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Mikagi K, Kawahara R, Kinoshita H, Aoyagi S. Effect of preoperative immunonutrition in patients undergoing hepatectomy; a randomized controlled trial. Kurume Med J 2012; 58:1-8. [PMID: 22027191 DOI: 10.2739/kurumemedj.58.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
No consensus has been reached concerning the effects of preoperative immunonutrition in patients undergoing hepatectomy. We evaluated the effects of immunonutrition before hepatectomy on perioperative management. This study was performed as a randomized controlled trial. Patients expected to undergo segmentectomy or more extensive hepatectomy for liver tumors were randomized to immunonutrition (IM) and control (C) groups each consisting of 13 patients. The IM group was given 750 ml of IMPACT in addition to half-size hospital meals orally from 5 days before to the day before surgery, and the C group was given conventional hospital meals. The blood level of eicosapentaenoic acid was elevated preoperatively in all patients of the IM group. The white blood cell count and interleukin 6 levels, which are indices of postoperative inflammation, were significantly lower in the IM group. As regards liver function, postoperative increases in the aspartate aminotransferase and alanine aminotransaminase levels were slightly suppressed in the IM group. No significant difference was noted in postoperative complications or duration of postoperative hospital stay. In patients undergoing hepatectomy, preoperative immunonutrition reduced inflammation and protected against liver dysfunction.
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Yokoyama S, Takagi K, Mori R, Aoyagi S. Aortic Valve Replacement in Patients with an Anomalous Left Circumflex Artery: Technical Considerations. J Card Surg 2011; 27:174-7. [DOI: 10.1111/j.1540-8191.2011.01365.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tahara N, Mizoguchi M, Honda A, Tahara A, Nitta Y, Kodama N, Koiwaya H, Aoyagi S, Imaizumi T. Successful shunt closure and improvement of hemodynamics in an ASD patient with severe pulmonary arterial hypertension and small shunt following a long-term use of bosentan. Int J Cardiol 2011; 158:e38-40. [PMID: 22078398 DOI: 10.1016/j.ijcard.2011.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Aoyagi S, Fukunaga S, Arinaga K, Teshima H, Ueda T, Mori R. Concurrent submitral left ventricular aneurysm and an aneurysm of the sinus of valsalva: report of a case. Surg Today 2011; 41:999-1002. [PMID: 21748621 DOI: 10.1007/s00595-010-4367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/25/2010] [Indexed: 10/18/2022]
Abstract
We herein describe a rare case of a concurrent submitral left ventricular (LV) aneurysm and an aneurysm of the sinus of Valsalva in a 65-year-old Japanese woman. The patient had a history of mitral valve replacement (MVR) for mitral regurgitation caused by a submitral LV aneurysm at the age of 58. At the time of the MVR, the orifice of the submitral LV aneurysm without thrombi was beneath the posterior leaflet, but surgical repair of the submitral LV aneurysm was not attempted. Although the patient was asymptomatic, when she underwent an echocardiogram at 65 years of age an aneurysm of the noncoronary sinus of Valsalva was detected. However, echocardiography performed before the initial operation had shown that the aneurysm of the sinus of Valsalva was coexistent with the submitral LV aneurysm. Since the submitral LV aneurysm revealed no progressive enlargement during the 7 years, patch closure of the aneurysm of the sinus of Valsalva alone was successfully performed.
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Aoyagi S, Fukunaga S, Arinaga K. Disc wear and entrapment in a Starr-Edwards mitral caged-disc valve. THE JOURNAL OF HEART VALVE DISEASE 2011; 20:474-476. [PMID: 21863665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A case of wear and entrapment of a polyethylene disc observed in a Starr-Edwards (SE) mitral caged-disc valve at 37 years after implantation is reported. A 66-year-old woman who had undergone mitral valve replacement with a SE disc valve 37 years previously was admitted to the authors' hospital. Cinefluoroscopy showed the polyethylene disc of the SE valve to have impinged against a calcified mass on the left ventricular posterior wall, causing a tipping motion of the disc during opening. The valve was successfully replaced at surgery. A macroscopic examination of the excised valve revealed wear of the polyethylene disc at sites where the disc abutted the cage struts, and where it impinged on the calcified mass. The long-term durability of the SE caged-disc valves has been favorable; however, when implanted for over 20 years, they should be carefully followed up.
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Shintani Y, Aoki H, Nishihara M, Ohno S, Furusho A, Hiromatsu SI, Akashi H, Imaizumi T, Aoyagi S. Hepatocyte growth factor promotes an anti-inflammatory cytokine profile in human abdominal aortic aneurysm tissue. Atherosclerosis 2011; 216:307-12. [DOI: 10.1016/j.atherosclerosis.2011.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 02/04/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
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Hiromatsu S, Nata S, Tobinaga S, Aoyagi S. A case of angioleiomyoma presenting as a pulsatile tumor in the left ring finger. Ann Vasc Surg 2011; 25:698.e9-12. [PMID: 21546211 DOI: 10.1016/j.avsg.2010.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 09/25/2010] [Indexed: 10/18/2022]
Abstract
Angioleiomyomas in the finger are rare and their preoperative diagnosis is difficult. Most of them are not associated with arteries and their chief complaint does not reveal pulsation tumor. We report a case of the angioleiomyoma in the finger which was misdiagnosed as arteriovenous fistula of tumor, based on the presence of pulsating tumor and angiography finding.
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Aoyagi S, Fukunaga S, Kosuga T, Akashi H. Left Atrial Intramural Hematoma after Resection of Myxoma: Report of a Case. Ann Thorac Cardiovasc Surg 2011; 17:411-4. [DOI: 10.5761/atcs.cr.10.01582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tanaka A, Onitsuka S, Shintani Y, Ohno T, Nata S, Kanaya K, Fukunaga S, Hiromatsu S, Akashi H, Aoyagi S. [Long-term outcomes of thoracic endovascular aortic repair with homemade stent-grafts]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2011; 64:9-14. [PMID: 21229672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We reviewed our experience with homemade stent-grafts in the repair of thoracic aortic lesions. The objective of this study was to assess the long-term outcomes of this therapy. From 1999 to 2008, homemade stent-grafts were inserted in 94 patients with various thoracic diseases. The endoprostheses were stainless steel Z-stents covered with polyester graft and were custom designed for each patient. Placement of the stent-grafts was technically successful in 85 of the 94 patients (90%). Within 30 days after the treatment, 4 patients died, 3 had cerebral infarction, and 3 had the onset of paraplegia or paraparesis. Primary endoleaks were observed in 10 patients (11%). During the mean follow-up period of 43 +/- 29 months, 10 patients had endoleaks and 8 had stent-graft migration. The aneurysm-related mortality rate was 12%. Our early outcomes of elective and emergency thoracic endovascular aortic repair with homemade stent-grafts demonstrated their therapeutic effectiveness in high-risk patients with various thoracic diseases. Endoleaks and migration were, however, the factors most responsible for secondary intervention in the mid-term period. Careful follow-up of the treated patients is needed to avoid the major complication in the long-term period.
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Aoyagi S, Fukunaga S, Teshima H. Reply to Letter to the Editor: Thrombolytic Treatment and Mechanical Disruption for Prosthetic Valve Thrombosis in the Right Heart. Artif Organs 2010. [DOI: 10.1111/j.1525-1594.2010.01162.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kitasato Y, Yasunaga M, Goto Y, Sato T, Akasu G, Shiota K, Sakai H, Ogata T, Okuda K, Kinoshita H, Shirouzu K, Aoyagi S. [Laparoscopic radiofrequency ablation for hepatocellular carcinoma]. Gan To Kagaku Ryoho 2010; 37:2662-2663. [PMID: 21224672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We examined the case of laparoscopic radiofrequency ablation (L-RFA) to hepatocellular carcinoma (HCC), and then the method of this treatment was considered in terms of selection and adjustment. Between January 2008 and May 2010, L-RFC was performed on 18 cases (27 tumors). A total operation time was 203 minutes (± 85.5). The median survival time was 562 days (± 197 day). The amount of blood was 21.0 g (± 68.4), and 3 postoperative complications (pleural effusion) were observed. The average length of hospital stay after the operation was 8 days. There was no vestigial remnant in all cases after the operation. The prognosis of death due to a liver failure was one case on the 516th day after the operation. All other 17 cases were survived. If the tumors were identified by the naked eye and ultrasonography, and considering the position in relation to the main vas, the ablation would be possible for the troublesome part in case of the percutaneous approach. Therefore, we thought the application of RFA to HCC would be more expandable.
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Akashi H, Nata S, Kanaya K, Shintani Y, Onitsuka S, Aoyagi S. Spontaneous Dissection of the Iliac Artery in a Patient With Fibromuscular Dysplasia. Ann Vasc Surg 2010; 24:952.e13-6. [DOI: 10.1016/j.avsg.2010.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/14/2009] [Accepted: 02/18/2010] [Indexed: 11/25/2022]
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Tanaka H, Okita Y, Kasegawa H, Takamoto S, Tabayashi K, Yagihara T, Ueda Y, Aoyagi S, Komeda M, Eishi K, Kurosawa H. The fate of bioprostheses in middle-aged patients: the Japanese experience. THE JOURNAL OF HEART VALVE DISEASE 2010; 19:561-567. [PMID: 21053733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Although the trend of bioprosthesis use has been evaluated extensively, the durability of currently available bioprostheses has not been determined in middle-aged patients. The study aim was to determine the long-term fate of bioprostheses implanted in patients aged < 60 years. METHODS Valve implantation data were collected from 43 centers in Japan. The data included patient age at implantation, type of valve, implant position, follow up period, and cause of reoperation including structural valve deterioration (SVD) and non-SVD. Between 1975 and 2005, a total of 697 bioprostheses was implanted in the mitral position, and 247 in the aortic position. The mean follow up period was 9.2 years. Rates of freedom from SVD and reoperation were determined using an actuarial method. RESULTS The mean age at implantation was 45 +/- 10.9 years. The 15-year freedom from SVD was 39% for those with valves implanted in the aortic position, and 27% in the mitral position (p = 0.004). For the same period, the actuarial freedom from reoperation was 31% for valves in the aortic position, and 24% in the mitral position (p = 0.178). The difference in actuarial freedom from SVD was not significant between age groups in the mitral position. However, there were differences in actuarial freedom from SVD in the aortic position for patients aged < 10 years when compared to the other age groups (p < 0.001). New-generation valves showed better long-term durability than older valves (p = 0.05). CONCLUSION The long-term freedom from SVD in middle-aged patients was unfavorable for bioprostheses implanted in the aortic and mitral positions. Middle-aged patients must be made aware that reoperation will be necessary; consequently, the choice of bioprosthesis should be dictated by patient-surgeon preference.
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Hiromatsu S, Nata S, Ohno T, Shintani Y, Kanaya K, Sakashita H, Fukunaga S, Aoyagi S. Non-permanent inferior vena cava filters for prophylaxis and treatment of lower limb venous thromboembolism. Vasc Endovascular Surg 2010; 44:668-73. [PMID: 20724287 DOI: 10.1177/1538574410379653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate and compare our recent clinical experience with temporary inferior vena cava (IVC) filters (TF) and retrievable IVC filters (RF). MATERIALS AND METHODS Patients who received TF or RF implantation between October 2002 and May 2009 were studied. The early clinical outcomes between the 2 groups were compared. RESULTS Nonpermanent IVC filters were placed in 119 patients (34 in TF and 85 in RF). Retrieval of RF and removal of TF were successful in 98.7% and 100%, respectively. The incidence of filter-related complications for TF was significantly higher than for RF (26.5% vs 3.5%; P = .0004). However, no symptomatic pulmonary embolism (PE) was observed during filter placement. CONCLUSION TF and RF provided similar protection from PE. We prefer RF because they can be left in permanently if it is impossible to remove or retrieve the filter for some reason.
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Aoyagi S, Fukunaga S, Teshima H. Treatment for mechanical valve thrombosis in the right heart: combined pharmacological and mechanical thrombolysis. Artif Organs 2010; 34:E238-41. [PMID: 20618228 DOI: 10.1111/j.1525-1594.2010.01021.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report clinical results of combined pharmacological and mechanical thrombolysis for mechanical prosthetic valve thrombosis (PVT) in the right heart. Between January 1992 and December 2008, combined thrombolysis, which consisted of an intravenous infusion of urokinase together with mechanical disruption of thrombus in a prosthetic valve by temporarily increasing the cardiac pacing rate, was performed in three patients with four cases of mechanical PVT in the right heart. The prosthetic valve in all three patients was a bileaflet mechanical valve, and was located in the tricuspid position in two patients and in the pulmonary position in the remaining patient. PVT was diagnosed by echocardiography and cineradiography. Thrombolysis was successful in all four cases in the three patients, and no hemorrhagic complications or clinically symptomatic pulmonary embolisms were observed. Mechanical disruption of thrombus using a pacemaker appears to be an effective adjunctive modality to thrombolysis with fibrinolytic agents for PVT in the right heart. Combined pharmacological and mechanical thrombolysis may improve success rates and reduce the time required for thrombolysis of PVT.
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Teshima H, Kawano H, Kashikie H, Nakamura K, Aoyagi S. Coronary artery bypass grafting in patients with pulmonary aspergillosis. Gen Thorac Cardiovasc Surg 2010; 58:197-201. [PMID: 20401715 DOI: 10.1007/s11748-009-0509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 07/09/2009] [Indexed: 11/27/2022]
Abstract
Cardiovascular surgery in patients with pulmonary aspergillosis has been rarely reported. Coronary artery bypass grafting (CABG) for three cases of angina pectoris with pulmonary aspergillosis was successfully performed. Patients were discharged from our hospital without any complications of invasive Aspergillus cardiovascular infection. Careful perioperative management for preventing pulmonary complications is important.
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Teshima H, Fukunaga S, Takaseya T, Tomoeda H, Akashi H, Aoyagi S. Obstruction of St. Jude Medical Valves in the Aortic Position: Plasma Transforming Growth Factor Type Beta 1 in Patients With Pannus Overgrowth. Artif Organs 2010; 34:210-5. [DOI: 10.1111/j.1525-1594.2009.00800.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oda T, Kato S, Tayama E, Fukunaga S, Akashi H, Aoyagi S. Mitral stenosis due to pannus overgrowth after rigid ring annuloplasty. THE JOURNAL OF HEART VALVE DISEASE 2010; 19:257-259. [PMID: 20369514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although mitral stenosis (MS) due to pannus overgrowth after mitral valve repair for rheumatic mitral regurgitation (MR) is not uncommon, it is extremely rare in relation to non-rheumatic mitral regurgitation. Whilst it has been suggested that the rigid annuloplasty ring induces pannus overgrowth in the same manner as the flexible ring, to date only in cases using the flexible ring has pannus formation been confirmed by a pathological examination after redo surgery. The case is described of a woman who had undergone mitral valve repair using a 28 mm rigid ring three years previously because of non-rheumatic MR, and subsequently suffered from MS due to pannus formation over the annuloplasty ring. To the present authors' knowledge, this is the first report of MS due to pannus formation after mitral valve repair using a rigid annuloplasty ring to treat non-rheumatic MR documented at reoperation.
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Fukunaga S, Tomoeda H, Ueda T, Mori R, Aoyagi S, Kato S. Recurrent Mitral Regurgitation Due to Calcified Synthetic Chordae. Ann Thorac Surg 2010; 89:955-7. [DOI: 10.1016/j.athoracsur.2009.07.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 10/19/2022]
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Tomoeda H, Ueda T, Teshima H, Arinaga K, Tayama K, Fukunaga S, Aoyagi S. Postoperative Left Ventricular Mass Regression After Aortic Valve Replacement for Aortic Stenosis. Ann Thorac Surg 2010; 89:745-50. [DOI: 10.1016/j.athoracsur.2009.12.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 12/10/2009] [Accepted: 12/15/2009] [Indexed: 12/01/2022]
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Egawa N, Hiromatsu S, Shintani Y, Kanaya K, Fukunaga S, Aoyagi S. Prevention of venous thromboembolism in thoracic and cardiovascular surgery. Asian Cardiovasc Thorac Ann 2010; 17:505-9. [PMID: 19917794 DOI: 10.1177/0218492309348639] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Venous thromboembolism is the most preventable illness among patients in hospital. We prepared guidelines for the prophylaxis of venous thromboembolism, based on previous experience of perioperative risk factors. The aim of this study was to evaluate the effectiveness of these guidelines. All 1,467 patients who underwent surgery for thoracic or cardiovascular disease between April 2002 and July 2004, before the prophylactic guidelines were implemented, were assigned to group A. Another 1,389 patients who had surgery between August 2004 and December 2006, after the guidelines had been implemented, formed group B. The incidences of venous thromboembolism perioperatively in the 2 groups were compared. Six (0.4%) patients in group A developed deep vein thrombosis or pulmonary embolism, whereas no patient in group B experienced thromboembolism. The difference between groups was significant, so we consider our guidelines for venous thromboembolism prevention in the perioperative period to be clinically useful.
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Aoyagi S, Izumi K, Hata H, Kawasaki H, Shimizu H. Usefulness of real-time tissue elastography for detecting lymph-node metastases in squamous cell carcinoma. Clin Exp Dermatol 2009; 34:e744-7. [DOI: 10.1111/j.1365-2230.2009.03468.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fukunaga S, Ueda T, Mori R, Shintani Y, Nata S, Mikasa K, Kanaya K, Akashi H, Aoyagi S. [Long-term results of aortic root replacement with a composite graft]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2009; 62:947-951. [PMID: 19827546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We analyzed the long-term results of aortic root replacement with a composite graft. Since 1992, 127 patients had undergone aortic root replacement with a composite graft. There were 92 men and 35 women with a mean age of 56.5 years. There were 69 patients with annuloaortic ectasia, 17 aortic dissections, and 41 ascending aortic dilatation due to aortic valve disease. Marfan syndrome was diagnosed in 19 patients. As surgical procedure, button technique was used in 90 patients, Cabrol technique in 11, and Piehler technique in 26. Open distal anastomosis was performed in 82 patients to avoid clamp injury of rest aorta. Early mortality was 3.1% and no major morbid events had occurred. Follow-up was completed in 95.9% of the patients and the mean follow-up period was 6.1 years. Actuarial survival at 5, 10, and 15 years was 86.2%, 83.4%, and 83.4%, respectively. Actuarial freedom from aortic valve reoperation at 10 and 15 years was 99.2% and 95.7%, respectively. The results of aortic root replacement with a composite graft were excellent. This procedure should be the 1st choice for surgical treatment of the aortic root disease.
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Teshima H, Kawano H, Kashikie H, Nakamura K, Imada T, Oda T, Aoyagi S. A new hydrocolloid dressing prevents surgical site infection of median sternotomy wounds. Surg Today 2009; 39:848-54. [PMID: 19784722 DOI: 10.1007/s00595-008-3974-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 08/06/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE This prospective and semi-randomized study was conducted to clarify the effectiveness of a new hydrocolloid dressing placed over median sternotomy wounds using an occlusive dressing technique. METHODS The subjects were 253 patients undergoing coronary artery bypass grafting (CABG), who were randomized to receive either the new hydrocolloid dressing (Karayahesive, n = 117) or a polyurethane foam dressing (Tegaderm plus Pad, n = 136) immediately after sternal wound closure. Karayahesive was left in place for 7 days, whereas the Tegaderm plus Pad was removed on postoperative day (POD) 2 and replaced with an adhesive wound dressing until POD 7. RESULTS In the Karayahesive group, complete integrity of the wound was achieved in 91% of the patients, with an infection developing in 3.4%: as a superficial surgical site infection (SSI) in three and as a deep SSI in one. On the other hand, in the Tegaderm plus Pad group, an infection developed in 10.3% (14 patients) of the patients: as a superficial SSI in nine and as a deep SSI in five (P < 0.05). The total treatment costs from the application of the dressing until completion of treatment was 699 yen for the Karayahesive and 910 yen for the Tegaderm plus Pad (P < 0.001). CONCLUSIONS The new hydrocolloid dressing, applied with an occlusive dressing technique to median sternotomy wounds, prevented SSI and was cost effective.
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Ishihara K, Hiromatsu S, Shintani Y, Kanaya K, Mikasa K, Aoyagi S. Clinical outcome of perioperative nonpermanent vena cava filter placement in patients with deep venous thrombosis or blood stasis of the vein. Surg Today 2009; 39:764-9. [PMID: 19779772 DOI: 10.1007/s00595-009-3959-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 02/10/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the recent clinical experience with nonpermanent inferior vena cava (IVC) filter placement preoperatively, especially with regard to patients who had deep venous thrombosis (DVT) due to compression by a tumor or an aneurysm. METHODS Preoperative prophylactic IVC filter placement was performed between October 2002 and March 2008 in 48 of 83 patients who underwent IVC filter placement. IVC filter placement was performed preoperatively in 35 of the 48 patients due to DVT located distally in an iliac vein or due to IVC compression by a tumor or aneurysm. This study examined the early and mid-term outcomes resulting from nonpermanent IVC filter placement. RESULTS The mean implantation period was 11.1 +/- 9.3 days (range, 3-56 days). Three patients (8.6%) experienced minor complications during the IVC filter placement. A thrombus was captured in the filter in 4 patients (8.8%). One patient in whom the filter was left as a permanent filter died during the follow-up period. No patient experienced any pulmonary embolus during the follow-up period. CONCLUSION Nonpermanent IVC filter insertion is perioperatively useful in surgical procedures that eliminate the compression of the vein by an excision of either the tumor or aneurysm compressing the vein.
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