strategy was applied in 17 cases since 2004 including eight cases of aortic repair (group A) and nine cases of a vascular tube (group B). The other 16 cases were graft interposition in five and no reimplantation in 11 for group C. There were no surgical deaths in either group A or B, and only one late death in group C. No patients sustained transient or permanent paraplegia in group A and B, while three cases of paraplegia occurred in group C (18.8%). All of the intercostal arteries were well preserved in group A and an average of 9.8 intercostal arteries for nine patients were reimplantated in group B. The present technique can optimally preserve the intercostal arteries maximally and showed an excellent surgical mortality and morbidity, especially with regard to the protection of the spinal cord. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

DOI： 10.1510/icvts.2009.223099

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PubMed

Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Background: Bone marrow-derived mesenchymal stem cells (MSCs) can differentiate into various types of cell, and the extracellular matrix (ECM) is acknowledged to be important for the regulation of cell functions. In this study, we demonstrated the effects of ECMs on the differentiation of human bone marrow-derived MSCs into a smooth muscle cell (SMC) lineage. Methods: Human MSCs (hMSCs) were cultured on dishes coated with 3 types of ECM including laminin (LM), collagen type IV (Col-IV) and fibronectin for 7 days, and simultaneously cultured on a noncoated dish as a control. Cell numbers of these cultured hMSCs were counted, and their expression of SMC-specific genes and proteins was evaluated. hMSCs were then seeded on LM-coated biodegradable sheets and implanted into rat subcutaneous space. After 2 weeks of implantation, these tissues were evaluated. Results: The number of hMSCs was significantly increased by culture on Col-IV-coated dishes. The expression of SMC-specific genes and proteins (alpha-smooth muscle actin, ASMA; h1-calponin, CALP) in hMSC was significantly upregulated from culture on LM-coated dishes. LM-coated sheets showed
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a significantly increased expression of ASMA and CALP protein in vivo. Moreover, a fully differentiated marker (SM2) was expressed in the in vivo implanted hMSCs in the course of 2 weeks on the LM-coated sheet. Conclusion: These results suggest that the signal transduction of the cell-matrix interaction for the differentiation of hMSCs into SMCs was activated when cultured with LM. LM-coated materials may thus be useful for cardiovascular tissue engineering. Copyright (C) 2009 S. Karger AG, Basel

DOI： 10.1159/000260061

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Publishing type：Research paper (international conference proceedings)  

Pulmonary venous obstruction (PVO) after correction of total anomalous pulmonary venous connection (TAPVC) frequently occurs due to intimal-hyperplasia and the required re-operation. We have developed a novel sustained-release drug delivery system, using Tacrolimuseluting biodegradable nano-fiber (TEBN). It consists of nano-scale fiber composed of biodegradable polymer and Tacrolimus. This study evaluated the effects of TEBN for prevention of venous anastomotic stricture in a rat model to apply to PVO operation. Tacrolimus was incorporated into poly (L-lactide-co-glycolide). The venous stricture model was made by rat inferior vena cava anastomosis. The IVC anastomosis was covered with TEBN with 1.0 wt% Tacrolimus (n=12) or without TEBN as a control (n=12), and evaluated histologically at 1, 2, and 4 weeks after operation. The ratio of intimal area was significantly reduced in the TEBN group compared with the control group (ratio
1 week: 0.43 ± 0.26 vs. 0.07 ± 0.04, P=0.04, 2 weeks: 0.39 ± 0.19 vs. 0.05 ± 0.02, P=0.01, 4 weeks: 0.31±0.15 vs. 0.09 ± 0.04, P=0.03, control vs. TEBN, respectively). Histological findings showed endothelialization along the inner surface of the vein even in TEBN. The TEBN reduced intimal hyperplasia and preserved endothelialization even in a venous stricture. These results suggested that this strategy might be useful for prevention of recurrent PVO after TAPVC correction. © 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

DOI： 10.1510/icvts.2008.192831

Scopus

PubMed

Publishing type：Research paper (scientific journal)   Publisher：MOSBY-ELSEVIER  

Objective: We developed a novel sustained drug-eluting device using tacrolimus-eluting biodegradable nanofiber to prevent anastomotic stricture and evaluated the effects in a rat abdominal aortic anastomosis model.
Methods: In vitro and in vivo tacrolimus release tests for tacrolimus-eluting biodegradable nanofiber were performed to confirm its sustained release. To verify the prevention of anastomotic stricture, tacrolimus-eluting biodegradable nanofiber was placed around the end-to-end anastomosis of abdominal aorta in rats. Five rats were allocated to the following 5 groups: ( 1) control without tacrolimus-eluting biodegradable nanofiber, ( 2) 5 mg of nanofiber only ( 0 wt% of tacrolimus), ( 3) 5 mg of tacrolimus-eluting biodegradable nanofiber containing 0.04 wt% of tacrolimus, ( 4) 5 mg of tacrolimus-eluting biodegradable nanofiber containing 0.1 wt% of tacrolimus, and ( 5) 5 mg of tacrolimus-eluting biodegradable nanofiber containing 1.0 wt% of tacrolimus. Morphometric and histologic analyses including immunohistochemistry were performed in each of the groups 2 weeks after the operation.
Results: The tacrolimus-eluting biodegradable nanofiber gradually released tacrolimus for at least 1 month in vitro and in vivo. The ratio of intimal area was significantly reduced in the 1.0 wt% tacrolimus-eluting biodegradable nanofiber group compared with the other groups (0.26, 0.24, 0.25, 0.21, and 0.08 in control, 0 wt%, 0.04 wt%, 0.1 wt%, and 1.0 wt%, respectively, P &lt;. 05). The cells, which constitute intimal hyperplasia, were positive for smooth muscle actin and SMemb, and factor VIII revealed that endothelial cells covered the surface of the aortic lumen even in the 1.0 wt% tacrolimus-eluting biodegradable nanofiber group in immunohistochemistry.
Conclusion: Tacrolimus-eluting biodegradable nanofiber reduced neointimal hyperplasia and preserved endothelialization. This device may be useful in the prevention of anastomotic stricture.

DOI： 10.1016/j.jtcvs.2008.11.017

Web of Science

PubMed

Language：Japanese   Publisher：JAPANESE SOCIETY FOR ARTIFICIAL ORGANS  

DOI： 10.11392/jsao1972.35.2_S171

Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

A 10-year-old girl suffered from chest discomfort during exercise. She experienced an acute myocardial infarction accompanied by an obstruction in an orifice to the left coronary artery. An emergency operation revealed that the aortic valve was quadricuspid, and a left-sided small cusp had adhered to the aortic wall resulting in an unusual sac with a tiny slit. Resection of the sac disclosed the ostium to left coronary artery. Blood toward the left coronary artery passed through the tiny slit. The mechanisms of obstruction in the coronary artery were uncertain. She recovered well after the aortic valve replacement with resection of the aortic cusps. (c) 2005 by The Society of Thoracic Surgeons.

DOI： 10.1016/j.athoracsur.2003.11.052

Web of Science

PubMed

Publishing type：Research paper (international conference proceedings)   Publisher：Japanese Association for Thoracic Surgery  

A rare case of a pseudoaneurysm from the mitral-aortic intervalvular fibrosa following bacterial endocarditis in a 17-year-old male is presented. Destructive infection secondarily involved the mitral-aortic intervalvular fibrosa. Perforation of this portion resulted in the formation of the pseudoaneurysm situated at the base of the left ventricle between the aorta and the left atrium. With echocardiography, computed topography, angiography, and magnetic resonance imaging (MRI), a pseudoaneurysm was diagnosed. MRI especially revealed detailed information and the extension of pseudoaneurysm. Our patient underwent resection of the pseudoaneurysm, reconstruction of left ventricular outflow with glutaraldehyde-preserved bovine pericardium, and replacement of the aortic valve. His postoperative course was uneventful. No recurrence of endocarditis was detected in the following year.

DOI： 10.1007/BF02719470

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本胸部外科学会  

Language：Japanese   Publisher：医学図書出版(株)  

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

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asia Publishing Exchange Pte Ltd  

A parallel aortic graft composed of a 20-mm graft with two 10-mm accessory grafts was used in the repair of a large thoracoabdominal aneurysm in a 50-year-old man. The graft was attached to 6 intercostal arteries and used immediately for spinal cord perfusion before repairing the aneurysm. The patient recovered quickly without paraplegia.

DOI： 10.1177/021849230100900315

Scopus

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：(一社)日本胸部外科学会  

Language：Japanese   Publisher：(一社)日本胸部外科学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本体外循環技術医学会編集委員会  

Language：Japanese   Publisher：JAPANESE SOCIETY FOR ARTIFICIAL ORGANS  

We have developed a new vacuum control system that can keep a hard-shell venous reservoir at a certain target low negative pressure. This device offers assistance with venous drainage and cardiotomy suction during cardiopulmonary bypass (CPB). It consists of an aspiration valve that controls the internal pressure of the hard-shell venous reservoir by releasing the source flow of the vacuum pump to atmospheric pressure. In this study, we used this device in clinical mock-up circuits to evaluate the changes in internal pressure of the hard-shell reservoir. The target pressure of the reservoir varied from-10 mmHg to-70 mmHg. This device could control changes in the internal pressure within a range of 4 mmHg when all cardiotomy suction tubes were switched on and off. This study showed that this device can stabilize the internal pressure of the hard-shell venous reservoir and offers improved handling of venous drainage during CPB. The device would be available not only for venous drainage but for cardiotomy sucking, and would be an applicable system for Minimally Invasive Cardiac Surgery and numerous other clinical uses.

DOI： 10.11392/jsao1972.28.517

CiNii Books

Other Link： http://search.jamas.or.jp/link/ui/1999238271

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：(一社)日本人工臓器学会  

Language：Japanese   Publisher：The Japanese Society of Extra-Corporeal Technology in Medicine  

DOI： 10.7130/hokkaidoshakai.25.21

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

Language：Japanese   Publisher：(一社)日本心臓病学会  

J-GLOBAL

J-GLOBAL

Language：Japanese  

CiNii Books

Other Link： http://search.jamas.or.jp/link/ui/2009052481

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：The Japanese Society for Cardiouascular Surgery  

HIV infection is an extremely serious problem, and the number of HIV-infected patients is increasing in the world. The introduction of highly active antiretroviral therapy (HAART) and protease inhibitors (PI) allows maintenance of the inhibition of viral replication and partial reinstating the immune system in most patients. As HIV has changed from a progressive fatal illness to a chronic condition, many infected patients increasingly require diverse health services including cardiac surgery. We report a case of a 68-year-old man with HIV infection who underwent successful coronary artery bypass grafting using a cardiopulmonary bypass. The operative indication were determined according to the CD 4 count and the amount of HIV-RNA. Standard precautions were taken in the same way as for hepatitis B and hepatitis C cases. There was no percutaneous exposure to HIV infected blood. The postoperative course was uneventful, and the patient was discharged with no complications of HIV. The patient has been quite well without any therapy for HIV over one year.

CiNii Books

Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

Language：Japanese   Publisher：The Japanese Society for Cardiouascular Surgery  

A 60-year-old man with constrictive tuberculous pericarditis rapidly progressing after his hospitalization underwent partial pericardiectomy, anterior to the bilateral phrenic nerves through a midline sternotomy without a cardiopulmonary bypass. The results of right cardiac examination a month postoperatively showed the cardiac diastolic dysfunction remained unchanged. However, the results after 6 months and also 3 years postoperatively showed the cardiac function recovered from the constrictive pericarditis. He is free from tuberculosis and heart failure. We should be aware of a sign of heart failure due to constrictive tuberculous pericarditis and take the surgical treatment into consideration. We regard the partial pericardiectomy without cardiopulmonary bypass as one of the effective treatments for constrictive tuberculous pericarditis.

CiNii Books

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

Language：Japanese   Publisher：The Japanese Society for Cardiouascular Surgery  

Chylothorax is a serious complication that can jeopardize the outcome of thoracic surgery and prolong hospitalization. We report a 66-year-old man who underwent graft replacement for a distal arch aneurysm, in whom a persistent postoperative chylothorax developed. It was necessary to perform continuous drainage and conservative management. Administration of octreotide sharply decreased the drainage volume and the chylothorax disappeared within 2 weeks. Early administration of octreotide for postoperative chylothorax may shorten the therapeutic period.

CiNii Books

Language：Japanese   Publisher：The Japanese Society for Cardiouascular Surgery  

Mycobactenal infection after open-heart surgery is a rare complication We report 2 cases of cutaneous infection caused by Mycobacterium fortuitum (M fortuitum) Case 1 A 56-year-old man had wound infection from the 10th postoperative day (POD) The growth of M fortuitum was detected on the 38th POD Combination of multiple antibiotic therapy was performed He was cured after several recurrences of cutaneous ulcer and abscess following 15 months Case 2 A 26-year-old man had wound infection from the 28th POD Deep sternal infection with mediastinitis developed Bacteriological examination revealed the growth of M fortuitum on the 61st POD Omentopexy was performed on the 67th POD Wound infection completely healed, and the patient was discharged from our hospital on the 137th POD Mycobacterial infection should be considered when the wound infection is resistant to ordina antibiotics

CiNii Books

Language：Japanese   Publisher：(NPO)日本心臓血管外科学会  

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：The Japanese Society for Cardiouascular Surgery  

We report 4 cases of valvular injury following nonpenetrating cardiac trauma in 3 men and 1 woman ranging in age from 24 to 72 years. In all cases the cause of trauma was blunt chest trauma. One patient was operated in 4 h, but the other 3 patients were operated on more than 6 months after the accidents. Lacerated aortic cusp was observed in 2 patients, ruptured anterior papillary muscle of mitral valve, and ruptured chordae tendinae of the tricuspid vale were observed in 1 patient each respectively. Three patients underwent valve replacement (2 aortic and 1 mitral valves), and another patient underwent chordoplasty in the tricuspid valve. Their post-operative courses were uneventful. Careful observation, such as echocardiography, were required following the blunt chest trauma.

CiNii Books

Language：Japanese   Publisher：The Japanese Society for Cardiouascular Surgery  

A 75-year-old woman suffered from chest compression on effort. Detailed examinations showed aortic valve stenosis and unusual separation of the left coronary artery from the aorta. Surgical exposure revealed that the aortic valve was composed of 3 cusps. Two of 3 cusps were calcified, and another small cusp had fused to the aortic wall. Fusion of the cusp produced a cyst with a hole that was 1.5 mm in diameter. Excision of the cyst disclosed the normal orifice of the left coronary artery. The aortic valve was resected and replaced with an artificial valve. Her postoperative course was uneventful, without any angina pectoris. Jpn. J. Cardiovasc. Surg. 32 : 366-369 (2003)

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books