研究者詳細 - 六鹿　雅登

論文 - 六鹿　雅登

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Pericardioperitoneal and pericardiopleural windows: A drainage technique for the treatment of recurrent cardiac tamponade. A case report.

Ishida S, Yagami K, Fujita T, Mutsuga M

International journal of surgery case reports 83 巻頁： 105962 2021年5月

"Millefeuille Technique" by Using Excised Intimal Layers in Repair of Type A Aortic Dissection.

Mutsuga M, Yagami K, Fujita T, Ishida S, Usui A

Heart, lung & circulation 2021年4月

A surgical case for pregnancy-related spontaneous coronary artery dissection.

Usui R, Mutsuga M, Yoshizumi T, Oshima H, Usui A

The Annals of thoracic surgery 2021年4月

Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair.

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

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2021年3月

Coronary artery aneurysm complicated by pneumothorax with a history of Kawasaki disease

Ishida Shinichi, Mutsuga Masato, Fujita Takashi, Ito Masao, Okamoto Sawako, Yagami Kei

JOURNAL OF SURGICAL CASE REPORTS 2021 巻 ( 3 ) 頁： rjab053 2021年3月

多職種チームで行う「献体を用いた臓器摘出トレーニング」in Clinical Anatomy Laboratory Nagoya (CALNA)

中村彰太, 六鹿雅登, 後藤和大, 仲西慶太, 杉山燈人, 門松由佳, 上野陽史, 後藤真輝, 尾関直樹, 福本紘一, 伊藤英樹, 小山富生, 碓氷章彦, 芳川豊史

移植 56 巻 ( Supplement ) 頁： s105 - s105 2021年

記述言語：日本語出版者・発行元：一般社団法人日本移植学会

【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。【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。【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。

DOI： 10.11386/jst.56.supplement_s105

CiNii Research

心臓移植において悪性腫瘍は一律に適応除外とされるべきか？

奥村貴裕, 木村祐樹, 近藤徹, 六鹿雅登, 碓氷章彦, 室原豊明

移植 56 巻 ( Supplement ) 頁： s504 - s504 2021年

記述言語：日本語出版者・発行元：一般社団法人日本移植学会

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。

DOI： 10.11386/jst.56.supplement_s504

CiNii Research

症例三度目の感染性心内膜炎に対しウシ心膜で縫着部を被覆した僧帽弁置換術の1例

石田真一, 藤田山, 八神啓, 六鹿雅登

胸部外科 73 巻 ( 11 ) 頁： 950 - 953 2020年10月

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

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

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

記述言語：英語出版者・発行元：The Japanese Coronary Association

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

DOI： 10.7793/jcad.25.010

CiNii Research

特集進化した大動脈基部置換術 Bio-Bentall手術の展望

六鹿雅登, 碓氷章彦

胸部外科 71 巻 ( 1 ) 頁： 37 - 42 2018年1月

Future Aspects of Bio-Bentall Procedure

Mutsuga M., Usui A.

Kyobu geka. The Japanese journal of thoracic surgery 71 巻 ( 1 ) 頁： 37 - 42 2018年1月

出版者・発行元：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

胸部大動脈に対するステントグラフト治療up-to-date Stanford A型大動脈解離術後の慢性解離性大動脈瘤に対する企業製frozen elephant trunkを用いた弓部置換術の手術成績

日尾野誠, 六鹿雅登, 大島英揮, 成田裕司, 阿部知伸, 藤本和朗, 徳田順之, 碓氷章彦

胸部外科 70 巻 ( 4 ) 頁： 281 - 285 2017年4月

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

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

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

出版者・発行元：Kyobu geka. The Japanese journal of thoracic surgery

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

Scopus

Aortic Valve Replacement of Quadricuspid Valve with Regurgitation

Yagami K., Oshima H., Narita Y., Abe T., Araki Y., Fujimoto K., Mutsuga M., Terazawa S., Ito H., Kuwabara F., Usui A.

Kyobu geka. The Japanese journal of thoracic surgery 69 巻 ( 4 ) 頁： 321 - 324 2016年4月

出版者・発行元：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

弓部大動脈瘤-こだわりの術式と遠隔期成績広範囲弓部大動脈瘤に対する外科治療の変遷

荒木善盛, 六鹿雅登, 徳田順之, 岡田正穂, 阿部知伸, 大島英揮, 碓氷章彦

胸部外科 66 巻 ( 11 ) 頁： 960 - 964 2013年10月

28年経過して再発した多発性左房粘液腫の1例

高野橋暁, 碓氷章彦, 六鹿雅登, 徳田順之, 荒木善盛, 成田裕司, 大島英揮, 上田裕一

胸部外科 65 巻 ( 12 ) 頁： 1089 - 1092 2012年11月

An unexpected example of protein-templated click chemistry

Suzuki T., Ota Y., Kasuya Y., Mutsuga M., Kawamura Y., Tsumoto H., Nakagawa H., Finn M., Miyata N.

Angewandte Chemie - International Edition 49 巻 ( 38 ) 頁： 6817 - 6820 2010年9月

出版者・発行元：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

[Surgical treatment for aortic root dilatation and aortic regurgitation after arterial switch operation].

Mutsuga M, Tamaki S, Yokoyama Y, Ishikawa H, Ishimoto N, Usui A, Ueda Y

Kyobu geka. The Japanese journal of thoracic surgery 61 巻 ( 12 ) 頁： 1043 - 7 2008年11月

Usefulness of bicarbonate-based Impella purge solution in a patient with heparin-induced thrombocytopenia: the first case report of long-term management in Japan Open Access

Nagai, S; Hiraiwa, H; Ito, R; Koyama, Y; Kondo, K; Kazama, S; Kondo, T; Morimoto, R; Okumura, T; Ito, H; Yoshizumi, T; Mutsuga, M; Murohara, T

JOURNAL OF ARTIFICIAL ORGANS 28 巻 ( 1 ) 頁： 83 - 89 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Artificial Organs

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

Predicting survival after Impella implantation in patients with cardiogenic shock: The J-PVAD risk score 国際誌 Open Access

Kondo, T; Yoshizumi, T; Morimoto, R; Imaizumi, T; Kazama, S; Hiraiwa, H; Okumura, T; Murohara, T; Mutsuga, M

EUROPEAN JOURNAL OF HEART FAILURE 27 巻 ( 1 ) 頁： 51 - 59 2025年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：European Journal of Heart Failure

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

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論文 - 六鹿 雅登

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論文 - 六鹿　雅登