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Handa K, Ohata T, Sekiya N, Nakamura T, Kuratani T, Masai T. Procedural selection strategy and clinical outcomes in mitral valve surgery with concomitant aortic valve replacement in elderly patients. Indian J Thorac Cardiovasc Surg 2024; 40:159-170. [PMID: 38389777 PMCID: PMC10879041 DOI: 10.1007/s12055-023-01626-0] [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: 05/31/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 02/24/2024] Open
Abstract
Introduction In the context of double-valve surgery for elderly high-risk patients involving both the aortic and mitral valves, a clinically significant problem has been that no clear criteria or surgical strategies have been reported for the selection of mitral valve plasty (MVP) or mitral valve replacement (MVR) for mitral valve disease management during surgical aortic valve replacement (SAVR) to achieve better clinical outcomes. This study investigated valve durability and survival using our surgical strategy for mitral valve disease with concomitant SAVR in elderly patients. Methods Eighty-six patients aged > 65 years (mean 75 years) who underwent a double-valve procedure for mitral valve surgery with concomitant SAVR from 2010 to 2022 were reviewed. Our surgical strategy for mitral valve disease with concomitant SAVR for the elderly patients was as follows: MVP was selected for patients in whom mitral valve disease was expected to be controlled with simple surgical procedures (n = 47), otherwise MVR was selected (n = 39). Results The hospital mortality rate was 8% (n = 7). The mean follow-up was 4.9 (0-12.3) years. And the 10-year survival rate was 62%. The 10-year freedom from aortic valve reoperation rate was 95%. No mitral valve reintervention was performed during follow-up. Echocardiographic follow-up demonstrated freedom from at least moderate mitral regurgitation in 86% of cases at 10 years. Conclusion In double-valve surgery for elderly high-risk patients, appropriate selection of the mitral valve procedure with concomitant SAVR provided better early and long-term survival and valve durability. This surgical strategy may be beneficial in elderly patients with combined aortic and mitral valve disease.
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001 Japan
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001 Japan
| | - Naosumi Sekiya
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001 Japan
| | - Teruya Nakamura
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001 Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001 Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-Ku, Osaka, 530-0001 Japan
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Yamana F, Kuratani T, Domae K, Sakamoto T, Hata M, Shirakawa Y, Masai T, Sawa Y. The Efficacy of Second-Stage Endovascular Repair Strategy for Acute Type A Aortic Dissection. J Endovasc Ther 2023:15266028231214206. [PMID: 38050851 DOI: 10.1177/15266028231214206] [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: 12/07/2023]
Abstract
PURPOSE To evaluate the usefulness of a hybrid treatment strategy for acute type A aortic dissection (AAAD). METHODS We retrospectively evaluated the outcomes of 39 partial arch replacements (PAR; 26 male/13 female, mean age=67.9 years) in 62 patients with AAAD operated at our hospital from January 2019 to January 2023. The technique included PAR with graft-designed landing length and translocated the brachiocephalic artery inflow site during the initial surgery to minimize the invasiveness of the surgery. Thereafter, second-stage thoracic endovascular aortic repair (second TEVAR) for distal aortic events in the chronic phase was performed. RESULTS There was 1 case of 30-day mortality (2.6%) and 2 cases of postprocedural cerebral infarction (5.1%). The cumulative survival rates were 97.4%/1 year and 97.4%/3 years. The cumulative freedom from aorta-related second-stage procedure for the distal aortic event after initial PAR, which was performed in 13 patients (33.3%), was 63.9%/1 year and 59.7%/3 years. All patients requiring re-intervention after initial PAR underwent a second TEVAR with a 100% success rate and no postoperative complications. CONCLUSION Initial PAR for AAAD in anticipation of the second TEVAR is a valuable strategy for enabling minimally invasive additional treatment of aorta-related re-intervention for distal aortic events in the chronic phase. CLINICAL IMPACT This study provides detailed information on the hybrid aortic repair strategy of the initial open partial arch repair and second staged endovascular repair for the acute type A aortic dissection. Based on this study, distal aortic re-intervention after initial open partial arch repair was necessary only in about 30% of cases, and no cases of SCI were observed in the initial treatment or in the second-stage endovascular repair and no cases of distal SINE were observed after the second staged endovascular repair. Overall, the results suggest that limiting the initial open partial arch repair can achieve good perioperative and early outcomes of initial surgery, and that second staged endovascular re-intervention for distal aortic events can be performed reliably, safely, and with minimal invasiveness.
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Affiliation(s)
- Fumio Yamana
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Keitaro Domae
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masatoshi Hata
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
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Yamana F, Domae K, Kawasumi R, Sakamoto T, Hata M, Shirakawa Y, Masai T, Sawa Y. Aortic thrombosis with visceral malperfusion during circulatory support with a combination of Impella and extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. J Artif Organs 2023; 26:330-334. [PMID: 36705891 DOI: 10.1007/s10047-023-01382-3] [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: 08/28/2022] [Accepted: 12/31/2022] [Indexed: 01/28/2023]
Abstract
Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used to aid myocardial recovery in patients with postcardiotomy cardiogenic shock (PCCS), it has been associated with adverse effects. The combined use of VA-ECMO and Impella (ECPELLA) for PCCS, however, has been reported to be efficacious with few reports of thromboembolic events. We present a case of aortic thrombosis with visceral malperfusion during ECPELLA management for PCCS. We performed the Bentall procedure, mitral valve repair, tricuspid annuloplasty, and coronary artery bypass graft on a 73-year-old man admitted with congestive heart failure caused by annuloaortic ectasia, along with severe aortic and mitral regurgitation. VA-ECMO and Impella were required, since the cardiopulmonary bypass weaning was difficult. Impella was removed on postoperative day 4. On postoperative days 5 and 6, laboratory data showed worsening renal dysfunction, lactate levels, and acidosis. Contrast-enhanced computed tomography showed thrombosis in the celiac and superior mesenteric arteries. Aortic thrombectomy was performed. Hyperkalemia, caused by a reperfusion injury, resulted in ventricular fibrillation. Continuous hemodiafiltration improved the hyperkalemia. However, irreversible acidosis progressed, and the VA-ECMO flow rate could not be sustained. On postoperative day 7, the patient died. Perioperative use of Impella for PCCS may be effective in improving postoperative cardiac function. When sudden organ failure is observed after surgery, it is necessary to not only keep the exacerbation of cardiogenic shock in mind, but also the possibility of thrombosis.
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Affiliation(s)
- Fumio Yamana
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Keitaro Domae
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan.
| | - Ryo Kawasumi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masatoshi Hata
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
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Nakae M, Kainuma S, Toda K, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Ueno T, Kuratani T, Kondoh H, Hiraoka A, Sakaguchi T, Yoshitaka H, Shirakawa Y, Takahashi T, Sakaki M, Masai T, Komukai S, Kitamura T, Hirayama A, Shimomura Y, Miyagawa S. Impact of complete revascularization in coronary artery bypass grafting for ischemic cardiomyopathy. JTCVS Open 2023; 15:211-219. [PMID: 37808015 PMCID: PMC10556818 DOI: 10.1016/j.xjon.2023.04.008] [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] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 10/10/2023]
Abstract
Objective In patients with ischemic cardiomyopathy, coronary artery bypass grafting ensures better survival than medical therapy. However, the long-term clinical impact of complete revascularization remains unclear. This observational study aimed to evaluate the effects of complete revascularization on long-term survival and left ventricular functional recovery in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting. Methods We retrospectively reviewed outcomes of 498 patients with ischemic cardiomyopathy who underwent complete (n = 386) or incomplete (n = 112) myocardial revascularization between 1993 and 2015. The baseline characteristics were adjusted using inverse probability of treatment weighting to reduce the impact of treatment bias and potential confounding. The mean follow-up duration was 77.2 ± 42.8 months in survivors. Results The overall 5-year survival rate (complete revascularization, 72.5% vs incomplete revascularization, 57.9%, P = .03) and freedom from all-cause death and/or readmission due to heart failure (54.5% vs 40.1%, P = .007) were significantly greater in patients with complete revascularization than those with incomplete revascularization. After adjustments using inverse probability of treatment weighting, the complete revascularization group demonstrated a lower risk of all-cause death (hazard ratio, 0.61; 95% confidence interval, 0.43-0.86; P = .005) and composite adverse events (hazard ratio, 0.59; 95% confidence interval, 0.44-0.79; P < .001) and a greater improvement in the left ventricular ejection fraction 1-year postoperatively (absolute change: 11.0 ± 11.9% vs 8.3 ± 11.4%, interaction effect P = .05) than the incomplete revascularization group. Conclusions In patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting, complete revascularization was associated with better long-term outcomes and greater left ventricular functional recovery and should be encouraged whenever possible.
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Affiliation(s)
- Masaro Nakae
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruhiko Kondoh
- Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Arudo Hiraoka
- Sakakibara Heart Institute of Okayama, Okayama, Japan
| | | | | | | | | | - Masayuki Sakaki
- National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | | | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshimitsu Shimomura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Osaka Cardiovascular Surgery Research (OSCAR) Group
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
- Sakakibara Heart Institute of Okayama, Okayama, Japan
- Osaka Police Hospital, Osaka, Osaka, Japan
- National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
- Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Mikami T, Yamauchi T, Sakakibara S, Ito Y, Suhara H, Hayashi Y, Kuratani T, Masai T, Sawa Y. Total arch and descending thoracic aortic replacement for massive hemoptysis requiring CPR caused by intrapulmonary penetration of chronic dissecting aortic aneurysm: a case report. Surg Case Rep 2022; 8:221. [PMID: 36517697 PMCID: PMC9751241 DOI: 10.1186/s40792-022-01573-9] [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: 06/11/2021] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Intrapulmonary penetration of the thoracic aorta is a rare, life-threatening complication of a chronic dissecting aortic aneurysm. It causes massive hemoptysis requiring prompt intervention to prevent fatal airway bleeding. A surgical approach that enables diverse surgical maneuvers and intraoperative organ protection is crucial. CASE PRESENTATION A 62-year-old man, who underwent graft replacement of the ascending aorta for an acute type A aortic dissection 20 months before, developed massive hemoptysis and cardiac arrest. The hemoptysis was secondary to an aortopulmonary fistula from a rapidly expanding dissecting aortic aneurysm. However, a successful return of spontaneous circulation was achieved with cardiopulmonary resuscitation, including establishment of veno-arterial extracorporeal membrane oxygenation. The patient successfully underwent a total arch and descending thoracic aortic replacement. This was achieved by a median sternotomy combined with a left thoracotomy using a straight incision with a rib-cross (SIRC) approach. The patient was uneventfully discharged and remained well for the following 2 years. CONCLUSIONS When performing a surgical graft replacement for an aortopulmonary fistula with a thoracic aortic aneurysm, the surgical approach chosen is critical. A surgical procedure using a median sternotomy combined with a left thoracotomy and a SIRC approach can be an effective therapeutic option.
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Affiliation(s)
- Tsubasa Mikami
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan ,grid.136593.b0000 0004 0373 3971Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Takashi Yamauchi
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan ,Department of Cardiovascular Surgery, Higashiosaka City Medical Center, Higashiosaka, Osaka Japan
| | - Satoshi Sakakibara
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan
| | - Yoshito Ito
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan
| | - Hitoshi Suhara
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan
| | - Yukio Hayashi
- grid.416720.60000 0004 0409 6927Anesthesiology Service, Sakurabashi Watanabe Hospital, Osaka, Osaka Japan
| | - Toru Kuratani
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan
| | - Takafumi Masai
- grid.416720.60000 0004 0409 6927Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-Ku, Osaka, Osaka 530-0001 Japan
| | - Yoshiki Sawa
- grid.136593.b0000 0004 0373 3971Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka Japan
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Shimomoto Y, Mukaiyama K, Hori T, Inaki Y, Masai T, Hayashi Y. Postoperative delirium does not affect cardiopulmonary exercise testing in aged patients undergoing cardiac valve surgery. JA Clin Rep 2022; 8:64. [PMID: 35962209 PMCID: PMC9374849 DOI: 10.1186/s40981-022-00553-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effect of delirium on cardiopulmonary exercise testing (CPX) is unknown. This retrospective study was to examine the effect of delirium on CPX at discharge in aged patients undergoing cardiac surgery. Methods This study included seventy patients aged 70 or older undergoing cardiac valve surgery, who entered our ICU and were discharged from our hospital between June 2016 and July 2018. All patients received active exercise by our rehabilitation team from the first postoperative day and were performed a CPX on a cycle ergometer before discharge. The anaerobic threshold oxygen uptake and the slope of the relationship between carbon dioxide output and minute ventilation were examined. We obtained the patient’s data, including patient’s characteristics, cardiac function, anesthesia data, laboratory data, ICU data, and length of ICU and hospital stay. Data were analyzed by unpaired t test or Fisher’s exact test. P < 0.05 was considered statistically significant. Results Of the 70 patients, 21 patients experienced delirium during ICU stay. The delirium group needed longer administration of sedatives and longer ICU stay and showed higher CRP value and lower renal function but similar cardiopulmonary function before discharge from our hospital compared with the non-delirium group. Conclusions Patients with a history of delirium during ICU showed higher CRP value and lower renal function before discharge, but the CPX values at discharge were not significantly affected by delirium.
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Handa K, Masai T, Ohata T, Sakamoto T, Kuratani T. Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve. J Cardiothorac Surg 2022; 17:97. [PMID: 35505349 PMCID: PMC9066869 DOI: 10.1186/s13019-022-01851-5] [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: 09/24/2021] [Accepted: 04/20/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods Five patients (54 (38–60) years of age; 3 men, 2 women) underwent this procedure from January 2011 to April 2022. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 69 (66–75)). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 36 (28–42) days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The median follow-up period was 9.6 (6.0–10.4) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions The short- and long-term outcomes of this procedure might be acceptable. This procedure might be considered as an effective and valuable option, especially in young patients.
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan.
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
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Yamana F, Maeda K, Hamanaka Y, Kodani N, Domae K, Hata M, Higuchi Y, Shirakawa Y, Masai T. Efficacy of non-obstructive aortic angioscopy for detecting a thoracic aortic graft rupture: a case report. Surg Case Rep 2022; 8:41. [PMID: 35286489 PMCID: PMC8921450 DOI: 10.1186/s40792-022-01394-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy. Case presentation An 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation. Conclusions To our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-022-01394-w.
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Affiliation(s)
- Fumio Yamana
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuma Hamanaka
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan
| | - Noriko Kodani
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keitaro Domae
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masatoshi Hata
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Handa K, Suhara H, Ohata T, Sakamoto T, Ito Y, Yanagino Y, Masai T. Successful surgical treatment of delayed left ventricular pseudoaneurysm related to Candida albicans infection after repair of ventricular septal rupture complicating acute myocardial infarction. J Cardiol Cases 2022; 25:87-90. [PMID: 35079305 PMCID: PMC8766318 DOI: 10.1016/j.jccase.2021.07.004] [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: 12/04/2020] [Revised: 06/13/2021] [Accepted: 07/03/2021] [Indexed: 11/08/2022] Open
Abstract
Left ventricular (LV) pseudoaneurysm is a rare complication after postinfarction repair of ventricular septal rupture (VSR), and surgical treatment of this condition due to mycosis has rarely been reported. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR due to myocardial infarction. A 75-year-old woman was admitted for fever and severe inflammatory reaction. Two and a half years previously, she had undergone postinfarct VSR repair and was treated for mycotic infective endocarditis due to C. albicans. Transthoracic echocardiography and computed tomography revealed a LV pseudoaneurysm (maximum transverse diameter 6.2 cm). The cause of the LV pseudoaneurysm was suspected to be infectious, and broad-spectrum antibiotic treatment was started. Fourteen days after admission, she developed acute abdominal pain and an elevated β-D-glucan level because the LV pseudoaneurysm ruptured. Emergency surgical treatment was performed with antimycotic drug therapy. The LV wall defect was reconstructed using bovine pericardium under cardiopulmonary support. Her postoperative course was good, and she was discharged to home. Echocardiography revealed no recurrence of the LV pseudoaneurysm at 4 months postoperatively. During 1 year of follow-up, the patient had been doing well without any infection or adverse event. <Learning objective: The development of a left ventricular (LV) pseudoaneurysm after repair of postinfarction ventricular septal rupture (VSR) is rare, and the cause of this condition is often unknown. Moreover, LV pseudoaneurysm due to mycosis has rarely been reported and is thought to have a poor prognosis. We report a rare case of successful surgical treatment of delayed LV pseudoaneurysm related to Candida albicans infection after repair of VSR complicating acute myocardial infarction.>
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Hitoshi Suhara
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Yoshito Ito
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Yusuke Yanagino
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka 530-0001, Japan
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Yamana F, Domae K, Shirakawa Y, Masai T. Cardiac calcified amorphous tumor with mitral valve perforation: A case report. J Cardiol Cases 2022; 25:297-299. [DOI: 10.1016/j.jccase.2021.11.010] [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] [Received: 08/14/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
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11
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Kainuma S, Toda K, Miyagawa S, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Kuratani T, Yokoi K, Ide S, Mizote I, Kioka H, Ohtani T, Hikoso S, Kondoh H, Hiraoka A, Sakaguchi T, Yoshitaka H, Kitamura T, Komukai S, Hirayama A, Taniguchi K, Sakata Y, Sawa Y, Yoshikawa Y, Hata H, Funatsu T, Masai T, Shirakawa Y, Takahashi T, Nishi H, Kawamura M, Monta O, Yamauchi T. Multiple percutaneous coronary interventions worsen outcomes for subsequent surgical correction of chronic ischemic mitral regurgitation. JTCVS Open 2021; 7:195-206. [PMID: 36003685 PMCID: PMC9390558 DOI: 10.1016/j.xjon.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/25/2022]
Abstract
Objective We investigated whether or not a history of multiple percutaneous coronary interventions (PCIs) is associated with clinical outcomes after surgery for ischemic mitral regurgitation. Methods A total of 309 patients with chronic ischemic mitral regurgitation and left ventricular ejection fraction ≤40% who underwent restrictive mitral annuloplasty were classified as follows: patients with no or 1 previous PCI (nonmultiple PCI group [n = 211]) and patients with 2 or more previous PCIs (multiple PCIs group [n = 98]). Mean follow-up duration was 53 ± 40 months. Results Before surgery, there were no intergroup differences in patient demographic characteristics except for lower estimated glomerular filtration rate in patients with multiple PCIs. These patients underwent concomitant coronary artery bypass grafting less frequently with a lower number of distal anastomoses (P < .05 for both). The 30-day mortality was 3.3% and 2.0% in the nonmultiple and multiple PCIs group, respectively (P = .72). During follow-up, there were 157 deaths. Patients with multiple PCIs showed lower 5-year survival rate (44% vs 64%; P = .002). After adjustments with inverse-probability-of-treatment weighting, multiple PCIs history was an independent risk factor for mortality (adjusted hazard ratio, 1.4; 95% confidential interval, 1.1-1.7; P = .002). Patients with multiple PCIs showed less improvement in left ventricular ejection fraction (interaction effect P < .001). Conclusions In patients with ischemic mitral regurgitation, a history of previous multiple PCIs was associated with increased risk of long-term postoperative mortality, with less improvement in left ventricular ejection fraction.
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12
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Kainuma S, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Ueno T, Kuratani T, Funatsu T, Kondoh H, Masai T, Hiraoka A, Sakaguchi T, Yoshitaka H, Daimon T, Taniguchi K, Sawa Y. Detrimental effects of elevated transpulmonary gradient on outcomes following restrictive mitral annuloplasty in patients with pre-existing pulmonary hypertension. J Thorac Dis 2021; 13:2746-2757. [PMID: 34164167 PMCID: PMC8182535 DOI: 10.21037/jtd-20-2898] [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] [Indexed: 12/02/2022]
Abstract
Background This study retrospectively examined the association between elevated trans-pulmonary gradient (TPG), which reflects pre-capillary contribution to pulmonary hypertension (PH), and postoperative pulmonary hemodynamics and outcomes following restrictive mitral annuloplasty (RMA) in patients with pre-existing PH. Methods Pre- and postoperative (1 month) cardiac catheterization was performed in 64 patients with severely impaired left ventricular function (i.e., ejection fraction ≤40%) and pre-existing PH (mean pulmonary artery pressure (PAP) ≥25 mmHg) who underwent RMA. Patients were segregated into two groups: low TPG (≤12 mmHg) and elevated TPG (>12 mmHg). The mean follow-up period was 54±27 months. The primary outcome seen was a change in pulmonary hemodynamics after RMA; secondary outcomes were composite adverse events, including all-cause mortality and readmission for heart failure. Results Compared to the low TPG group, patients in the elevated TPG group were more likely to show a postoperative mean PAP of ≥25 mmHg (84% vs. 38%), TPG of >12 mmHg (79% vs. 11%), and pulmonary vascular resistance of ≥240 dynes/sec/cm−5 (84% vs. 6.7%) (all P<0.001), although both groups showed comparable degrees of mitral regurgitation improvement. Serial echocardiography demonstrated that Doppler-derived systolic PAP, which once decreased in both groups, remained stable in the low group while steadily increasing in the elevated group (group effect P<0.001). Patients with elevated TPG had lower freedom from composite adverse events (5-year, 20% vs. 70%, P=0.003). After adjusting for baseline covariates, the elevated TPG was independently associated with increased risk of adverse events (adjusted hazard ratio 2.9, 95% CI: 1.2–6.9, P=0.017). Conclusions Elevated TPG negatively affects postoperative pulmonary hemodynamics and late outcomes in patients with advanced cardiomyopathy and pre-existing PH who have undergone RMA. These findings suggest that the assessment of TPG should be included in post-RMA risk stratification.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Kainuma S, Toda K, Daimon T, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Ueno T, Kuratani T, Funatsu T, Kondoh H, Masai T, Hiraoka A, Sakaguchi T, Yoshitaka H, Shirakawa Y, Takahashi T, Sakaki M, Taniguchi K, Sawa Y. Bilateral Internal Thoracic Artery Grafting Improves Survival for Severe Left Ventricular Dysfunction and Diabetes. Circ J 2021; 85:1991-2001. [PMID: 33828021 DOI: 10.1253/circj.cj-20-0907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND In patients with severe left ventricular (LV) dysfunction requiring coronary artery bypass grafting (CABG), the association between diabetic status and outcomes after surgery, as well as with survival benefit following bilateral internal thoracic artery (ITA) grafting, remain largely unknown.Methods and Results:Patients (n=188; mean [±SD] age 67±9 years) with LV ejection fraction ≤40% who underwent isolated initial CABG were classified into non-diabetic (n=64), non-insulin-dependent diabetic (NIDM; n=74), and insulin-dependent diabetic (IDM; n=50) groups. During follow-up (mean [±SD] 68±47 months), the 5-year survival rate was 84% and 65% among non-diabetic and diabetic patients, respectively (P=0.034). After adjusting for all covariates, both NIDM and IDM were associated with increased mortality, with hazard ratios (HRs) of 1.9 (95% confidence interval [CI] 1.0-3.7; P=0.049) and 2.4 (95% CI 1.2-4.8; P=0.016), respectively. Among non-diabetic patients, there was no difference in the 5-year survival rate between single and bilateral ITA grafting (86% vs. 80%, respectively; P=0.95), whereas bilateral ITA grafting increased survival among diabetic patients (57% vs. 81%; P=0.004). Multivariate analysis revealed that bilateral ITA was significantly associated with a decreased risk of mortality (HR 0.3; 95% CI 0.1-0.8; P=0.024). CONCLUSIONS NIDM and IDM were significantly associated with worse long-term clinical outcome after CABG for severe LV dysfunction. Bilateral ITA grafting has the potential to improve survival in diabetic patients with severe LV dysfunction.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | | | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama
| | | | | | - Masayuki Sakaki
- Department of Cardiovascular Surgery, National Hospital Organization Osaka National Hospital
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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Nakae M, Kainuma S, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Komukai S, Kitamura T, Hirayama A, Ueno T, Kuratani T, Kondoh H, Masai T, Hiraoka A, Sakaguchi T, Yoshitaka H, Shirakawa Y, Takahashi T, Taniguchi K, Sawa Y. Incidence, determinants and clinical impact of left ventricular function recovery after surgical treatments for ischaemic cardiomyopathy. Eur J Cardiothorac Surg 2021; 60:689-696. [PMID: 33779701 DOI: 10.1093/ejcts/ezab122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/07/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This retrospective study aimed to clarify the incidence, determinants and clinical impact of left ventricular (LV) function non-recovery after coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy. METHODS A total of 490 patients with ischaemic cardiomyopathy (LV ejection fraction ≤ 40%) undergoing CABG were analysed. Follow-up echocardiography was performed at 1 month, 1 year, and annually thereafter. LV function recovery was defined as ejection fraction (EF) ≥40% at least once during follow-up. LV function non-recovery was defined as EF <40% at any follow-up. The primary and secondary end points were changes in LV function and all-cause mortality, respectively. Clinical follow-up was completed in 461 patients (94.1%; mean follow-up: 64.5 ± 45.5 months). RESULTS During follow-up, echocardiographic assessments were performed 1863 times (mean, 3.8 ± 2.4), and 193 patients (39.4%) exhibiting LV function non-recovery were identified. Overall survival was significantly higher in the recovery group (53.9%) than in the non-recovery group (31.4%) at 10 years (P < 0.001). Independent predictors of LV function non-recovery were preoperative LV end-systolic diameter [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10; P < 0.001] and bilateral internal thoracic artery grafting (OR 0.61, 95% CI 0.39-0.95; P = 0.028). In a multivariable Cox proportional hazards model, LV function non-recovery was significantly associated with all-cause mortality (hazard ratio 2.14, 95% CI 1.60-2.86; P < 0.001). CONCLUSIONS Almost 40% of patients with ischaemic cardiomyopathy undergoing CABG did not achieve LV function recovery and were associated with poor prognosis. To achieve LV function recovery, CABG with bilateral internal thoracic artery may be recommended before excessive LV remodelling occurs. CLINICAL TRIAL REGISTRATION NUMBER Institutional review board of Osaka University Hospital, number 16105.
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Affiliation(s)
- Masaro Nakae
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Osaka, Japan
| | - Toshiki Takahashi
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Osaka, Japan
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Kainuma S, Mitsuno M, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Kashiyama N, Ueno T, Kuratani T, Kondoh H, Funatsu T, Hiraoka A, Sakaguchi T, Yoshitaka H, Shirakawa Y, Takahashi T, Sakaki M, Masai T, Saito S, Monta O, Kitamura T, Komukai S, Hirayama A, Taniguchi K, Miyamoto Y, Sawa Y. Surgical Ablation Concomitant With Nonmitral Valve Surgery for Persistent Atrial Fibrillation. Ann Thorac Surg 2021; 112:1909-1920. [PMID: 33545152 DOI: 10.1016/j.athoracsur.2020.11.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Consensus regarding an optimal atrial fibrillation (AF) ablation lesion set concomitant with aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) has not been established. METHODS We enrolled 125 consecutive patients (89 men; 70 ± 8 years old) with persistent AF who underwent radiofrequency-based pulmonary vein isolation (PVI) (PVI group, n = 53) or a Cox-Maze procedure (Maze group, n = 72) with AVR and/or CABG. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent Cox-Maze with and those who underwent PVI, we established weighted Cox proportional-hazards regression models with inverse probability of treatment weighting. Mean follow-up was 63 ± 34 months (maximum, 154 months). RESULTS There was 1 in-hospital death in each group. Patients who underwent Cox-Maze showed a higher freedom from AF at all follow-up examinations. After the operation, there were 32 deaths, 13 thromboembolisms, 8 hemorrhagic events, and 22 heart failure readmissions. The Maze group had higher rates for 5-year survival (88% vs 64%, P = .013) and freedom from composite events (74% vs 42%, P < .001). After adjustment with inverse probability of treatment weighting, the Cox-Maze procedure still showed a lower risk of overall mortality (adjusted hazard ratio, 0.38; 95% confidence interval, 0.21-0.66; P = .001) and composite adverse events (adjusted hazard ratio, 0.52; 95% confidence interval, 0.35-0.76; P = .001). CONCLUSIONS In patients with persistent AF indicated for nonmitral valve surgery, a concomitant Cox-Maze procedure resulted in superior AF- and event-free survival compared with PVI, without increased risk of early mortality. These findings may assist decision making for surgical management of persistent AF concomitant with AVR and/or CABG.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Masataka Mitsuno
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Osaka, Japan
| | - Toshiki Takahashi
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Osaka, Japan
| | - Masayuki Sakaki
- Department of Cardiovascular Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Osaka, Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yuji Miyamoto
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Yamauchi T, Yamamoto H, Miyata H, Kobayashi J, Masai T, Motomura N. Surgical Aortic Valve Replacement for Aortic Stenosis in Dialysis Patients ― Analysis of Japan Cardiovascular Surgery Database ―. Circ J 2020; 84:1271-1276. [DOI: 10.1253/circj.cj-20-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center
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17
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Kainuma S, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Kawamura T, Kawamura A, Ueno T, Kuratani T, Kondoh H, Masai T, Hiraoka A, Sakaguchi T, Yoshitaka H, Shirakawa Y, Takahashi T, Saito S, Monta O, Sado J, Kitamura T, Komukai S, Hirayama A, Taniguchi K, Sawa Y. Restrictive mitral annuloplasty with or without coronary artery bypass grafting in ischemic mitral regurgitation. ESC Heart Fail 2020; 7:1560-1570. [PMID: 32400096 PMCID: PMC7373912 DOI: 10.1002/ehf2.12705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/24/2019] [Revised: 12/30/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Aims In patients with ischaemic mitral regurgitation (MR), the impact of mitral valve surgery with concomitant coronary artery bypass grafting (CABG) on post‐operative survival and left ventricular (LV) reverse remodelling remains unknown. Therefore, we investigated these outcomes following restrictive mitral annuloplasty (RMA) with and without CABG in those patients. Methods and results This study included 309 patients with chronic MR and ischaemic cardiomyopathy for whom concomitant CABG was indicated (n = 225) or not indicated (n = 84) with RMA. The primary endpoint was all cause mortality during the follow‐up, and the secondary endpoint was defined as the composite of mortality and re‐admission for heart failure. Linear mixed model was used to analyse serial echocardiographic changes in LV function. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent RMA with and those who underwent it without CABG, we established weighted Cox proportional‐hazards regression models with inverse‐probability‐of‐treatment weighting. Pre‐operatively, there were no intergroup differences in age (RMA with CABG, 67 ± 9 vs. RMA without CABG, 68 ± 11, P = 0.409) and logistic EuroSCORE II (16 ± 14 vs. 15 ± 15%, P = 0.496). The 30‐day mortalities were 2.7% and 3.6%, respectively (P = 0.67). During follow‐up with a mean duration of 72 ± 37 months (range, 5.6–179), there were 157 deaths and 105 re‐admissions for heart failure. Overall 1‐year and 5‐year survival rates were 83 ± 2% and 58 ± 3%, respectively. Patients who did not receive CABG with RMA had a significantly lower 5‐year survival rate (45% vs. 63%, P = 0.049) and freedom from adverse events defined as mortality and/or admission for heart failure (19% vs. 43%, P < 0.001) than those who did. After adjustments for clinical covariates with inverse‐probability‐of‐treatment weighting, concomitant CABG was identified as an independent protective factor for adverse events (hazard ratio: 0.53; 95% confidence interval: 0.44–0.64; P < 0.001). Along with significant MR reduction, LV function parameters changed over time after surgery in both groups, with greater improvements in patients who underwent RMA with CABG (time effect, P < 0.001; and interaction effect, P = 0.002). Conclusions RMA can be performed with an acceptable operative mortality, irrespective of indications for CABG. Patients with ischaemic MR for whom CABG is indicated with RMA are more likely to show better long‐term and event‐free survival and greater improvements in LV systolic function. The optimal revascularization strategy should be discussed with a heart team whenever indicated in patients with ischaemic MR; otherwise, they may miss the opportunity to benefit from concomitant CABG during subsequent RMA.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | | | - Toshiki Takahashi
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan
| | - Junya Sado
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1 Yamadaoka, Suita, Osaka, 565-0871, Japan
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18
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Yamauchi T, Takano H, Takahashi T, Masai T, Sakaki M, Shirakawa Y, Kitabayashi K, Asano N, Toda K, Sawa Y. Equations Estimating the Predissected Diameter of the Ascending Aorta for Acute Type A Aortic Dissection. Ann Thorac Surg 2019; 108:481-490. [PMID: 30914284 DOI: 10.1016/j.athoracsur.2019.02.046] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/27/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A successful endovascular treatment for acute type A dissection has been recently reported. However, there has been no consensus regarding the appropriate stent graft size based on the estimated predissected aortic diameter for this pathology. METHODS We developed new equations for estimating the predissected ascending aorta and aortic arch by investigating computed tomography images that had been scanned less than 3 years before dissection. From 684 patients with type A AAD, 28 were matched for the study. We measured the predissected whole circumference length (pre-wCL), postdissected whole circumference length (post-wCL), postdissected true lumen circumference length (post-tCL), postdissected major diameter (post-Dma), and postdissected minor diameter (post-Dmi) of the acutely dissected aorta. This was followed by the calculation of (post-tCL + post-wCL)/2 and (post-Dma + post-Dmi)/2. Six equations (linear function) and modified equations were derived from each of the abovementioned parameters. RESULTS Four equations (post-wCL, post-Dma, [post-tCL + post-wCL]/2, and [post-Dma + post-Dmi]/2) had nearly the same bias and accuracy (<9.42 mm). For clinical use, we also developed one modified equation using the post-wCL (y = 0.9x) among four parameters because of its simplicity and decreased the possibility of measurement error. The biases of circumference length and accuracy were 5.5 ± 4.9 mm and 84.6%, respectively, and they improved to 4.4 ± 3.3 mm and 93.4% in cases with a ratio of post-tCL/post-wCL of 0.66 or more. CONCLUSIONS Our newly developed equation can be used to calculate the predissected ascending aortic diameter and aortic arch diameter in cases of acute type A dissection.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiki Takahashi
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masayuki Sakaki
- Department of Cardiovascular Surgery, Osaka National Hospital, Osaka, Japan
| | | | | | - Naoki Asano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Masuda H, Masai T, Takatani M, Kato H. A life-threatening infection due to Corynebacterium striatum: a lesson learned. Interact Cardiovasc Thorac Surg 2019; 26:709-710. [PMID: 29253156 DOI: 10.1093/icvts/ivx405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 11/14/2022] Open
Abstract
Because the genus Corynebacterium colonize the human skin, detection of Corynebacterium striatum in a sterile blood specimen is sometimes considered as contamination. An 80-year-old man who underwent cardiovascular operation presented with high-grade fever postoperatively. Corynebacterium striatum was detected in the blood and wound exudate, and the patient was diagnosed with mediastinitis due to Corynebacterium striatum. One month earlier, a patient with similar symptoms due to C. striatum-related mediastinitis died in our care. The Corynebacterium striatum isolates from both patients had identical biochemical and genetic characteristics, suggesting that Corynebacterium striatum was acquired nosocomially. We have learnt a lesson from this negative experience: early diagnosis of Corynebacterium striatum-related infection and early administration of glycopeptide antibiotics could have saved this patient. It is notable that C. striatum can cause life-threatening infection after cardiovascular operation.
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Affiliation(s)
- Hirotada Masuda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Mina Takatani
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Haru Kato
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
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20
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Yamauchi T, Masai T, Takano H, Shirakawa Y, Toda K, Sawa Y. Equations for Estimating the Predissected Diameter of the Descending Aorta From Computed Tomographic Images at the Onset of Aortic Dissection. J Am Heart Assoc 2018; 7:JAHA.118.009196. [PMID: 29945916 PMCID: PMC6064904 DOI: 10.1161/jaha.118.009196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Estimation of the predissected descending aortic diameter is important for deciding on the size of a stent graft in cases of acute aortic dissection. However, no equations for estimating this diameter have been previously reported. METHODS AND RESULTS We developed and validated new equations by investigating computed tomography images that were scanned within 3 years before dissection and those that were scanned immediately after the onset of dissection. Among 1127 patients with acute aortic dissection (425 type A and 702 type B), 36 were matched for the study from October 2005 to March 2017 at 4 centers. New equations were developed in 17 patients and validated in 19 patients. We measured the predissected whole circumference length (CL) and postdissected whole CL, true lumen CL, the major diameter, and the minor diameter of the acutely dissected aorta, followed by calculation of (post-trueCL+post-wholeCL)/2 and (post-major diameter+post-minor diameter)/2. Six equations (linear function) and modified equations were derived from each of the above-mentioned parameters. In the derivation sets, equations that used the parameter of (post-trueCL+post-wholeCL)/2 were strongly correlated with pre-wholeCL (Y=0.9433x+5.0147; R2=0.9001) and showed significantly less bias compared with the other 5 equations (P<0.0001). In validation sets using this equation, the mean bias of the circumference length and diameter was 2.7±2.8 and 0.85±0.89 mm, respectively. A total of 99.2% of the calculated values were within 3 mm in diameter or less. CONCLUSIONS Our newly developed equations can be used to calculate the predissected aortic diameter in cases of acute aortic dissection and might help to decide the size of the stent graft.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan .,Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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21
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Shirakawa T, Yoshitatsu M, Koyama Y, Kurata A, Miyoshi T, Mizoguchi H, Masai T, Toda K, Sawa Y. To what extent can 3D model replicate dimensions of individual mitral valve prolapse? J Artif Organs 2018; 21:348-355. [PMID: 29556869 DOI: 10.1007/s10047-018-1033-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/15/2017] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
Determining the complex geometry of mitral valve prolapse is often difficult. We constructed 3D models of six prolapsed mitral valves for surgical assessment, and evaluated how accurately the models could replicate individual valve dimensions. 3D polygon data were constructed based on an original segmentation method for computed tomography images. The model's replication performance was confirmed via dimensional comparison between the actual hearts during surgery and those models. The results revealed that the prolapsed segments matched in all cases; however, torn chordae were replicated in four cases. The mean height differences were 0.0 mm (SD 1.6, range - 2 to + 2 mm) for the anterolateral side, 0.0 mm (SD 1.7, range - 2 to + 2 mm) for the prolapsed leaflet center, and - 1.5 mm (SD 0.6, range - 1 to - 2 mm) for the posteromedial side. Regression analysis showed a strong and positive correlation, and Bland-Altman plots indicated quantitative similarity of the models to the actual hearts. We concluded that our 3D valve models could replicate the actual mitral valve prolapses within acceptable dimensional differences. Our concepts are useful for better 3D valve creation and better surgical planning with reliable 3D valve models.
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Affiliation(s)
- Takashi Shirakawa
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Masao Yoshitatsu
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yasushi Koyama
- Department of Diagnostic Radiology and Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroki Mizoguchi
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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22
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Kainuma S, Yamamoto H, Yamada S, Yamada Y, Sumiyoshi A, Okamura A, Iwakura K, Miyata Y, Hayashi Y, Ueda M, Sawa Y, Masai T. Iatrogenic Injury of Right Coronary Artery During Tricuspid Annuloplasty. Circ J 2017; 81:1956-1958. [PMID: 28442645 DOI: 10.1253/circj.cj-17-0153] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Hiroya Yamamoto
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Shohei Yamada
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Yu Yamada
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | | | | | | | - Yuka Miyata
- Department of Anesthesiology, Sakurabashi Watanabe Hospital
| | - Yukio Hayashi
- Department of Anesthesiology, Sakurabashi Watanabe Hospital
| | - Masakazu Ueda
- Department of Section of Clinical Echocardiography, Sakurabashi Watanabe Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
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Yamauchi T, Masai T, Fujii K, Sawa Y, Shirai S, Kamigaki M, Itou N. Long-term clinical results of acute myocardial infarction at the left main trunk requiring percutaneous cardiopulmonary support. J Artif Organs 2017; 20:303-310. [PMID: 28887708 DOI: 10.1007/s10047-017-0972-7] [Citation(s) in RCA: 3] [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: 02/09/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
The clinical results of patients with acute myocardial infarction (AMI) at the left main trunk (LMT) remain unclear, especially in cases requiring percutaneous cardiopulmonary support (PCPS). Twenty seven cases of AMI at the LMT requiring emergent PCPS were retrospectively investigated. These 27 patients were aged 44-83 years (65.6 ± 8.6 years) and 20 (81.5%) were men. Peak creatine kinase (CK) leakage ranged from 538 to 34,010 IU/l (13,553 ± 7656 IU/l). Eight (29.6%) patients were discharged without mechanical support. Ten (37.0%) patients underwent left ventricular assist device (LVAD) implantation, five of whom with preoperative organ failure could not survive more than 6 months after implantation. The other nine (33.3%) patients died of low output syndrome or brain damage. The overall survival rates were 53.7, 41.3, 33.0, and 28.3% at 3 months, 6 months, 1 year, and 2 years, respectively. Multivariate analysis showed that Killip class 3/4 at hospital arrival was an independent risk factor for hospital mortality (odds ratio 20.4). Patients with more than 5 days of PCPS support period (n = 6), ≥ 4 h to revascularization (n = 6) or maximum CK leakage ≥20,000 IU/dl (n = 3) were not associated with successful PCPS or IABP weaning. The long-term clinical outcomes of patients with LMT disease requiring PCPS is devastating. Rapid cardiopulmonary resuscitation and coronary revascularization and timely insertion of LVAD before the onset of complications might lead to better survival.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan.
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, Osaka, 530-0001, Japan
| | - Kenji Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, Osaka, 530-0001, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Shinya Shirai
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
| | - Mitsunori Kamigaki
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
| | - Naofumi Itou
- Department of Cardiology, KKR Sapporo Medical Center, 6-3-40 Ichijo Hiragishi, Toyohira, Sapporo, Hokkaido, 062-0931, Japan
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Misumi Y, Masai T, Kainuma S, Sawa Y. Staged open repair for a complex adult aortic coarctation. J Card Surg 2017; 32:500-503. [PMID: 28833633 DOI: 10.1111/jocs.13179] [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: 11/28/2022]
Abstract
We describe a two-stage open repair for a complex aortic coarctation in an adult. A total arch replacement with an elephant trunk was performed via a median sternotomy followed in 10 days by a replacement of the descending aorta through a left thoracotomy.
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Affiliation(s)
- Yusuke Misumi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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25
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Nakamaru R, Oe H, Iwakura K, Masai T, Fujii K. Calcified amorphous tumor of the heart with mitral annular calcification: a case report. J Med Case Rep 2017; 11:195. [PMID: 28720119 PMCID: PMC5516357 DOI: 10.1186/s13256-017-1337-9] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/30/2017] [Indexed: 11/12/2022] Open
Abstract
Background Calcified amorphous tumor of the heart is a rare, non-neoplastic cardiac mass characterized by nodular calcium in the background of amorphous degenerating fibrinous material. Clinical diagnosis of calcified amorphous tumor can be difficult, and current single imaging techniques do not specifically differentiate calcified amorphous tumor from other cardiac tumors such as calcified atrial myxoma, calcified thrombi, or vegetation. Complete surgical resection is the treatment of choice for both symptom improvement and prevention of embolization, as well as for pathological diagnosis. Case presentation A 70-year-old Asian man with end-stage renal disease complained of chest discomfort during exercise. He had no history of thromboembolism or endocarditis. A transthoracic echocardiogram revealed mitral annular calcification as well as a highly mobile mass (8 × 6 mm) attached to the ventricular side of the posterior mitral valve leaflet. As the mass was highly mobile, suggesting a high risk of embolization, he underwent surgical resection. A histopathological examination revealed multiple nodular amorphous calcifications, along with fibrous connective tissue. There were no identifiable myxoma or malignancy cells. Consequently, the diagnosis of calcified amorphous tumor was confirmed. Conclusions In the present case, a calcified amorphous tumor arose from mitral annular calcification. A characteristic of mitral annular calcification-related calcified amorphous tumor is its highly mobile nature, with a high risk of stroke or other systemic embolism. Therefore, surgical therapy should be considered for treatment of calcified amorphous tumors.
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Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan
| | - Hiroki Oe
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan.
| | - Katsuomi Iwakura
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan
| | - Takafumi Masai
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan
| | - Kenshi Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan
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Misumi Y, Masai T, Toda K, Nakamura T, Miyagawa S, Yoshikawa Y, Fukushima S, Saito S, Domae K, Kainuma S, Ueno T, Kuratani T, Daimon T, Sawa Y. Restrictive Mitral Annuloplasty With or Without Papillary Muscle Approximation for Functional Mitral Regurgitation. J Heart Valve Dis 2017; 26:447-455. [PMID: 29302944] [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: 06/07/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The impact of adding papillary muscle approximation (PMA) to restrictive mitral annuloplasty (RMA) on postoperative left ventricular (LV) function is unknown. Changes in LV function parameters and clinical outcome were evaluated following RMA with and without PMA in patients with clinically relevant functional mitral regurgitation (FMR). METHODS A total of 176 patients with advanced cardiomyopathy underwent RMA either with (n = 59) or without (n = 117) PMA. Propensity score analysis was used to adjust for group differences in several baseline characteristics, such as age, gender and LV ejection fraction (LVEF) (C-statistic = 0.80, goodness-of-fit value = 0.58). RESULTS Serial echocardiography in 30 propensity score-matched pairs demonstrated decreases in LV end-systolic dimension (RMA alone: 57 ± 9 mm at baseline versus 54 ±11 mm at one month versus 56 ± 13 mm at latest examination; RMA + PMA: 56 ± 8 mm versus 53 ± 9 mm versus 48 ± 11 mm, respectively) and improvement in LVEF (RMA alone: 28 ± 8% versus 28 ± 11% versus 29 ± 10%; RMA + PMA: 30 ± 8% versus 30 ± 9% versus 36 ± 13%, respectively) in both groups. Greater degrees of changes in value were noted for patients receiving RMA + PMA (group effect p <0.05 for both). The two-year survival of both groups was similar (73 ± 8% versus 77 ± 23%, p = 0.7), but the RMA + PMA group showed a trend towards a greater freedom from composite events, defined as mortality and/or unscheduled heart failure re-admission (48 ± 9% versus 63 ± 9%, p = 0.1). CONCLUSIONS RMA + PMA induced greater long-term effects on unloading of the left ventricle and improvements in LV systolic function than did RMA alone. PMA may be a useful adjunct repair in combination with RMA, although its clinical benefits remain to be determined.
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Affiliation(s)
- Yusuke Misumi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Teruya Nakamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Keitaro Domae
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo Collage of Medicine, Hyogo, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
- Osaka Cardiovascular Surgery Research (OSCAR) Study Group, Japan. Electronic correspondence:
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Kainuma S, Taniguchi K, Toda K, Funatsu T, Kondoh H, Miyagawa S, Yoshikawa Y, Hata H, Saito S, Ueno T, Kuratani T, Daimon T, Masai T, Sawa Y. Predictors and Clinical Impact of Functional Mitral Stenosis Induced by Restrictive Annuloplasty for Ischemic and Functional Mitral Regurgitation. Circ J 2017; 81:1832-1838. [PMID: 28659549 DOI: 10.1253/circj.cj-17-0060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are few reports of the determinants of "functional" mitral stenosis in terms of a residual mitral valve (MV) pressure gradient >5 mmHg following restrictive mitral annuloplasty (RMA) or the effect on long-term outcome in patients with functional mitral regurgitation (MR).Methods and Results:Serial cardiac catheterization and echocardiographic studies were performed in 55 patients with functional MR who underwent RMA using a 24/26-mm semi-rigid complete ring. The mean postoperative (1 month) catheter-measured MV gradient was 3.4±1.6 mmHg, which was independently associated with corresponding cardiac output [standardized partial regression coefficient (SPRC)=0.59] and indexed effective orifice area (SPRC=-0.25). Body surface area (BSA) had the greatest contribution to MV gradient (SPRC=0.38), followed by use of a 24-mm ring (SPRC=0.33) and hemodialysis (SPRC=0.26). Receiver-operating characteristic curve analysis demonstrated an optimal BSA cutoff value of 1.86 m2to predict post-MV stenosis (21% for <1.86 m2vs. 86% for ≥1.86 m2, P=0.002). During follow-up (75±32 months), freedom from adverse events did not differ between patients with (n=16) and without (n=39) an MV gradient ≥5 mmHg (log-rank P=0.24). CONCLUSIONS Post-RMA MV gradient was determined not only by the degree of annular reduction but also by patients' hemodynamic factors (e.g., cardiac output). Implantation of a 24/26-mm annuloplasty ring for patients with BSA ≥1.86 m2indicated a high likelihood of post-MV stenosis. However, mild MV stenosis did not adversely affect late outcome after RMA.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital.,Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | | | - Takafumi Masai
- Departments of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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Koyama Y, Shirakawa T, Yoshitatsu M, Masai T. The Advantage of The Iagnosis and Treatment on Heart Failure by Cardiac CT Imaging as the Second Tools. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.08.089] [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: 10/23/2022]
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Kainuma S, Mitsuno M, Toda K, Funatsu T, Nakamura T, Miyagawa S, Yoshikawa Y, Fukushima S, Yoshioka D, Saito T, Nishi H, Takahashi T, Sakaki M, Monta O, Matsue H, Masai T, Sakaguchi T, Yoshitaka H, Ueno T, Kuratani T, Daimon T, Taniguchi K, Miyamoto Y, Sawa Y. Dilated left atrium as a predictor of late outcome after pulmonary vein isolation concomitant with aortic valve replacement and/or coronary artery bypass grafting. Eur J Cardiothorac Surg 2015; 48:765-77; discussion 777. [DOI: 10.1093/ejcts/ezu532] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 12/10/2014] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE Poly-L-lactide sternal pins have been reported to be beneficial for sternal closure. However, we sometimes experience a small sternum, and the size characteristics of the sternum have not been fully investigated. We analyzed size features of the sternum to determine the optimal size of sternal pin for sternal closure. METHODS Chest computed tomography scans were preoperatively obtained in 144 patients undergoing major cardiovascular surgery. We reviewed all scans at the level of the sternum, and measured the width of the bone marrow of the sternum on each computed tomography slice. RESULTS The mean values of bone marrow width of the sternal manubrium and body of male patients were significantly higher than those of females (manubrium: 38.6 ± 3.9 mm in males, 34.5 ± 3.3 mm in females, p < 0.0001; body: 23.4 ± 3.7 mm in males, 20.8 ± 2.8 mm in females, p < 0.0001). There was no correlation between the bone marrow width of the sternal body and body surface area in either males or females (males: r = 0.08, p = 0.45, females: r = 0.08, p = 0.58). CONCLUSION To select the appropriate size of sternal pin, preoperative measurement of the bone marrow width of the sternum is recommended because it cannot be predicted from body size.
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Affiliation(s)
- Masashi Kawamura
- Department of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan
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Kashiyama N, Masai T, Yoshitatsu M, Yamauchi T, Ogasawara Y, Matsunaga Y, Sawa Y. A simple way to treat mitral valve prolapse: chordal replacement using a new mitral leaflet retractor. Interact Cardiovasc Thorac Surg 2014; 18:701-5. [DOI: 10.1093/icvts/ivu040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Kainuma S, Taniguchi K, Toda K, Funatsu T, Miyagawa S, Kondoh H, Masai T, Otake S, Yoshikawa Y, Nishi H, Sakaguchi T, Ueno T, Kuratani T, Daimon T, Sawa Y. Restrictive mitral annuloplasty with or without surgical ventricular reconstruction in ischaemic cardiomyopathy: impacts on neurohormonal activation, reverse left ventricular remodelling and survival. Eur J Heart Fail 2013; 16:189-200. [DOI: 10.1002/ejhf.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/02/2013] [Indexed: 11/12/2022] Open
Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery; Japan Labor Health and Welfare Organization Osaka Rosai Hospital; Osaka Japan
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Kazuhiro Taniguchi
- Department of Cardiovascular Surgery; Japan Labor Health and Welfare Organization Osaka Rosai Hospital; Osaka Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery; Japan Labor Health and Welfare Organization Osaka Rosai Hospital; Osaka Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Haruhiko Kondoh
- Department of Cardiovascular Surgery; Japan Labor Health and Welfare Organization Osaka Rosai Hospital; Osaka Japan
| | - Takafumi Masai
- Osaka Cardiovascular Surgery Research (OSCAR) Group; Osaka Japan
| | - Shigeaki Otake
- Osaka Cardiovascular Surgery Research (OSCAR) Group; Osaka Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
| | - Takashi Daimon
- Department of Biostatistics; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery; Osaka University Graduate School of Medicine; Suita, Osaka 565-0871 Japan
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Kashiyama N, Masai T, Yoshitatsu M, Yamauchi T, Ogasawara Y, Matsunaga Y, Sawa Y. 181 * A SIMPLE WAY TO TREAT MITRAL VALVE PROLAPSE: CHORDAL REPLACEMENT USING A NEW MITRAL LEAFLET RETRACTOR. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.181] [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: 11/14/2022] Open
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Matsue H, Masai T, Yoshikawa Y, Kawamura M, Miyata T. Successful repair for isolated cleft mitral valve diagnosed by three-dimensional transesophageal echocardiography. J Heart Valve Dis 2012; 21:412. [PMID: 22808853] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Hajime Matsue
- Division of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
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Kondoh H, Taniguchi K, Funatsu T, Toda K, Masai T, Takahashi T, Kuki S. Total arch replacement with long elephant trunk anastomosed at the base of the innominate artery: a single-centre longitudinal experience. Eur J Cardiothorac Surg 2012; 42:840-8; discussion 848. [PMID: 22518042 DOI: 10.1093/ejcts/ezs117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Total arch replacement, with a long elephant trunk (ET) anastomosed at the base of the innominate artery using an undersized graft, is performed for a variety of arch aneurysms. We investigated the long-term clinical outcomes of this procedure, as well as its long-term effectiveness for preventing retrograde flow into the aneurysm and further dilation of the descending aorta. METHODS We treated 127 consecutive patients with an arch aneurysm, who were divided into two groups according to the diameter of the descending aorta at the Th6-Th8 thoracic vertebral level: 35 mm or less (Single-ET, n = 94) and >35 mm (Staged-ET, n = 33). The graft diameter was undersized by 10-20% of the distal aortic diameter. ET length was determined by preoperative computed tomography (CT) to locate the distal end at Th6-Th8. Thrombosis around the ET and the descending aorta diameter around the distal end of the ET were evaluated using CT. RESULTS Two patients (1.6%) died within 30 days, while seven (5.5%) died in the hospital, three (2.4%) had a new stroke, three (2.4%) had permanent paraplegia and one (0.8%) had paraparesis. CT demonstrated complete thrombosis of the perigraft space around the ET in 81 patients (86%) in the Single-ET group and 11 (33%) in the Staged-ET group within 1 month after surgery, but not in the remaining 35 patients. Twenty-seven of the 35 patients without complete thrombosis underwent a subsequent second-stage operation. In those, the descending aorta showed no further dilation around the distal end of the ET, while new-onset perigraft perfusion occurred in two patients in the Single-ET group at 14 and 126 months, respectively. Overall survival was 89, 86, 78 and 74% at 1, 3, 5 and 7 years, respectively. CONCLUSIONS Our operative strategy for extensive thoracic aortic aneurysms using a long ET technique yielded satisfactory short- and long-term outcomes.
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Affiliation(s)
- Haruhiko Kondoh
- Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization, Osaka Rosai Hospital, Osaka, Japan.
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Takeda K, Masai T, Ishida M, Sunagawa G. Unusual presentation of multiple recurrent cardiac sarcomas as acute acalculous cholecystitis caused by rapid expansion into the right cardiac chamber: report of a case. Surg Today 2011; 42:479-81. [PMID: 22109659 DOI: 10.1007/s00595-011-0022-7] [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] [Received: 09/02/2010] [Accepted: 04/17/2011] [Indexed: 11/29/2022]
Abstract
Sarcomas are rare malignant cardiac tumors and their prognosis is extremely poor, with a high recurrence rate despite extensive initial surgical resection. The development of therapeutic alternatives looks bleak for recurrent sarcomas, however, and complete surgical resection is crucial for any hope of survival even for the recurrent patients. We herein report the case of a 38-year-old male patient with multiple recurrent cardiac sarcomas causing acute acalculous cholecystitis 20 months after the resection of the primary tumor.
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Affiliation(s)
- Koji Takeda
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Kitaku, Umeda, Osaka, 530-0001, Japan.
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Kainuma S, Taniguchi K, Daimon T, Sakaguchi T, Funatsu T, Kondoh H, Miyagawa S, Takeda K, Shudo Y, Masai T, Fujita S, Nishino M, Sawa Y. Does stringent restrictive annuloplasty for functional mitral regurgitation cause functional mitral stenosis and pulmonary hypertension? Circulation 2011; 124:S97-106. [PMID: 21911824 DOI: 10.1161/circulationaha.110.013037] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND It remains controversial whether restrictive mitral annuloplasty (RMA) for functional mitral regurgitation (MR) can induce functional mitral stenosis (MS) that may cause postoperative residual pulmonary hypertension (PH). METHODS AND RESULTS One hundred eight patients with left ventricular (LV) dysfunction and severe MR underwent RMA with stringent downsizing of the mitral annulus. Systolic pulmonary artery pressure (PAP) and mitral valve performance variables were determined by Doppler echocardiography prospectively and 1 month after RMA. Fifty-eight patients underwent postoperative hemodynamic measurements. Postoperative echocardiography showed a mean pressure half-time of 92 ± 14 ms, a transmitral mean gradient of 2.9 ± 1.1 mm Hg, and a mitral valve effective orifice area of 2.4 ± 0.4 cm(2), consistent with functional MS. Doppler-derived systolic PAP was 32 ± 8 mm Hg, which correlated weakly with the transmitral mean gradient (ρ=0.23, P=0.02). Postoperative cardiac catheterization also showed significant improvements in LV volume and systolic function, pulmonary capillary wedge pressure, cardiac index, and systolic PAP; the latter was associated with LV end-diastolic pressure [standardized partial regression coefficient (SPRC)=0.51], pulmonary vascular resistance (SPRC=0.47), cardiac index (SPRC=0.37), and transmitral pressure gradient (SPRC=0.20). In a multivariate Cox proportional hazard model, postoperative PH (systolic PAP >40 mm Hg), but not mitral valve performance variables, was strongly associated with adverse cardiac events. CONCLUSIONS RMA for functional MR resulted in varying degrees of functional MS. However, our data were more consistent with the residual PH being caused by LV dysfunction and pulmonary vascular disease than by the functional MS. The residual PH, not functional MS, was the major predictor of post-RMA adverse cardiac events.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization Osaka Rosai Hospital, Sakai, Osaka, Japan
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Takeda K, Sakaguchi T, Miyagawa S, Shudo Y, Kainuma S, Masai T, Taniguchi K, Sawa Y. The extent of early left ventricular reverse remodelling is related to midterm outcomes after restrictive mitral annuloplasty in patients with non-ischaemic dilated cardiomyopathy and functional mitral regurgitation. Eur J Cardiothorac Surg 2011; 41:506-11. [DOI: 10.1093/ejcts/ezr004] [Citation(s) in RCA: 17] [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] [Indexed: 11/14/2022] Open
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Saito T, Masai T, Takeda K, Sunagawa G, Sawa Y. A case of successful valve repair for aortic insufficiency associated with discrete subaortic stenosis. Ann Thorac Cardiovasc Surg 2011; 17:521-3. [PMID: 21881383 DOI: 10.5761/atcs.cr.10.01614] [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] [Indexed: 11/16/2022] Open
Abstract
Discrete subaortic stenosis (DSS) is an uncommon form of left ventricular outflow tract obstruction especially in adulthood. Moreover, aortic regurgitation (AR), which is a common sequence of DSS, requiring surgical correction is extremely rare. We report the case of a 33-year old man who had severe DSS accompanied with moderate aortic insufficiency. He underwent successful surgery including relief of DSS and aortic valve repair. Although careful follow-up is mandatory for recurrent AR and DSS, our approach was thought to be feasible for a young adult patient with DSS complicated with AR.
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Affiliation(s)
- Tetsuya Saito
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Kitaku, Umeda, Osaka, Japan.
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Sunagawa G, Masai T, Takeda K, Ishida M, Yamauchi T, Sawa Y. Successful bridge to recovery in a patient surviving fatal device-related complications after implantation of a Toyobo left ventricular assist system. J Artif Organs 2011; 14:364-6. [PMID: 21769687 DOI: 10.1007/s10047-011-0592-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
Abstract
Emergent left ventricular assist system (LVAS) removal due to device complication is associated with high morbidity and mortality. This report describes a case of a 51-year-old man with dilated cardiomyopathy who successfully underwent emergent LVAS removal after a device-related complication. Although the patient's left ventricular function was still compromised, LVAS removal was indicated secondary to cerebral hemorrhage. Fortunately, the patient had an uneventful course over the ensuing 8 months and maintained good quality of life.
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Affiliation(s)
- Gengo Sunagawa
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Kitaku Umeda 2-4-32, Osaka 530-0001, Japan.
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Shudo Y, Sakaguchi T, Kamata S, Miyagawa S, Nishi H, Yoshikawa Y, Yoshikawa Y, Fukushima S, Saito S, Taniguchi K, Takeda K, Masai T, Sawa Y. CHANGE IN MITRAL VALVE CONFIGURATION AFTER UNDERSIZED SADDLE SHAPED MITRAL VALVE ANNULOPLASTY IN FUNCTIONAL MITRAL REGURGITATION: QUANTITATIVE ANALYSIS WITH REAL TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY AND THE SOFTWARE SYSTEM. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60752-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kainuma S, Masai T, Yoshitatsu M, Miyagawa S, Yamauchi T, Takeda K, Morii E, Sawa Y. Advanced left-atrial fibrosis is associated with unsuccessful maze operation for valvular atrial fibrillation. Eur J Cardiothorac Surg 2011; 40:61-9. [PMID: 21215652 DOI: 10.1016/j.ejcts.2010.11.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/31/2010] [Accepted: 11/03/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Atrial dilatation and fibrosis are considered to be important factors in the occurrence and maintenance of atrial fibrillation (AF). However, the relationship between those structural remodeling and postoperative sinus conversions after a maze operation has been rarely studied. The purpose of this study was to determine whether pathological evaluation of atrial tissues was useful for predicting an unsuccessful maze operation in patients with valvular AF. METHODS Between March 2006 and June 2007, left-atrial tissues in the posterior wall and right-atrial appendage were obtained from 47 consecutive patients (24 patients with chronic AF, and 23 with sinus rhythm) undergoing mitral valve surgery (MVS). A concomitant maze operation was performed for all patients with chronic AF. Atrial cell diameters were measured using hematoxylin and eosin staining, and quantitative assessment of atrial fibrosis was performed with Masson trichrome staining using an image analyzer (Image Processor for Analytical Pathology, Sumika Technoservice Co., Hyogo, Japan). RESULTS Successful MVS was performed for all patients and there were no complications associated with tissue sampling. Patients with chronic AF had more advanced histological features in both atria as compared with those with sinus rhythm. Sixteen of 24 patients, who underwent a maze operation, had successfully restored sinus rhythm (successful maze group), while that in the remaining eight was not restored (unsuccessful maze group). Patients in the unsuccessful maze group had a larger left-atrial dimension and cardiothoracic ratio as compared with those in the successful group, whereas the duration of AF was not significantly different. Patients in the unsuccessful maze group also had greater hypertrophy of cardiomyocytes and more extensive intercellular fibrosis in the left atrium, while there were no differences for right-atrial pathological features between the groups. Multivariate logistic analysis confirmed that a larger amount of left-atrial fibrosis (>15%) was significantly associated with an unsuccessful maze operation. CONCLUSIONS The present results suggested that advanced fibrosis in the left atrium, but not in the right atrium, might be significantly associated with an unsuccessful maze operation in patients with valvular AF.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
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Matsue H, Masai T, Yoshikawa Y, Kawamura M. Serious acute coronary thrombosis associated with heparin-induced thrombocytopenia in off-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2010; 11:188-90. [PMID: 20504888 DOI: 10.1510/icvts.2010.232983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 72-year-old female underwent off-pump coronary bypass grafting one month after heparin exposure. Immediately after protamine administration, she developed hypotension due to acute graft failure. Grafting to left anterior descending branch was revised under intra-aortic balloon pump insertion and she was transferred to intensive care unit under stable hemodynamic condition. However, she gradually developed low cardiac output syndrome and echocardiography showed new onset of myocardial infarction. Coronary angiography on the first postoperative day revealed diffuse serious coronary thrombosis involving all grafts and grafted native coronary arteries. Emergent percutaneous coronary intervention (PCI) was performed for native vessels. Laboratory examination revealed severe progressive thrombocytopenia and she was clinically diagnosed as heparin-induced thrombocytopenia (HIT). After cessation of all heparins and alternative anticoagulation with argatroban, thrombocytopenia was improved and some of occluded grafts were recanalized. She was discharged on the 51st postoperative day. Acute graft thrombosis, especially caused by HIT, is a serious complication, which sometimes results in mortality. This is a successful case treated by PCI followed by an alternative anticoagulation.
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Affiliation(s)
- Hajime Matsue
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital 2-4-32, Umeda, Kita-Ku, Osaka City, Osaka 530-0001, Japan.
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Hayakawa K, Mizutani J, Wada K, Masai T, Yoshihara I, Mitsuoka T. Effects of Soybean Oligosaccharides on Human Faecal Flora. Microbial Ecology in Health and Disease 2009. [DOI: 10.3109/08910609009140252] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- K. Hayakawa
- Intestinal Flora Laboratory, The Calpis Food Industry Co., Ltd, Fuchinobe, Sagamihara, Kanagawa, 229, Japan
| | - J. Mizutani
- Intestinal Flora Laboratory, The Calpis Food Industry Co., Ltd, Fuchinobe, Sagamihara, Kanagawa, 229, Japan
| | - K. Wada
- Intestinal Flora Laboratory, The Calpis Food Industry Co., Ltd, Fuchinobe, Sagamihara, Kanagawa, 229, Japan
| | - T. Masai
- Intestinal Flora Laboratory, The Calpis Food Industry Co., Ltd, Fuchinobe, Sagamihara, Kanagawa, 229, Japan
| | - I. Yoshihara
- Chemical Laboratory of Intestinal Microbial Products, Kamegai, Niigata, Niigata, 950-21, Japan
| | - T. Mitsuoka
- Department of Biomedical Science, Faculty of Agriculture, The University of Tokyo, Bunkyo-ku, Tokyo, 113, Japan
- Laboratory for Intestinal Flora, Frontier Research Program, Riken, Wako, Saitama, 351-01, Japan
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Toda K, Taniguchi K, Masai T, Takahashi T, Kuki S, Sawa Y. Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients. Ann Thorac Surg 2009; 88:16-22. [DOI: 10.1016/j.athoracsur.2009.03.092] [Citation(s) in RCA: 15] [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: 01/28/2009] [Revised: 03/27/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Yamauchi T, Masai T, Takeda K, Kainuma S, Sawa Y. Percutaneous cardiopulmonary support after acute myocardial infarction at the left main trunk. Ann Thorac Cardiovasc Surg 2009; 15:93-97. [PMID: 19471222] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 03/03/2008] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Percutaneous cardiopulmonary support (PCPS) has recently become an accepted modality for the treatment of cardiogenic shock after acute myocardial infarction (AMI). However, the clinical outcomes of patients with AMI at the left main trunk (LMT) undergoing PCPS remain unclear. PATIENTS AND METHODS From January 2000 to September 2007, we experienced 16 cases of AMI at the LMT requiring emergent PCPS. The average age ranged from 56 to 74 (mean 68.8), and 13 were male. All cases underwent percutaneous coronary intervention (PCI). The maximum creatine kinase leakage ranged from 6,069 to 22,580 IU/l (mean; 12,880 IU/l). The time to revascularization ranged from 30 min to 1,138 min (mean 229 min). An intra-aortic balloon pumping (IABP) was inserted in all patients. RESULTS Among our 16 patients, 10 (62.5%) could be successfully weaned off PCPS, and 6 (37.5%) could be weaned off both PCPS and IABP and discharged. Three patients underwent left ventricular assist system (LVAS) implantation. Two of them, without preoperative severe systemic complications, survived more than 100 days after implantation, whereas the third died perioperatively because of a systemic complication from the preoperative period. Eight patients died of low output syndrome or brain death. Cardiac function did not recover in patients in whom the time to revascularization was more than 4 hours and PCPS support duration more than 3 days. CONCLUSIONS The clinical outcomes of patients with LMT disease requiring PCPS is not satisfactory. In order to improve clinical outcomes of these patients, a strategy involving a timely insertion of LVAS before the onset of complications might be necessary.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan
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Taniguchi K, Kawamaoto T, Kuki S, Masai T, Mitsuno M, Nakano S, Kawashima Y, Matsuda H. Left ventricular myocardial remodeling and contractile state in chronic aortic regurgitation. Clin Cardiol 2009; 23:608-14. [PMID: 10941548 PMCID: PMC6654784 DOI: 10.1002/clc.4960230812] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In chronic aortic regurgitation, eccentric hypertrophy, with combined concentric hypertrophy of the left ventricle, is an important adaptive response to volume overload, which in itself is a compensatory mechanism for permitting the ventricle to normalize its afterload and to maintain normal ejection performance (physiologic hypertrophy). However, progressive dilatation of the left ventricle leads to depressed left ventricular (LV) contractility and myocardial structural changes, including cellular hypertrophy and interstitial fibrosis (pathological hypertrophy). HYPOTHESIS The study was undertaken to determine the relationship between left ventricular myocardial structure and contractile function in 14 patients with chronic aortic regurgitation by cardiac catheterization and endomyocardial biopsies. METHODS Myocardial cell diameter and percent interstitial fibrosis were obtained from biopsy samples. Contractile function was evaluated from the ratio of end-systolic wall stress to end-systolic volume index (ESS/ESVI) and the ejection fraction-end-systolic stress (EF-ESS) relationship, which was obtained from 30 normal control subjects. RESULTS Myocardial cell diameter correlated significantly with the ESVI (r = 0.72, p < 0.005), ejection fraction (r = -0.58, p < 0.05), and ESS/ESVI (r = -0.58, p < 0.05). The percent interstitial fibrosis also correlated inversely with ESS/ESVI (r = -0.71, p < 0.005). Compared with very few patients with an ESVI < 70 ml/m2, the majority of patients with ESVI > or = 70 ml/m2 had a cell diameter of > or = 30 microns and a percent interstitial fibrosis of > or = 10%. The nine patients who had depressed contractile function, as assessed from the EF-ESS relationship, had a higher percent interstitial fibrosis (p < 0.05) than five patients showing a normal EF-ESS relationship, despite the fact that there was no significant difference in myocardial cell diameter between them. Thus, advanced cellular hypertrophy and excessive interstitial fibrosis were significantly and independently associated with myocardial contractile dysfunction and appeared to be responsible for ventricular remodeling. CONCLUSION Our findings suggest that in many patients with aortic regurgitation, eccentric hypertrophy changes its nature from physiologic to nonphysiologic during the earlier stages in the course of the disease rather than during the stage described previously.
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Affiliation(s)
- K Taniguchi
- Department of Cardiovascular Surgery, Labor Welfare Corporation Osaka Rosai Hospital, Sakai, Japan
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Saito S, Matsumiya G, Sakaguchi T, Fujita T, Yamauchi T, Takeda K, Kuratai T, Ichikawa H, Taniguchi K, Masai T, Sawa Y. 217: Cardiac Fibrosis Correlates with the Degree of Reverse Remodeling after Restrictive Mitral Annuloplasty in Patients with Idiopathic Dilated Cardiomyopathy. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.847] [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: 10/21/2022] Open
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Nakamura T, Masai T, Yamauchi T, Higuchi T, Ito H, Toyoshima Y, Sawa Y. Successful surgical management for severe mitral regurgitation unmasked after pericardiectomy for chronic constrictive pericarditis. Ann Thorac Surg 2009; 86:1994-6. [PMID: 19022033 DOI: 10.1016/j.athoracsur.2008.05.005] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/09/2008] [Accepted: 05/05/2008] [Indexed: 01/12/2023]
Abstract
A 78-year-old cachectic woman who previously had repair of atrial septal defect was admitted to the hospital for congestive heart failure. Cardiac workup revealed chronic constrictive pericarditis; no evidence of coronary or valvular disease was found. She underwent corrective surgery for pericardiectomy. Intraoperative transesophageal echocardiography after pericardiectomy demonstrated acute development of severe mitral regurgitation, which was not preoperatively observed. She eventually required mitral valve replacement and tricuspid valve repair after conservative management failed. She recovered from the operation and was discharged. We believe that this is the first report of successful surgical management of mitral regurgitation that developed acutely after pericardiectomy.
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Affiliation(s)
- Teruya Nakamura
- Division of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan
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Kainuma S, Masai T, Yamauchi T, Takeda K, Ito H, Sawa Y. Primary malignant pericardial mesothelioma presenting as pericardial constriction. Ann Thorac Cardiovasc Surg 2008; 14:396-398. [PMID: 19131929] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 11/26/2007] [Indexed: 05/27/2023] Open
Abstract
A 55-year-old man with a history of pericardiocentesis for massive pericardial effusion of unknown etiology was admitted to our hospital because of shortness of breath and systemic edema in September 2005. Transthoracic echocardiography demonstrated the massive PE 2 cm in diameter and with several areas of thick hyperrefractile echoes arising from the pericardium. Computed tomography (CT) demonstrated a large mediastinal mass encasing the heart; a pressure of the right ventricle (RV) showed a pattern of dips and plateaus on cardiac catheterization. Pericardiocentesis was attempted, but no fluid could be aspirated. The patient's symptoms progressed day by day despite maximum pharmacological support with catecholamines and diuretics. Surgical treatment was planned to relieve the symptoms and confirm the definitive diagnosis. Pericardiectomy and partial resection of the tumor under cardiopulmonary bypass (CPB) could be performed, and this resulted in a marked relief of symptoms. Histological examination confirmed the malignant pericardial mesothelioma. In conclusion, pericardiectomy and resection of the tumor might be indicated for the relief of symptoms in a critical case presenting as pericardial constriction associated with malignant pericardial mesothelioma.
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Affiliation(s)
- Satoshi Kainuma
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, and Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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