Faculty Profiles - MUTSUGA Masato

Papers - MUTSUGA Masato

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The incidence and influencing factors of in-hospital frailty progression following transcatheter aortic valve implantation. Open Access

Tatsuya Miyazaki, Akihito Tanaka, Yoshiyuki Tokuda, Yoshinori Shirai, Koji Mizutani, Kenji Furusawa, Sho Akita, Takahiro Ozeki, Kiyonori Kobayashi, Hideki Ishii, Masato Mutsuga, Toyoaki Murohara

Internal medicine (Tokyo, Japan) Vol. 63 ( 24 ) page： 3283 - 3289 2024.12

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

Clinical Features and Postoperative Mobilization following Total Aortic Arch Replacement.

Yuya Shirai, Yoshiyuki Tokuda, Yohei Tsuchikawa, Kiyonori Kobayashi, Shinya Tanaka, Natsumi Yoshito, Yuto Hori, Daichi Takagi, Yoshihiro Nishida, Masato Mutsuga

International heart journal Vol. 65 ( 6 ) page： 1075 - 1078 2024.11

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

DT LVADの現状と今後-DT治療の拡大による諸問題への取り組み(患者の看取りを含めて) DT-LVAD実施施設新規参入後1年間に施行した4例の検討

吉住朋, 植村友稔, 山本暁邦, 平岩宏章, 風間信吾, 近藤徹, 森本竜太, 奥村貴裕, 六鹿雅登

人工臓器 Vol. 53 ( 2 ) page： S - 56 2024.10

最新のLVAD治療における合併症抑止への取り組みドライブライン感染撲滅を目指した当院の取り組み

吉住朋, 林泰成, 風間信吾, 平岩宏章, 近藤徹, 森本竜太, 奥村貴裕, 六鹿雅登

人工臓器 Vol. 53 ( 2 ) page： S - 71 2024.10

現代の日本に適した臓器アロケーションシステムの確立に向けて心臓移植におけるアロケーションシステムの課題と改善への提案

奥村貴裕, 風間信吾, 平岩宏章, 近藤徹, 森本竜太, 吉住朋, 六鹿雅登, 室原豊明

移植 Vol. 59 ( 総会臨時 ) page： 191 - 191 2024.9

拡張相肥大型心筋症に対して心臓移植4年経過後、肺高血圧症の合併を診断された一例

平岩宏章, 長井伸, 伊藤亮太, 小山雄一郎, 近藤喜代太, 風間信吾, 近藤徹, 森本竜太, 奥村貴裕, 伊藤英樹, 吉住朋, 六鹿雅登, 室原豊明

移植 Vol. 58 ( 4 ) page： 407 - 408 2024.3

Factors associated with postsurgical muscle weakness in patients who undergo thoracic aortic surgery: a retrospective cohort study. International journal

Miho Shimizu, Takuji Adachi, Kiyonori Kobayashi, Masato Mutsuga, Hideki Oshima, Akihiko Usui, Sumio Yamada

Physiotherapy theory and practice Vol. 39 ( 10 ) page： 2180 - 2188 2023.10

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

Web of Science

PubMed

当院のMCS使用下で発症した頭蓋内出血症例の検討

長井伸, 森本竜太, 伊藤亮太, 近藤喜代太, 小山雄一郎, 風間信吾, 平岩宏章, 奥村貴裕, 六鹿雅登, 室原豊明

人工臓器 Vol. 52 ( 2 ) page： S - 103 2023.10

心臓移植Allocation Systemは具体的にどのように変更すべきか心臓移植待機中の現状とHeart Allocation System改定への課題

奥村貴裕, 六鹿雅登, 風間信吾, 平岩宏章, 森本竜太, 吉住朋, 室原豊明

移植 Vol. 58 ( 総会臨時 ) page： 154 - 154 2023.9

Cardiac rehabilitation in a heart failure patient using customized “cardiac support net” treatment: A case report Reviewed

Kiyonori Kobayashi, Toshiaki Akita, Sho Akita, Hideki Ito, Sachie Terazawa, Masato Mutsuga, Akihiko Usui

Nagoya J Med Sci Vol. 85 ( 3 ) page： 626 - 634 2023.8

Cardiac Rehabilitation in Severe Heart Failure Patients with Impella 5.0 Support via the Subclavian Artery Approach Prior to Left Ventricular Assist Device Implantation

Miho Shimizu, Hiroaki Hiraiwa, Shinya Tanaka, Yohei Tsuchikawa, Ryota Ito, Shingo Kazama, Yuki Kimura, Takashi Araki, Takashi Mizutani, Hideo Oishi, Tasuku Kuwayama, Toru Kondo, Ryota Morimoto, Takahiro Okumura, Hideki Ito, Tomo Yoshizumi, Masato Mutsuga, Akihiko Usui, Toyoaki Murohara

Journal of Personalized Medicine Vol. 13 ( 4 ) page： 630 - 630 2023.4

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

Web of Science

PubMed

移植前後における心筋生検のキーポイント

奥村貴裕, 木村祐樹, 平岩宏章, 坂本岳, 小山雄一郎, 伊藤亮太, 風間信吾, 森本竜太, 伊藤英樹, 吉住朋, 六鹿雅登, 室原豊明

移植 Vol. 57 ( 4 ) page： 391 - 391 2023.4

植込み型左室補助人工心臓装着患者における運動能力の軌跡(Trajectory of Exercise Capacity in Patients with Durable Left Ventricular Assist Device)

風間信吾, 坂本岳, 伊藤亮太, 木村祐樹, 小山雄一郎, 平岩宏章, 近藤徹, 森本竜太, 奥村貴裕, 吉住朋, 六鹿雅登, 室原豊明

日本循環器学会学術集会抄録集 Vol. 87回 page： OJ05 - 6 2023.3

Impact of an improved driveline management for HeartMate II and HeartMate 3 left ventricular assist devices. International journal

Masato Mutsuga, Takahiro Okumura, Ryota Morimoto, Toru Kondo, Hideki Ito, Sachie Terazawa, Yoshiyuki Tokuda, Yuji Narita, Kazuki Nishida, Toyoaki Murohara, Akihiko Usui

Artificial organs Vol. 47 ( 2 ) page： 387 - 395 2023.2

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

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

Yohei Tsuchikawa, Yoshiyuki Tokuda, Hideki Ito, Miho Shimizu, Shinya Tanaka, Kazuki Nishida, Daichi Takagi, Akimasa Fukuta, Natsuki Takeda, Hiromasa Yamamoto, Masaya Hori, Yoshihiro Nishida, Masato Mutsuga

Circulation journal : official journal of the Japanese Circulation Society Vol. 87 ( 2 ) page： 306 - + 2023.1

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

植込型補助人工心臓治療管理施設からの提言心臓移植実施施設、DT非実施施設における重症心不全管理

奥村貴裕, 六鹿雅登, 木村祐樹, 風間信吾, 平岩宏章, 森本竜太, 伊藤英樹, 吉住朋, 室原豊明

人工臓器 Vol. 51 ( 2 ) page： S - 47 2022.10

Relationship between muscle strength and rehospitalization in ventricular assist device patients. International journal

Kiyonori Kobayashi, Masato Mutsuga, Akihiko Usui

Scientific reports Vol. 12 ( 1 ) page： 50 - 50 2022.1

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

胸部大動脈手術患者における術後筋力低下の関連因子

清水美帆, 足立拓史, 小林聖典, 六鹿雅登, 大島英揮, 碓氷章彦, 山田純生

日本臨床生理学会雑誌 Vol. 51 ( 4 ) page： 60 - 60 2021.10

左室補助人工心臓患者における6分間歩行距離の遠隔期成績に関する検討

小林聖典, 六鹿雅登, 高木大地, 堀将也, 服部慶子, 伊藤英樹, 碓氷章彦

日本臨床生理学会雑誌 Vol. 51 ( 4 ) page： 60 - 60 2021.10

Left brachiocephalic vein aneurysm: a case report

Ueno Harushi, Yazawa Mari, Tsubouchi Hideki, Nakanishi Keita, Sugiyama Tomoshi, Kadomatsu Yuka, Goto Masaki, Ozeki Naoki, Nakamura Shota, Fukui Takayuki, Mutsuga Masato, Yoshikawa Toyofumi Fengshi Chen

SURGICAL CASE REPORTS Vol. 7 ( 1 ) page： 66 2021.3

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Papers - MUTSUGA Masato