1
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Tahara N, Fukumoto Y, Tayama E. Utility of vector flow mapping and [18F]fluorodeoxyglucose-positron emission tomography/computed tomography to assess left ventricular workload in obstructive hypertrophic cardiomyopathy. Eur Heart J 2024; 45:1488. [PMID: 38289896 DOI: 10.1093/eurheartj/ehae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
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2
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Saisho K, Mori N, Nakagawa M, Nakamura E, Tanaka Y, Kaku H, Tanaka Y, Isobe T, Otsuka H, Sudo T, Sakai H, Ishibashi N, Hisaka T, Tayama E, Fujita F. Aortoesophageal fistula due to esophageal cancer: a case report of successful management. Surg Case Rep 2024; 10:88. [PMID: 38630370 PMCID: PMC11024079 DOI: 10.1186/s40792-024-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but potentially life-threatening condition. The best treatment for the AEF due to esophageal carcinoma is still unresolved. Here, we report a rare case of AEF caused by esophageal cancer, that was successfully treated with emergency thoracic endovascular aortic repair (TEVAR), followed by esophagectomy and gastric tube reconstruction. CASE PRESENTATION A 64-year-old man presented with loss of consciousness and hypotension during chemoradiotherapy for advanced esophageal cancer. Enhanced computed tomography showed extravasation from the descending aorta into the esophagus at the tumor site. We performed emergency TEVAR for the AEF, which stabilized the hemodynamics. We then performed thoracoscopic subtotal esophagectomy on day 4 after TEVAR to prevent graft infection, followed by gastric tube reconstruction on day 30 after TEVAR. At 9 months after the onset of AEF, the patient continues to receive outpatient chemotherapy and leads a normal daily life. CONCLUSION TEVAR is a useful hemostatic procedure for AEF. If the patient is in good condition and can continue treatment for esophageal cancer, esophagectomy and reconstruction after TEVAR should be performed to prevent graft infection and maintain quality of life.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masashi Nakagawa
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiji Nakamura
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yu Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideaki Kaku
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yuya Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoya Sudo
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
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Mine H, Saku K, Takagi K, Nohara S, Hiromatsu S, Fukumoto Y, Tayama E. Postoperative anticoagulation management using subcutaneous unfractionated heparin for a patient with nonbacterial thrombotic endocarditis: a case report. J Surg Case Rep 2024; 2024:rjae215. [PMID: 38605694 PMCID: PMC11007639 DOI: 10.1093/jscr/rjae215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) presents nonbacterial vegetation on cardiac valves. NBTE requires appropriate anticoagulant therapy to prevent recurrence after surgery. However, there has not yet been established evidence for anticoagulant therapy in NBTE, and low molecular weight heparin is not approved in Japan. We present a case of NBTE that was successfully managed with anticoagulant therapy using subcutaneous unfractionated heparin. A 59-year-old woman was diagnosed with NBTE on the mitral and tricuspid valve associated with breast cancer, underwent valve replacement. Warfarin and continuous intravenous unfractionated heparin were started. However, disseminated intravascular coagulation occurred after heparin was discontinued. Continuous intravenous unfractionated heparin injection was resumed immediately, and subcutaneous unfractionated heparin was administered before discharge. Postoperative echocardiography revealed no vegetation on the prosthetic valves thereafter. Subcutaneous unfractionated heparin therapy is useful to prevent the recurrence of NBTE as the anticoagulation in outpatients.
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Affiliation(s)
- Hiroki Mine
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Shoichiro Nohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Shinichi Hiromatsu
- Division of Vascular Surgery, Kurume University Medical Center, 155-1 Kokubumachi, Kurume 839-0863, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
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Kono T, Takagi K, Takaseya T, Fukuda T, Saku K, Zaima Y, Shojima T, Arinaga K, Tayama E. Early thrombus formation including hypo-attenuated leaflet thrombosis after surgical bioprosthetic aortic valve replacement. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02010-4. [PMID: 38403822 DOI: 10.1007/s11748-024-02010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To assess the occurrence, predictors, and outcomes of hypo-attenuated leaflet thickening (HALT) and thrombus outside the prosthetic valve following surgical aortic valve replacement. METHODS A total of 118 patients underwent surgical aortic valve replacement with bioprosthetic valves between July 2020 and June 2022. Sixty-two (52.5%) patients, which is a fairly high number of patients, underwent cardiac computed tomography and transthoracic echocardiography one week after surgery. Patients were divided into two groups, those with HALT (n = 14) and those without HALT (n = 48). RESULTS Of the 62 patients who underwent cardiac computed tomography, HALT was observed in 14 (22.5%) patients during the very early postoperative phase. Reduced leaflet motion was observed in two of the 14 patients. The low-attenuation areas were located outside the prosthetic valve in 10 cases (71.4%) in the HALT group and in 14 cases (29.2%) in the non-HALT group. More than 50% of patients (57.1%) with HALT and 79.2% without HALT were administered warfarin. Neither in-hospital deaths nor postoperative thromboembolic events were observed during hospitalization. No patient had a mean pressure gradient > 20 mmHg in either group. CONCLUSION HALT was observed in one-fifth of the cases after surgical aortic valve replacement during the very early postoperative phase in an institution wherein administration of continuous heparin infusion after surgery is a standard practice. HALT did not affect the early prognosis or incidence of cerebral infarction.
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Affiliation(s)
- Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomofumi Fukuda
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Takagi K, Arinaga K, Takaseya T, Otsuka H, Shojima T, Kono T, Zaima Y, Saku K, Oryoji A, Tayama E. Mitral valve repair using a semi-rigid posterior band: a 10-year Japanese single-center experience of 244 patients. J Thorac Dis 2024; 16:333-343. [PMID: 38410614 PMCID: PMC10894386 DOI: 10.21037/jtd-23-1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/08/2023] [Indexed: 02/28/2024]
Abstract
Background Mitral valve repair (MVr) is an established procedure for patients who require surgery for primary mitral regurgitation (PMR). The Colvin-Galloway Future Band (CGFB) is a semi-rigid posterior band expected to improve the clinical outcomes of MVr. However, information on the hemodynamic and functional performance and long-term outcomes of CGFB is limited. We evaluated the quality, durability, and clinical performance after MVr using CGFB for PMR as the cohort study. Methods A total of 244 patients who underwent MVr with CGFB were enrolled. Clinical and echocardiographic assessments were performed (mean follow-up period, 4.0±2.4 years). Results Posterior mitral leaflet resection was the most common MVr procedure. CGFBs measuring 28 mm (35.2%) and 30 mm (36.5%) were used. The incidence of systolic anterior motion (SAM) was 1.6%. A total of 93.4% of the patients had no or trace MR at discharge. Over 90% of patients had no or mild MR at the last follow-up. The mean pressure gradient and mitral valve orifice area one year after MVr ranged between 2.6 and 3.6 mmHg and 2.3 and 3.4 cm2, respectively. At follow-up, 85.4% of the patients were New York Heart Association class I. Three patients underwent repeat mitral valve surgery. Conclusions The CGFB demonstrates satisfactory quality and durability in MVr for PMR. Other advantages include a low occurrence of SAM and acceptable hemodynamic outcomes, particularly in patients requiring a smaller annuloplasty device.
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Affiliation(s)
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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Shojima T, Takagi K, Saku K, Fukuda T, Tayama E. Preoperative management using Impella support for acute aortic dissection with left coronary malperfusion: a case report. Egypt Heart J 2024; 76:11. [PMID: 38285313 PMCID: PMC10825086 DOI: 10.1186/s43044-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Acute aortic dissection (AAD) with impaired perfusion of the left coronary artery has a poor prognosis, even after urgent radical aortic surgery, due to extensive myocardial damage. Although Impella, a microaxial-flow catheter pump, is useful in managing acute myocardial infarction, it is generally contraindicated in patients with AAD because it is an intra-aortic device and the aortic structure is compromised in these cases. Here, we introduce a novel intervention that allowed a planned aortic repair after managing circulation using Impella and venoarterial extracorporeal membrane oxygenation in a case of AAD with left main trunk malperfusion. CASE PRESENTATION A 40-year-old man presented with cardiogenic shock. Percutaneous coronary intervention was performed to address left main trunk obstruction using an intra-aortic balloon pump; however, circulatory instability persisted. The patient was transferred to our hospital after venoarterial extracorporeal membrane oxygenation. Impella CP™ was used to improve his circulatory status. However, a subsequent CT scan confirmed an AAD diagnosis. After 5 days of stable circulatory support, the patient underwent aortic root replacement and coronary artery bypass grafting. CONCLUSIONS In patients with AAD and coronary malperfusion, adjunctive circulatory management with Impella may be a valuable therapeutic option.
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Affiliation(s)
- Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomofumi Fukuda
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan.
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Anegawa T, Sasaki KI, Ishizaki Y, Negoto S, Oryoji A, Nakamura E, Otsuka H, Hiromatsu S, Fukumoto Y, Tayama E. Effects of Pemafibrate on Reducing Oxidative Stress and Augmenting Angiogenesis in Ischemic Limb Tissue. Kurume Med J 2024:MS6934006. [PMID: 38233183 DOI: 10.2739/kurumemedj.ms6934006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Oxidative damage is observed in the ischemic limbs of patients with arteriosclerosis obliterans. We investigated whether pemafibrate, a selective peroxisome proliferator-activated receptor alpha modulator, reduced oxidative stress in ischemic limbs and consequently rescued limb damage in model mice. MATERIALS AND METHODS We surgically induced hind-limb ischemia in mice and orally administered pemafibrate solution (P-05 group, 0.5 mg/kg/day; P-10 group, 1.0 mg/kg/day) or control solution (control group). Seven days after the surgery, differences in reactive oxygen species (ROS) contents, antioxidative enzyme and transcription factor expression, blood flow, and capillary density in ischemic limbs were assessed. RESULTS Tissue ROS levels were lower in the P-05 and P-10 groups compared with those in the control group. Although the tissue expression levels of nuclear factor-erythroid 2-related factor 2 increased in the P-10 group compared with that in the control group, no corresponding changes were observed in the tissue expression of four antioxidative enzymes. The limb salvage rates and capillary densities in ischemic limbs were higher in the P-05 and P-10 groups than that in the control group. CONCLUSION Pemafibrate treatment reduced oxidative stress and augmented angiogenesis in ischemic limbs, contributing to prevention of limb damage in mice.
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Affiliation(s)
- Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yuta Ishizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Eiji Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Shinichi Hiromatsu
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
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Takaseya T, Itaya N, Sasaki KI, Sasaki M, Yokomizo M, Honda A, Oshita K, Azuma J, Fukumoto Y, Tayama E. Cusp overlap technique decreases paravalvular leakage in self-expandable transcatheter aortic valve replacement. Heart Vessels 2024; 39:48-56. [PMID: 37606754 DOI: 10.1007/s00380-023-02307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage.
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Affiliation(s)
- Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan.
| | - Naoki Itaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Masahiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Michiko Yokomizo
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Kensuke Oshita
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Junpei Azuma
- Division of Radiology, Kurume University Hospital, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan
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Takagi K, Fukuda T, Saku K, Tayama E. A Case of Andexanet Alfa Induced Heparin Resistance in Emergent Aortic Surgery: Successful Anticoagulation Management Using Antithrombin Administration. Cureus 2023; 15:e50856. [PMID: 38249168 PMCID: PMC10798854 DOI: 10.7759/cureus.50856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Andexanet alfa (AnAl) is utilized for the urgent reversal of direct oral anticoagulants (DOACs) in cases of severe bleeding. While the guidelines from the Society of Thoracic Surgeons recommend AnAl for urgent cardiac surgery in patients treated with DOACs, concerns persist regarding the potential of AnAl to induce heparin resistance. This report details the case of an 85-year-old woman diagnosed with acute type A aortic dissection, who received AnAl due to prior edoxaban use. During the emergent aortic surgery, she exhibited heparin resistance following the administration of unfractionated heparin (UFH). The administration of antithrombin III (ATIII) significantly influenced activated clotting times, facilitating successful surgery while maintaining adequate anticoagulation. This case underscores the importance of cautious management of AnAl-induced heparin resistance during critical surgeries, emphasizing the role of ATIII supplementation for effective anticoagulation.
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Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN
| | - Tomofumi Fukuda
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN
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Takagi K, Saku K, Tayama E. Long thrombus with a removed microaxial blood pump catheter 10 days after ECPELLA support. Eur Heart J Case Rep 2023; 7:ytad538. [PMID: 37954571 PMCID: PMC10639098 DOI: 10.1093/ehjcr/ytad538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan
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Tayama E, Takagi K, Shojima T, Otsuka H, Takaseya T, Arinaga K. Review of Implantable Left Ventricular Assist Devices. Kurume Med J 2023; 68:171-181. [PMID: 37316290 DOI: 10.2739/kurumemedj.ms6834007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Mechanical circulatory support has been an indispensable treatment for severe heart failure. While the development of a total artificial heart has failed, left ventricular assist devices (LVAD) have evolved from extracorporeal to implantable types. The first generation implantable LVAD (pulsatile device) was used as a bridge to transplantation, and demonstrated improvement in survival rate and activity of daily living. The evolution from the first-generation (pulsatile device) to the second-generation (continuous flow device: axial flow pump and centrifugal pump) has resulted in many clinical benefits by reducing mechanical failures and minimizing device size. Furthermore, third-generation devices, which use a moving impeller suspended by magnetic and/or hydrodynamic forces, have improved overall device reliability and durability. Unfortunately, there are still many device-related complications, and further device development and improvement of patient management methods are required. However, we expect to see further development of implantable VADs, including for destination therapy, in future.
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Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine
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12
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Takagi K, Shojima T, Kono T, Kikusaki S, Homma T, Shibata T, Otsuka M, Fukumoto Y, Tayama E. ECPELLA as the bridge to surgery in patients with cardiogenic shock due to post-infarct papillary muscle rupture: management of mechanical circulatory support during operation. J Artif Organs 2023; 26:237-241. [PMID: 36112331 DOI: 10.1007/s10047-022-01365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022]
Abstract
Papillary muscle rupture is a fatal complication with a high operative mortality. Most patients experience cardiogenic shock and hypoxia due to pulmonary edema caused by severe mitral regurgitation. Although preoperative stabilization using a mechanical assist device potentially improves surgical outcomes, an appropriate strategy has not yet been established. ECPELLA, combining venoarterial extracorporeal membrane oxygenation and Impella, has the potential to stabilize preoperative status and improve outcome in patients with refractory cardiogenic shock due to papillary muscle rupture. Herein, we present 3 cases involving the efficacy of ECPELLA and our tips of surgical and ECPELLA management in patients with papillary muscle rupture.
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Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan.
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Satoshi Kikusaki
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takehiro Homma
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Maki Otsuka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
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13
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Nakamura E, Takagi K, Saku K, Negoto S, Anegawa T, Imai S, Otsuka H, Hiromatsu S, Tayama E. Large Thrombus Entrapped in a Patent Foramen Ovale during Inferior Vena Cava Filter Protection for Venous Thromboembolism. Case Rep Emerg Med 2023; 2023:8829652. [PMID: 37691692 PMCID: PMC10484647 DOI: 10.1155/2023/8829652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
Background. A large thrombus entrapped in the patent foramen ovale (PFO) is an extremely rare condition. Moreover, it is considered even rarer after temporary inferior vena cava filter (TIVCF) placement for the prevention of fatal pulmonary embolism due to venous thromboembolism (VTE). Case Report. A 58-year-old man presented with syncope following chest pain and dyspnea due to PE exacerbation during TIVCF protection, which then led to cardiogenic shock. Echocardiography revealed a large thrombus entrapped in the PFO, and computed tomography (CT) showed a bilateral pulmonary artery embolism. The patient was treated with open surgical embolectomy for a pulmonary artery thrombus and PFO thrombus with simultaneous closure of the PFO. The patient's postoperative course was uneventful. Results and Conclusion. Surgical embolectomy was useful with respect to the feasibility of resection of both intracardiac thrombus and pulmonary artery thrombus performed simultaneously, contributing to the prevention of systemic embolisms, and echocardiography plays an important role for early diagnosis.
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Affiliation(s)
- Eiji Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kousuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shinichi Imai
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shinichi Hiromatsu
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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14
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Kono T, Tahara N, Bekki M, Saku K, Sugiyama Y, Honda A, Takaseya T, Shojima T, Takagi K, Abe T, Fukumoto Y, Tayama E. Inflammatory response of Teflon felt strip 41 years after surgical repair for Ebstein's anomaly. J Nucl Cardiol 2023; 30:1700-1701. [PMID: 35610535 DOI: 10.1007/s12350-022-02991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
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15
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Takagi K, Saku K, Kono T, Zaima Y, Matsushima Y, Homma T, Shibata T, Otsuka M, Yokomizo M, Ohshita K, Fukumoto Y, Tayama E. Direct aorta implantation of microaxial blood pump via right anterior thoracotomy. JTCVS Tech 2023; 19:64-67. [PMID: 37324353 PMCID: PMC10268493 DOI: 10.1016/j.xjtc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, Kurume, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, Kurume, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, Kurume, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, Kurume, Japan
| | - Yoshihisa Matsushima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University, School of Medicine, Kurume, Japan
| | - Takehiro Homma
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University, School of Medicine, Kurume, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University, School of Medicine, Kurume, Japan
| | - Maki Otsuka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University, School of Medicine, Kurume, Japan
| | | | - Kensuke Ohshita
- Department of Anesthesiology, Kurume University, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University, School of Medicine, Kurume, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, Kurume, Japan
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16
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Kono T, Otsuka H, Anegawa T, Oryoji A, Shintani Y, Nakamura E, Hiromatsu S, Tayama E. Endovascular Aortic Repair for Heavily Calcified Abdominal Aortic Stenosis Using the Gore Viabahn Vbx Balloon-Expandable Covered Stent. Kurume Med J 2023. [PMID: 37100603 DOI: 10.2739/kurumemedj.ms682014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Open surgery for the treatment of focal infrarenal aortic stenosis in high-risk patients may result in complications and mortality. Endovascular aortic repair may be used to treat these lesions. Here, we present the case of a 78-year-old woman with severe, highly calcified stenosis of the infrarenal abdominal aorta, which was successfully treated with the GORE VIABAHN VBX (Gore Medical; Flagstaff, AZ) balloon-expandable covered stent. Long-term and randomized controlled studies comparing open surgery with EVAR are necessary to evaluate the usefulness of this novel device.
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Affiliation(s)
- Takanori Kono
- Department of Surgery, Kurume University School of Medicine
| | | | | | | | | | - Eiji Nakamura
- Department of Surgery, Kurume University School of Medicine
| | | | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine
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17
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Shojima T, Zaima Y, Takagi K, Kono T, Saku K, Tayama E. [Result of Surgical Treatment for Active Infective Endocarditis at the Aortic Position]. Kyobu Geka 2023; 76:260-264. [PMID: 36997172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Herein, we retrospectively review our experience with surgical treatment of active aortic valve infective endocarditis, particularly aortic annular abscess, and central nervous system complications. From 2012 to 2021, 46 consecutive patients underwent surgery during the active phase of infective endocarditis, 25 of which were performed at the aortic position. One patient died early (<30 days) due to low output syndrome and another 2 patients who were never discharged died because of general prostration. The actuarial survival rate was 84% at 1 year, and 80% at 3 and 5 years. Eleven patients [6 native valve endocarditis (NVE), 5 prosthetic valve endocarditis (PVE)] had valve annular abscess requiring removal of the infected tissue and reconstruction of a definite anatomic continuity, and aortic valve replacement was subsequently performed in 7 patients and aortic root replacement in 4 patients. Direct closure was performed in 4 patients with partial annulus defects, and reconstruction with an autologous nor bovine pericardium patch was performed in 6 patients with large annulus defects. Preoperative imaging revealed acute cerebral embolism in 10 patients. In eight cases, surgery was performed within 7 days after diagnosis of cerebral embolism. No patient had abnormal postoperative neurological findings. There were no reoperations and no recurrence of infective endocarditis.
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Affiliation(s)
- Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, Japan
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18
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Itaya N, Sasaki KI, Takaseya T, Sasaki M, Yamaji K, Honda A, Fukumoto Y, Tayama E. Transcatheter aortic valve implantation for aortic valve stenosis 17 years after aortic root remodeling via the Yacoub method. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
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19
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Shintani Y, Hiromatsu S, Yamada K, Negoto S, Anegawa T, Nakamura E, Ootsuka H, Tayama E. Isolated External Iliac Artery Aneurysm with Fibromuscular Dysplasia. Ann Vasc Dis 2023; 16:69-72. [PMID: 37006869 PMCID: PMC10064297 DOI: 10.3400/avd.cr.21-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/20/2022] [Indexed: 01/20/2023] Open
Abstract
Isolated aneurysms of the external iliac artery are rare in patients with fibromuscular dysplasia. In this study, we report the case of a 74-year-old man with advanced gastric cancer who was found to have a medium-sized aneurysm of the external iliac artery (35 mm) on preoperative computed tomography angiograms. The patient underwent laparoscopic gastrectomy followed by replacement of the external iliac artery 6 months later. Histological examination of biopsy specimens revealed fibromuscular dysplasia. The 6 month postoperative course was uneventful. Such a case of external iliac artery aneurysm caused by fibromuscular dysplasia is very rare, and open surgery is recommended for its removal.
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20
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Nishida T, Kono T, Takagi K, Tayama E. Right-parasternal approach for aortic valve replacement and ascending aortic repair after ante-thoracic route gastric tube reconstruction. J Card Surg 2022; 37:5505-5508. [PMID: 36259759 DOI: 10.1111/jocs.17052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
Due to the limitations of surgical incisions and approaches brought on by the presence of gastric tube (GT), open heart surgery following ante-thoracic route GT reconstruction remains challenging. A-73-year-old man, who had a history of esophageal resection and ante-thoracic route GT reconstruction required aortic valve replacement (AVR) concomitant with ascending aortic repair (AAR) for aortic stenosis and dilated ascending aorta. We performed open heart surgery via a right-parasternal approach to avoid injury to the GT and nutrient arteries. This approach provided a good operative field, similar to median sternotomy. To our knowledge, this is the first case of AVR concomitant with AAR after ante-thoracic route GT reconstruction via a right-parasternal approach. We consider that the right-parasternal approach is reasonable for patients with ante-thoracic route GT reconstruction.
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Affiliation(s)
- Takamichi Nishida
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
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21
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Imai S, Tahara N, Igata S, Tahara A, Bekki M, Sugiyama Y, Maeda-Ogata S, Honda A, Otsuka H, Ushijima T, Okabe Y, Kaida H, Abe T, Tanaka H, Fukumoto Y, Tayama E. Vascular/perivascular inflammation in IgG4-related disease. J Nucl Cardiol 2022; 29:2920-2933. [PMID: 34704218 DOI: 10.1007/s12350-021-02812-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is characterized by the infiltration of IgG4-positive plasma cells and fibrosclerotic inflammation in multiple organs. Although vascular complications are present in some patients with IgG4-RD, vascular and/or perivascular inflammatory activity compared to control subjects remains unknown. This study sought to investigate vascular/perivascular inflammation in IgG4-RD patients compared to control subjects using 18F-fluorodeoxyglucose-positron emission tomography combined with computed tomography (FDG-PET/CT). METHODS We examined 37 consecutive patients diagnosed as IgG4-RD (29 males, mean age of 64.3 ± 8.3 years old), who underwent FDG-PET/CT. Thirty-seven age- and gender-matched subjects without IgG4-RD were employed as controls. Vascular/perivascular inflammation was quantified by blood-normalized standardized uptake value, known as a target-to-background ratio (TBR). RESULTS All IgG4-RD patients presented with multiple region involvements. Twelve (32.4%) of the IgG4-RD patients had vascular complications, all of which appeared in the abdominal aorta. IgG4-RD patients had significantly higher TBR values in the descending aorta, abdominal aorta, and common iliac artery than control subjects. Also, IgG4-RD patients with vascular complication exhibited higher TBR values in the infra-renal aorta and common iliac artery than those without vascular complication. CONCLUSIONS We found that vascular FDG activity is significantly elevated in IgG4-RD patients regardless of vascular complication than control subjects. FDG-PET/CT is a useful modality for assessing vascular/perivascular inflammation, which may contribute vascular complication in IgG4-RD patients.
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Affiliation(s)
- Shinichi Imai
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Sachiyo Igata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Atsuko Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Shoko Maeda-Ogata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tomoyuki Ushijima
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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22
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Shibao K, Murasato Y, Araki M, Tayama E, Fukumoto Y. Acute hypoxemia caused by Impella in a patient with fulminant myocarditis and patent foramen ovale. J Cardiol Cases 2022; 27:36-40. [PMID: 36618839 PMCID: PMC9808478 DOI: 10.1016/j.jccase.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Impella ™ (Abiomed, Danvers, MA, USA) is effective in the acute management of fulminant myocarditis and myocardial infarction with cardiogenic shock. Here, we report a case of a 70-year-old man with fulminant myocarditis in cardiogenic shock who developed right-left shunt via patent foramen ovale during acute management with Impella 5.0, resulting in sudden hypoxemia. With combined support of veno-arterial extracorporeal membrane oxygenation and Impella (ECPELLA), his circulation and oxygenation became stable. The same phenomenon is well known in left ventricular assist device. In such situations, ECPELLA is effective to improve the hypoxic condition. It should be kept in mind that hypoxemia can occur in patients with intracardiac shunt disease when using Impella. Learning objective: Impella is effective to maintain circulation in patients with cardiogenic shock; however, several complications have been reported. Intra-cardiac shunt can suddenly cause severe hypoxemia by Impella. We should mention the presence of intra-cardiac shunt, if the patients have sudden hypoxemia when using left ventricular assist.
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Affiliation(s)
- Kodai Shibao
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan,Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masahiro Araki
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan,Corresponding author at: Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
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23
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Kono T, Takaseya T, Takagi K, Tayama E. Hypo-attenuated leaflet thickening after Perceval sutureless bioprosthesis implantation. J Card Surg 2022; 37:3928-3931. [PMID: 36040457 DOI: 10.1111/jocs.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 12/01/2022]
Abstract
Modern multi-slice computed tomography (CT) has increased the detection of hypo-attenuated leaflet thickening (HALT). Furthermore, HALT's impact on transcatheter or surgical biological aortic valve (AV) prostheses has attracted attention. However, few reports on HALT in sutureless bioprostheses exist. Herein, we report a case of early structural valve deterioration due to HALT after AV replacement (AVR) with a Perceval bioprosthesis, which improved after anticoagulation therapy. A 79-year-old man admitted to our hospital with paroxysmal atrial fibrillation (PAF) during hemodialysis was also diagnosed with AV stenosis and, coronary artery disease, and PAF. He underwent AVR, coronary artery bypass grafting, and left atrial appendage resection. Although the postoperative course was uneventful with dual antiplatelet therapy, postoperative enhanced CT revealed HALT with reduced leaflet motion, and echocardiography showed an increased transvalvular pressure gradient. After using warfarin with target prothrombin time-international normalized ratio of 2-2.5 and/or heparin with target activated partial thromboplastin time of 45-60 s, the HALT disappeared with an improved transvalvular pressure gradient without any thromboembolic events.
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Affiliation(s)
- Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
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24
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Hirata Y, Tayama E, Nomura R, Fukuda T, Onzuka T, Furukawa K. Extracorporeal membrane oxygenation for the control of pulmonary artery hemorrhage. Asian Cardiovasc Thorac Ann 2022; 30:733-736. [PMID: 35440231 DOI: 10.1177/02184923221095724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of catheter-induced pulmonary hemorrhage, which had a favorable outcome on using extracorporeal membrane oxygenation. This procedure helped shunt pulmonary blood flow and significantly reduced bleeding from the pulmonary artery. Massive hemoptysis was observed while weaning the patient off cardiopulmonary bypass. Thus, catheter-induced pulmonary hemorrhage was suspected. After the bronchial blocker was inserted, extracorporeal membrane oxygenation was initiated to reduce pulmonary blood flow. The bronchial blocker was removed the day after the surgery, and the extracorporeal membrane oxygenation was withdrawn on the fourth day after the surgery. Tracheal bleeding did not recur during the postoperative period.
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Affiliation(s)
- Yuichiro Hirata
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Ryuya Nomura
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Tomofumi Fukuda
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Tatshushi Onzuka
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Kojiro Furukawa
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
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Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
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Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
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Takaseya T, Takagi K, Tayama E. In which patients should the Trifecta bioprosthesis be chosen? J Card Surg 2021; 36:4343-4344. [PMID: 34473362 DOI: 10.1111/jocs.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Tohru Takaseya
- Department of Surgery, Kurume University of Medicine, Fukuoka, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University of Medicine, Fukuoka, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University of Medicine, Fukuoka, Japan
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Saku K, Takagi K, Fukuda T, Tayama E, Tanaka H. Short-segment coronary artery bypass grafting using radial artery to repair bilateral coronary ostial aneurysms after aortic root replacement in a patient with Marfan syndrome. J Card Surg 2021; 36:3399-3401. [PMID: 34053120 DOI: 10.1111/jocs.15684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Coronary ostial aneurysm is a complication of aortic root replacement, particularly in Marfan syndrome. Reconstructing the coronary artery is an important problem during reoperation. Herein, we report a case of coronary artery bypass grafting using radial artery to repair bilateral coronary ostial aneurysms after aortic root replacement in a patient with Marfan syndrome.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Tomofumi Fukuda
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Eiki Tayama
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
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Takagi K, Arinaga K, Takaseya T, Otsuka H, Shojima T, Shintani Y, Kono T, Zaima Y, Kikusaki S, Saku K, Tayama E. Hemodynamic and clinical performance of the 25-mm Medtronic Mosaic porcine bioprosthesis in the mitral position. J Artif Organs 2021; 25:34-41. [PMID: 34023940 DOI: 10.1007/s10047-021-01277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
The 25-mm Medtronic Mosaic porcine bioprosthesis (MB25) is the smallest bioprosthesis that has been approved for use in the mitral position in Japan. Various studies have reported satisfactory hemodynamic performance and good long-term outcomes of the Medtronic Mosaic porcine bioprosthesis. However, the hemodynamic and clinical performances of the MB25 in the mitral position remain unknown. This study aimed to evaluate the hemodynamic and clinical performance of the MB25 in mitral valve replacement (MVR). Twenty patients who underwent MVR using the MB25 between February 2013 and April 2018 were studied. We evaluated the hemodynamic performance of the MB25, cardiac chamber size, cardiac function, and systolic pulmonary artery pressure (PAP) using echocardiography during follow-up. The study outcomes were major adverse cardiac events (MACEs) and all-cause mortality. Sixteen patients (80%) had a patient prosthesis mismatch defined as an index effective orifice area of ≤ 1.2 cm2/m2. The left atrial dimension was significantly reduced after surgery (p = 0.0282). The mean pressure gradients (MPG) in the mitral position were 5.5 ± 1.7 mmHg at discharge and 4.2 ± 1.3 mmHg at 1 year postoperatively. The MPG in the mitral position significantly decreased during the follow-up period (p = 0.0489). Systolic PAP significantly improved postoperatively. The 1-, 3-, and 5-year survival rates were 87, 79, and 70%, respectively. No cardiac death occurred. There were no MACEs or reports of structural valve degeneration during the follow-up period. The hemodynamic and clinical performances of the MB25 in the mitral position were satisfactory as the smallest biological mitral valve. The MB25 is a reasonable option for MVR to reduce the surgical difficulty in high-risk patients with an advanced age, a small body size or MAC and when recurrent MVR or complex procedures are performed.
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Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan.
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yusuke Shintani
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Satoshi Kikusaki
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
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Kono T, Takagi K, Saku K, Kikusaki S, Zaima Y, Shojima T, Takaseya T, Arinaga K, Tayama E. Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience. J Artif Organs 2021; 24:458-464. [PMID: 33770272 DOI: 10.1007/s10047-021-01262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
To assess the early hemodynamics after mitral valve replacement (MVR) using the St Jude Medical (SJM) Epic bioprosthesis. MVR was performed using the SJM Epic bioprosthesis in 35 patients from June 2018 to April 2020; three patients were excluded because the postoperative transthoracic echocardiography (TTE) data were unavailable. Data from postoperative TTE at 1 week and 3 months after the procedure were reviewed. The mean mitral pressure gradient (mMPG) was calculated using a continuous wave Doppler method. Left ventricular outflow tract (LVOT) was calculated using a pulse wave Doppler method. The effective orifice area (EOA) was measured from pressure half time. There were 12 men (37.5%) and 20 women (62.5%) with a mean age of 75.9 years (61-88 years). The mean body surface area was 1.51 ± 0.22 cm2. The 25 mm and 27 mm valves were used in more than 50% of cases. The mMPG was 4.9 ± 1.7 mmHg and 5.4 ± 1.6 mmHg at 1 week and 3 months after surgery, respectively. EOA was 2.18 ± 0.50 cm2 and 2.31 ± 0.59 cm2 at 1 week and 3 months after surgery, respectively. The peak velocity of the LVOT (n = 22) was 103.3 ± 21.3 cm/s and 106.8 ± 27.4 cm/s at 1 week and 3 months after surgery, respectively. No findings suggested paravalvular regurgitation and LVOT obstruction. Using the SJM Epic bioprosthesis in MVR resulted in satisfactory hemodynamics in the early postoperative period, even with small valve sizes. Further accumulation of cases and evidence, including mid- to long-term results, is required in the future.
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Affiliation(s)
- Takanori Kono
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoshi Kikusaki
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Arinaga
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Takagi K, Shintani Y, Tayama E. A lost suture needle in the left ventricle 4 years after cardiac surgery. J Card Surg 2021; 36:2168-2170. [PMID: 33682968 DOI: 10.1111/jocs.15488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 11/29/2022]
Abstract
We present an unusual case of a patient with a lost suture needle in the left ventricle, 4 years after cardiac surgery. We show the temporal image comparison using computed tomography as well as the macro and pathological findings of the suture needle and myocardium.
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Affiliation(s)
- Kazuyoshi Takagi
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Yusuke Shintani
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
| | - Eiki Tayama
- Department of Surgery, School of Medicine, Kurume University, Kurume, Japan
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Takaseya T, Oryoji A, Takagi K, Fukuda T, Arinaga K, Hiromatsu S, Tayama E. Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis. Heart Vessels 2021; 36:1256-1263. [PMID: 33586008 PMCID: PMC8260398 DOI: 10.1007/s00380-021-01802-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/29/2021] [Indexed: 12/02/2022]
Abstract
Aortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients’ characteristics and early and mid-term results were compared between the two groups. There were no differences in patients’ characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient–prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.
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Affiliation(s)
- Tohru Takaseya
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan.
| | - Atsunobu Oryoji
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Tomofumi Fukuda
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Koichi Arinaga
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Shinichi Hiromatsu
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University, Asahi-machi 67, Kurume-shi, Fukuoka, Japan
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Kono T, Takagi K, Tayama E. Minimally invasive cardiac surgery in a patient with osteopetrosis and symptomatic mitral regurgitation. J Card Surg 2020; 36:709-711. [PMID: 33283379 DOI: 10.1111/jocs.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
Osteopetrosis is a rare hereditary bone development disorder caused by osteoclast dysfunction, which increases bone density. Although few studies have investigated cardiovascular disease in osteopetrosis, sternotomy outcomes in this condition are unclear. We report the case of a patient with osteopetrosis and severe mitral regurgitation. A 63-year-old woman with exertional dyspnea had regurgitant systolic murmur audible at the apex. Transthoracic echocardiography showed severe mitral regurgitation due to posterior leaflet prolapse on the anterolateral side. Radiological findings revealed increased bone density (consistent with osteopetrosis). Considering risks in median sternotomy, we performed minimally invasive cardiac surgery through right minithoracotomy for mitral regurgitation. Preoperative imaging showed sclerotic rib changes; nevertheless, sufficient surgical views obtained involved the intercostal space. No residual mitral regurgitation was observed, and the postoperative course was good. To the best of our knowledge, this is the first case report on minimally invasive cardiac surgery for mitral regurgitation with osteopetrosis.
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Affiliation(s)
- Takanori Kono
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Hirata Y, Tayama E, Ueda T, Uchiyama H, Onzuka T, Furukawa K, Morita S. Comparison of intra-wound drainage tubes after cardiac surgery: Blake drains versus Multichannel drains. Int J Artif Organs 2020; 44:434-439. [PMID: 33183146 DOI: 10.1177/0391398820972413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Blake and Multichannel drains have been used in our department. Although both are made up of silicone, they differ in structure. We investigated the drainage effects of these two types of drains and the factors related to their occlusion. METHODS We enrolled 100 consecutive cases (50 using Blake drains and 50 using Multichannel drains) of cardiovascular surgery performed in our department from July 2017 to April 2018. The formation of thrombi in the groove and tube of the drains was evaluated in each case. The tube portion was checked for the presence of occlusion, and the groove portion was examined for the number and ratio of thrombi formed in the grooves. RESULTS The clot formation rate in the groove part was slightly higher in the Multichannel cases than in the Blake cases. In addition, analysis within the Multichannel cases revealed that the thrombus formation rate between the catheter lumen and the three grooves (without the catheter lumen) was significantly different, with the highest groove clot formation rate occurring in the catheter lumen. Out of 34 cases of occlusions, there were 26 cases (52%) of Multichannel drains, and only 8 cases (16%) of Blake drains (p < 0.01). A multiple logistic regression analysis revealed that the most important contributory factor in tube obstruction was the drain type. CONCLUSIONS The catheter lumen of the Multichannel drain was more susceptible to thrombus formation than the groove. The tube part of the Multichannel drain was more prone to occlusion than that of the Blake drain.
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Affiliation(s)
- Yuichiro Hirata
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Hikaru Uchiyama
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Tatsushi Onzuka
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Kojiro Furukawa
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
| | - Shigeki Morita
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyusyu Medical Center, National Hospital Organization, Fukuoka, Japan
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Takagi K, Tayama E. Hormone replacement therapy for open heart surgery in a patient with panhypopituitarism and diabetes insipidus. Interact Cardiovasc Thorac Surg 2020; 31:413-414. [DOI: 10.1093/icvts/ivaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
We present an unusual case of a patient with panhypopituitarism and diabetes insipidus who underwent aortic valve replacement. We successfully managed these complicated endocrine disorders by using appropriate hormonal replacement therapy.
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Affiliation(s)
- Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
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Imasaka KI, Tomita Y, Nishijima T, Tayama E, Morita S, Toriya R, Shiose A. Pectoral Muscle Atrophy After Axillary Artery Cannulation for Aortic Arch Surgery. Semin Thorac Cardiovasc Surg 2019; 31:414-421. [PMID: 30654025 DOI: 10.1053/j.semtcvs.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/11/2022]
Abstract
To investigate postoperative pectoral atrophy in 141 patients undergoing aortic arch surgery involving bilateral axillary artery cannulations with side grafts. The depth from the skin to the axillary artery surrounding the thoracoacromial artery (zone 1), and the thicknesses of pectoralis major (zone 2) and pectoralis minor (zone 3) were measured by computed tomography before surgery, at 1 and 6 months after surgery, and at the most recent follow-up assessment (PostT2) (mean = 41 months, range 11-75 months). Based on the median value (47.4 mm) of zone 1, the preoperative pectoral thickness was categorized into 2 groups: pectoral thickness >47.4 mm (thick group) and ≤47.4 mm (thin group). Mean changes in the pectoral thickness from baseline were evaluated using the longitudinal mixed-effects model. Forty-three of 110 patients underwent total arch replacements and extra-anatomical bypasses for left subclavian artery anastomoses. In 3 patients, axillary artery grafts became infected. There was no obvious harm associated with muscle wasting. Mean changes from baseline in zones 1, 2, and 3 showed significant declines at PostT2 (-13.40 ± 9.73 mm [P < 0.0001], -7.00 ± 5.23 mm [P < 0.0001], and -7.23 ± 6.42 mm [P < 0.0001], respectively). In the thick group, the progression of pectoral atrophy in zones 1 and 3 was significantly more than that of the thin group (P < 0.0001 for both zones). Postoperative pectoral atrophy progressed rapidly. The preoperative pectoral size might be of no use in the prevention of pectoral atrophy. Further investigation to prevent the pectoral atrophy is needed.
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Affiliation(s)
- Ken-Ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takuya Nishijima
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigeki Morita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ryohei Toriya
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan
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Imasaka KI, Tayama E, Morita S, Tomita Y. Neurological outcome and efficacy of intensive craniocervical screening for elective cardiac surgery. Interact Cardiovasc Thorac Surg 2019; 26:216-223. [PMID: 29049799 DOI: 10.1093/icvts/ivx307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/13/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of intensive craniocervical screening before elective cardiovascular surgery. METHODS A retrospective analysis of 1134 consecutive patients who underwent routine screening before cardiovascular surgery between November 2004 and December 2014 was conducted. The study was divided into 2 distinct cohorts of patients undergoing surgery: before (n = 500) and after (n = 634) the introduction of intensive screening in January 2009. In 2009, preoperative screening underwent a transition from the evaluation of carotid atherosclerosis alone to that of craniocervical atherosclerosis. Additionally, patients with moderate or greater stenosis on intensive screening underwent single-photon emission computed tomography with acetazolamide. Craniocervical atherosclerosis was classified as no or mild [0-49%: n = 836 (before/after: 370/466)], moderate [50-69%: n = 118 (56/62)] or severe [70-100%: n = 141 (36/105)]. One of 166 (0.6%) patients with moderate or greater stenosis undergoing single-photon emission computed tomography with acetazolamide after the introduction of intensive screening was diagnosed as having impaired cerebral autoregulation. RESULTS The occurrences of perioperative stroke were 2.8% before the introduction of intensive screening and 0.9% after that (P = 0.033). Notably, intraoperative stroke significantly decreased from 1.4% to 0.2% (P = 0.034). Specifically, the occurrence of perioperative stroke in patients with no or mild stenosis decreased significantly after the introduction of intensive screening, from 2.7% to 0.4% (P = 0.007). CONCLUSIONS The incidence of perioperative stroke decreased following the introduction of intensive screening. Intensive screening may be able to detect patients with a greater risk of perioperative stroke.
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Affiliation(s)
- Ken-Ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigeki Morita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Imasaka KI, Tayama E, Morita S, Toriya R, Tomita Y. Transaortic Alfieri Edge-to-Edge Repair for Functional Mitral Regurgitation. Ann Thorac Surg 2018; 105:e141-e143. [DOI: 10.1016/j.athoracsur.2017.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/04/2017] [Accepted: 10/14/2017] [Indexed: 11/28/2022]
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Motomatsu Y, Imasaka KI, Tayama E, Tomita Y. Severe aortic stenosis and patent ductus arteriosus in an aged patient. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Imasaka KI, Tayama E, Tomita Y. The impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. J Thorac Cardiovasc Surg 2017; 153:1045-1053. [PMID: 28411747 DOI: 10.1016/j.jtcvs.2016.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/09/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to clarify the impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. METHODS Between 2008 and 2015, 200 consecutive patients underwent elective aortic arch surgery with selective antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Nonselective screening for carotid or intracranial atherosclerosis was performed using carotid ultrasonography or magnetic resonance angiography. Carotid or intracranial atherosclerosis was classified as below moderate (0%-49% stenosis), moderate (50%-69%), or severe (70%-100%). In patients with moderate or severe stenosis, cerebral hemodynamics were evaluated using single-photon emission computed tomography with acetazolamide. RESULTS None of the 37 patients undergoing preoperative single-photon emission computed tomography with acetazolamide had impaired cerebral hemodynamics. In-hospital mortality rate was 3.5% (7/200). Postoperative neurologic morbidity included permanent stroke in 8 patients (4.0%) and transient neurologic deficits in 27 patients (14%). Permanent stroke occurred in 3 of 159 patients (1.9%) with below moderate stenosis and 5 of 41 patients (12.2%) with moderate or severe stenosis (P = .008). Seven of 8 patients (87.5%) with stroke experienced multiple atherothrombotic embolizations, and 1 patient experienced a stroke of unknown cause. In multivariate analysis, previous cerebrovascular accident (odds ratio, 5.0; 95% confidence interval, 2.07-12.42; P = .0004) and shaggy aorta (odds ratio, 4.2; 95% confidence interval, 1.58-10.98; P = .0045) were significant determinants of neurologic morbidity. CONCLUSIONS Embolism was the major cause of permanent stroke in our patient population. Preoperative craniocervical and aortic screening may aid in modifying the operative strategy to reduce the occurrence of stroke.
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Affiliation(s)
- Ken-Ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
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Aoyagi S, Tayama E, Oda T, Kosuga T, Yasunaga H. Intra-Atrial Excision of the Left Atrial Appendage: A Simple and Easy Technique. Heart Lung Circ 2016; 26:413-415. [PMID: 27769756 DOI: 10.1016/j.hlc.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022]
Abstract
In patients with atrial fibrillation, closure of the left atrial appendage (LAA) is recommended to prevent thromboembolic events, however, conventional exclusion or excision techniques have potential drawbacks such as persistent blood flow into the appendage and a residual stump. We propose a simple and easy technique for LAA closure consisting of intra-atrial excision of the LAA, which is invaginated into the left atrium (LA), and direct suture closure of the orifice from inside the LA. In this technique, complete elimination of the LAA was achieved without leaving a residual stump because the LAA was excised at the orifice and was closed at the base of the LAA.
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Affiliation(s)
- Shigeaki Aoyagi
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Japan.
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takeshi Oda
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Japan
| | - Tomokazu Kosuga
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Japan
| | - Hiroshi Yasunaga
- Department of Cardiovascular Surgery, St. Mary's Hospital, Kurume, Japan
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Aoyagi S, Fukunaga S, Tayama E, Nakamura E, Egawa N, Hosokawa Y. Benefits of a β-Blocker for Intractable Hemolysis Due to Paraprosthetic Leakage. Asian Cardiovasc Thorac Ann 2016; 15:441-3. [PMID: 17911077 DOI: 10.1177/021849230701500518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a 58-year-old man who was successfully treated with a β-adrenergic receptor blocking agent for intractable hemolysis due to paraprosthetic leakage. After replacement of a mitral prosthetic valve with another mechanical valve, the patient suffered intractable intravascular hemolysis resulting from recurrent paraprosthetic leakage. With oral administration of a β-adrenergic receptor blocker, betaxolol hydrochloride, for 3 months, the hemoglobin value increased from 9.7 g·dL−1 to 12.4 g·dL−1, although glutamic oxaloacetic transaminase and lactic dehydrogenase values remained elevated.
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Affiliation(s)
- Shigeaki Aoyagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
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Affiliation(s)
- Takanori Kono
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
- Department of Cardiovascular Surgery, Kurume University School of Medicine
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Hidetsugu Hori
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Yuta Yamaki
- Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization of Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Kurume University School of Medicine
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Imasaka KI, Tayama E, Tomita Y. Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection. J Thorac Cardiovasc Surg 2015; 150:538-45. [DOI: 10.1016/j.jtcvs.2015.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
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Motomatsu Y, Imasaka KI, Tayama E, Tomita Y. Midterm Results of Sternal Band Closure in Open Heart Surgery and Risk Analysis of Sternal Band Removal. Artif Organs 2015; 40:153-8. [DOI: 10.1111/aor.12514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Yuma Motomatsu
- Department of Cardiovascular Surgery; Clinical Research Institute; National Hospital Organization Kyushu Medical Center; Fukuoka Japan
| | - Ken-ichi Imasaka
- Department of Cardiovascular Surgery; Clinical Research Institute; National Hospital Organization Kyushu Medical Center; Fukuoka Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery; Clinical Research Institute; National Hospital Organization Kyushu Medical Center; Fukuoka Japan
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery; Clinical Research Institute; National Hospital Organization Kyushu Medical Center; Fukuoka Japan
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Imasaka KI, Yasaka M, Tayama E, Tomita Y. Obstructive carotid and/or intracranial artery disease rarely affects the incidence of haemodynamic ischaemic stroke during cardiac surgery: a study on brain perfusion single-photon emission computed tomography with acetazolamide. Eur J Cardiothorac Surg 2014; 48:739-46. [DOI: 10.1093/ejcts/ezu502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/26/2014] [Indexed: 11/14/2022] Open
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Imasaka KI, Tayama E, Tomita Y. Preoperative renal function and surgical outcomes in patients with acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2014; 20:470-6. [DOI: 10.1093/icvts/ivu430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ito S, Yamaguchi S, Saeki H, Oki E, Tayama E, Ikejiri K, Morita M, Maehara Y. Significance of preoperative evaluation of the right gastroepiploic artery graft to the coronary artery in patients undergoing abdominal surgery. World J Surg 2014; 38:1051-7. [PMID: 24280978 DOI: 10.1007/s00268-013-2375-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A major concern with the use of the right gastroepiploic artery (RGEA) as the graft for coronary artery bypass grafting (CABG) is the potential for injury, which can result in critical myocardial ischemia during future abdominal surgery. METHODS We examined the availability of preoperative image evaluation, preoperative recognition of the RGEA graft, and operative findings such as graft identification, graft injury, and cardiac events in 11 patients who underwent abdominal surgery after CABG using the RGEA as the graft. RESULTS Prior to the abdominal surgery, contrast-enhanced computed tomography (CT) was performed in all 11 patients, while coronary angiography or three-dimensional CT angiography was performed in five patients. We detected the RGEA graft retrospectively in nine of ten patients in whom the images from contrast-enhanced CT were still available. Among the seven patients whose RGEA grafts were in the operative field, the RGEA graft was identified in five patients, while the RGEA graft was not identified in the remaining two patients because of adhesions. There were no intraoperative cardiac events in any of the 11 patients. CONCLUSIONS It is important to determine whether an RGEA graft is present when repeat laparotomy is required after CABG. In cases where an RGEA graft is present, it is essential to evaluate the patency and location of the graft since this will be crucial for planning the reoperation strategy. Preoperative recognition and evaluation of the RGEA graft can help avoid graft injury, even if the graft cannot be detected intraoperatively.
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Affiliation(s)
- Shuhei Ito
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
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Tayama E, Tomita Y, Imasaka KI, Kono T. Iatrogenic left ventricular-right atrial communication after tricuspid annuloplasty; a case report. J Cardiothorac Surg 2014; 9:104. [PMID: 24942072 PMCID: PMC4075505 DOI: 10.1186/1749-8090-9-104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/16/2014] [Indexed: 11/10/2022] Open
Abstract
A 75-year-old man (Asian, Japanese) was readmitted for examination of a heart murmur and haemolytic anemia 3 months after mitral valve and tricuspid annuloplasties and coronary artery bypass. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract and extending to the right atrium, a small defect between the left ventricle and the right atrium. No periprosthetic leaks were found in the mitral position. We judged that surgical repair of the defect was essential to treat mechanical haemolysis. At operation, we found a communication (3 mm in diameter) just beneath the detached prosthetic ring at the anteroseptal commissure of the tricuspid valve. After partially removing the tricuspid ring from the anteroseptal commissure area, the defect was closed using a single mattress suture with pledget. In this case, the tricuspid annuloplasty stitch in the atrioventricular region was probably placed on the membranous septum rather than on the tricuspid annulus. A tear then occurred in the atrioventricular membranous septum, leading to left ventricular–right atrial communication.
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Affiliation(s)
- Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
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Tayama E, Hori H, Ueda T, Kono T, Imasaka KI, Harada T, Tomita Y. Usefulness of 18F-FDG-PET/CT in aortic graft infection: two cases. J Cardiothorac Surg 2014; 9:42. [PMID: 24597795 PMCID: PMC3996034 DOI: 10.1186/1749-8090-9-42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
Diagnosis of vascular graft prosthesis infection is crucial, but not straightforward. Here we report two cases in which [(18)F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was very useful in the diagnosis of aortic graft infection. Case 1: A 77-year-old Japanese man, two months status post aortic arch graft surgery, suffered from repeated fevers. Blood cultures revealed bacteremia. (18)F-FDG-PET/CT ruled out graft infection and diagnosed lumbar pyogenic spondylitis, which was treated with antibiotics, sparing the patient a possible reoperation. Case 2: A 53-year-old Japanese man, seven years status post replacement of the aortic root and ascending aorta, had been suffering from an ostensibly aseptic fistula for over a year and a half. Although repeated CT findings had been negative, (18)F-FDG-PET/CT clearly demonstrated communication between the fistula and the ascending aortic graft. He was treated with repeat ascending aortic replacement, omentopexy, and antibiotics. Our experience supports (18)F-FDG-PET/CT as a promising modality in cases of suspected vascular graft infection.
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Affiliation(s)
- Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institution, Kyushu Medical Center, National Hospital Organization, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
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Imasaka KI, Motomatsu Y, Hori H, Kono T, Tanoue Y, Tayama E, Tomita Y. Ventricular energetics early after surgery for chronic mitral regurgitation: repair versus replacement. J Heart Valve Dis 2013; 22:804-809. [PMID: 24597401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to compare the effects of mitral valve (MV) repair and replacement with partial (posterior leaflet only) chordal preservation on left ventricular (LV) performance in chronic degenerative mitral regurgitation (MR) by assessing ventricular energetics. METHODS Contractility (end-systolic elastance), afterload (effective arterial elastance), and ventricular efficiency (ventriculoarterial coupling and the ratio of stroke work to pressure-volume area were determined using transthoracic echocardiography data obtained before and at one month after surgery in 29 patients undergoing MV repair, and in 12 patients undergoing partial chordal-sparing MV replacement. A two-way analysis of variance with repeated measures was used for comparisons among patients who underwent MV surgery (valve repair versus valve replacement). RESULTS The LV diastolic volume index was decreased significantly in both groups (p<0.0001), whereas the LV systolic volume index did not change significantly (p=0.956). Despite the similar remarkable decrease in ejection fraction (p<0.0001) in both groups, end-systolic elastance remained unchanged (p=0.312). Effective arterial elastance was increased significantly in both groups (p<0.0001). Ventriculoarterial coupling and the ratio of stroke work to pressure-volume area deteriorated similarly in both groups (p<0.0001 and p<0.0001). CONCLUSION Compensation of LV geometry after correction of chronic MR preserved ventricular contractility. Furthermore, the results of MV repair were not superior to those of MV replacement with partial chordal preservation in the early postoperative period. This suggested that partial chordal-sparing MV replacement is an effective method for the treatment of chronic MR in selected patients.
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Affiliation(s)
- Ken-ichi Imasaka
- Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | - Yuma Motomatsu
- Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | - Hidetsugu Hori
- Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | - Takanori Kono
- Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | | | - Eiki Tayama
- Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
| | - Yukihiro Tomita
- Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka
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