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Takagi S, Goto Y, Yanagisawa J, Ogihara Y, Okawa Y. Thoracic Endovascular Aortic Repair Without Subclavian Revascularization of a Ruptured Kommerell Diverticulum. JACC Case Rep 2024; 29:102349. [PMID: 38665999 PMCID: PMC11041829 DOI: 10.1016/j.jaccas.2024.102349] [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: 01/16/2024] [Revised: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
A ruptured Kommerell diverticulum is extremely rare. This is the first report of thoracic endovascular aortic repair without subclavian revascularization of a ruptured Kommerell diverticulum with a right-sided aortic arch. However, decisions regarding subclavian revascularization should be individualized based on the patient's anatomy and clinical presentation.
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Affiliation(s)
- Sho Takagi
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Junji Yanagisawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yui Ogihara
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Imamura Y, Kitamura H, Aichi C, Fukumoto Y, Tamaki M, Okawa Y. [A Successful Surgical Treatment of Hemolytic Anemia Caused by Aortic Valve Perivalvular Leakage and Severely Kinked Elephant Trunk:Report of a Case]. Kyobu Geka 2024; 77:306-309. [PMID: 38644179] [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: 04/23/2024]
Abstract
Both perivalvular leakage and kinked prosthetic graft may cause hemolysis. A 72-year-old man was refereed to our hospital because of hemolytic anemia. He has past histories of total aortic arch replacement and repeat aortic valve replacement for aortic aneurysm and prosthetic valve endocarditis. Pre-operative examinations demonstrated aortic valve perivalvular leakage and severe graft kinking of the elephant trunk. Repeat aortic valve replacement and axillo-femoral bypass were performed successfully. Hemolysis got better after the operation and the patient discharged home in stable condition.
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Affiliation(s)
- Yusuke Imamura
- Division of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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Takagi S, Goto Y, Yanagisawa J, Ogihara Y, Okawa Y. Strategy for acute DeBakey type I aortic dissection considering midterm results: a retrospective cohort study comparing ascending aortic replacement and total arch replacement with frozen elephant trunk technique. J Cardiothorac Surg 2024; 19:15. [PMID: 38247014 PMCID: PMC10801927 DOI: 10.1186/s13019-024-02484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Acute type A aortic dissection is treated with an emergency procedure that uses ascending aortic replacement (AAR). However, to avoid a residual dissected aorta with a false lumen, total arch replacement (TAR) is required. The frozen elephant trunk (FET) technique is a promising surgical approach that promotes false lumen obliteration in a single step. Therefore, this retrospective single-center study aimed to evaluate the operative outcomes of AAR and TAR with FET. METHODS Between 2007 and 2021, 143 patients with acute DeBakey type I aortic dissection underwent a central repair using AAR (n = 95) or TAR with FET (n = 43). All perioperative variables, the duration of all-cause mortality, and aortic events defined as dilatation of the distal aorta > 5 cm, new occurrences of aortic dissection, distal aortic surgery, and distal aortic rupture were recorded. We compared these perioperative variables and mid-term results with an additional focus on distal aortic events. RESULTS Patient background data did not differ between the two groups. Perioperative results for the TAR with FET group vs the AAR group showed similar operative times (306 vs 298 min, P = 0.862), but the TAR group had longer cardiopulmonary bypass times (154 vs 179 min, P < 0.001). The freedom from all-cause death for the TAR vs AAR groups using the Kaplan-Meier method was 81.9% vs 85.4% and 78.0% vs 85.4% (P = 0.407) at 1 and 3 years, respectively. Freedom from aorta-related events was 90.6% vs 97.6% and 69.3% vs 87.0% (P = 0.034) at 1 and 3 years, respectively. CONCLUSIONS TAR with FET had comparable perioperative results to AAR in acute DeBakey type I aortic dissection and was considered a valuable method to avoid aorta-related events in the midterm.
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Affiliation(s)
- Sho Takagi
- Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan.
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan
| | - Junji Yanagisawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan
| | - Yui Ogihara
- Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-Cho, Toyohashi, 441-8530, Japan
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Goto Y, Takagi S, Yanagisawa J, Okawa Y. Concomitant surgery of minimally invasive direct coronary artery bypass with left atrium appendage closure. BMJ Case Rep 2023; 16:e256642. [PMID: 38011944 PMCID: PMC10685910 DOI: 10.1136/bcr-2023-256642] [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] [Accepted: 11/11/2023] [Indexed: 11/29/2023] Open
Abstract
Surgical approaches of minimally invasive direct coronary artery bypass and left atrial appendage exclusion are different, and issues may arise in cases of concomitant surgery. Moreover, the safety of concomitant procedures has not been established. A man in his 80s with a history of stroke required minimally invasive coronary artery bypass grafting and left atrial appendage closure for the stenosis of the left anterior descending artery and atrial fibrillation. He suffered from bladder bleeding, which required early reduction of anticoagulant and antiplatelet medication. Therefore, he wished for surgical treatment. A lateral incision was necessary for left atrial appendage closure in minimally invasive surgery. We performed totally endoscopic harvest of the internal thoracic artery without a robotic system. This method allowed the incision to be made more laterally. Combining the endoscopic harvest of the internal mammary artery with left atrial appendage closure via lateral incision may be a reasonable technique.
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Affiliation(s)
- Yoshihiro Goto
- Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Sho Takagi
- Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Junji Yanagisawa
- Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
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Sugimoto K, Takahashi K, Okune M, Ueno M, Fujita T, Doi H, Tobaru T, Takanashi S, Kinoshita Y, Okawa Y, Fuku Y, Komiya T, Tsujita K, Fukui T, Shimokawa T, Watanabe Y, Kozuma K, Sakaguchi G, Nakazawa G. Impact of quantitative flow ratio on graft function in patients undergoing coronary artery bypass grafting. Cardiovasc Interv Ther 2023; 38:406-413. [PMID: 37017900 DOI: 10.1007/s12928-023-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Recent studies showed that preoperative functional assessment with fractional flow reserve (FFR) could predict a long-term patency of arterial bypass grafts in patients with coronary artery bypass grafting (CABG). Quantitative flow ratio (QFR) is a novel angiography-based approach to estimate FFR. This study aimed to investigate whether preoperative QFR could discriminate arterial bypass function at 1 year after surgery. The PRIDE-METAL registry was a prospective, multicenter observational study that enrolled 54 patients with multivessel coronary artery disease. By protocol, left coronary stenoses were revascularized by CABG with arterial grafts, whereas right coronary stenoses were treated with coronary stenting. Follow-up angiography at 1 year after surgery was scheduled to assess arterial graft patency. QFR was performed using index angiography by certified analysts, blinded to bypass graft function. The primary end point of this sub-study was the discriminative ability of QFR for arterial graft function, as assessed by receiver-operating characteristic curve. Among 54 patients enrolled in the PRIDE-METAL registry, index and follow-up angiography was available in 41 patients with 97 anastomoses. QFR were analyzed in 35 patients (71 anastomoses) with an analyzability of 85.5% (71/83). Five bypass grafts were found to be non-functional at 1 year. The diagnostic performance of QFR was substantial (area under the curve: 0.89; 95% confidence interval: 0.83 to 0.96) with an optimal cutoff of 0.76 to predict functionality of bypass grafts. Preoperative QFR is highly discriminative for predicting postoperative arterial graft function.Trial registration: Clinical.gov reference: NCT02894255.
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Affiliation(s)
- Keishiro Sugimoto
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kuniaki Takahashi
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Mana Okune
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masafumi Ueno
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Insutitute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medicine Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
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Takagi S, Hirano K, Nakasu A, Yanagisawa J, Goto Y, Okawa Y. Revascularization for controlling hypertension and improving cardiorenal failure in Leriche syndrome. ESC Heart Fail 2022; 9:3608-3613. [PMID: 35808953 DOI: 10.1002/ehf2.14069] [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: 03/31/2022] [Revised: 05/15/2022] [Accepted: 06/27/2022] [Indexed: 11/12/2022] Open
Abstract
Leriche syndrome usually occurs when atherosclerotic obstructions result in luminal narrowing of the abdominal aorta or iliac arteries and leads to thrombosis; it rarely causes heart or renal failure. We report the case of a 58-year-old Asian man with heart and renal failure as the dominant clinical manifestations of renovascular hypertension caused by Leriche syndrome. We performed an aorto-bifemoral bypass and unilateral renal artery stenting. Post-operative echocardiography showed improved cardiac function, with the left ventricular ejection fraction increasing from 30% before surgery to 54.2% after surgery. Moreover, his heart rate and blood pressure became stable, and his serum creatinine and brain natriuretic peptide levels decreased from 3.46 to 1.08 mg/dL and 685 to 4 pg/mL, respectively. Our case report shows that aorto-bifemoral bypass and unilateral renal artery stenting can effectively treat heart and renal failure resulting from renovascular hypertension caused by Leriche syndrome.
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Affiliation(s)
- Sho Takagi
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Junji Yanagisawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Inagaki M, Koyama Y, Sawada K, Okawa Y. [Aortic Regurgitation due to Rupture of a Fibrous Strand in Fenestrated Aortic Valve:Report of a Case]. Kyobu Geka 2022; 75:185-188. [PMID: 35249950] [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: 06/14/2023]
Abstract
Fenestration of the aortic valve cusps rarely causes aortic regurgitation. A 54-year-old woman was diagnosed with aortic regurgitation secondary to a ruptured fibrous strand in a fenestrated aortic valve cusp. Diastolic murmur was pointed out during health checkup five months earlier, and transthoracic echocardiography revealed severe aortic valve regurgitation with a mobile mass attached to the aortic valve cusp. The patient underwent aortic valve replacement. Intraoperatively, we observed a ruptured fibrous strand attached to the non-coronary cusp and cusp laceration, both of which caused severe aortic regurgitation. Histopathological examination of the resected specimen showed myxomatous degeneration. The patient's postoperative course was uneventful, and she was discharged in a stable condition on postoperative day 14.
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Affiliation(s)
- Masahiro Inagaki
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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Yoshihiro G, Takagi S, Yanagisawa J, Nakasu A, Okawa Y. Endoscopic Internal Thoracic Artery Harvesting with Changes in Scope Position. Heart Surg Forum 2021; 24:E950-E951. [PMID: 34962471 DOI: 10.1532/hsf.4195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022]
Abstract
Although minimally invasive direct coronary artery bypass (MIDCAB) is a less invasive procedure, internal thoracic artery (ITA) harvesting is difficult. A 65-year-old woman was advised to undergo MIDCAB for recurrent in-stent restenosis. We harvested the ITA using three-dimensional endoscopy without robotics and determined the scope position using enhanced computed tomography. We changed the camera installation between the wound and the camera port, according to the harvesting site with a harmonic scalpel using the skeletonized technique. We harvested the ITA from the subclavian vein level superiorly to the xyphoid process level inferiorly.
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Affiliation(s)
- Goto Yoshihiro
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
| | - Sho Takagi
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
| | - Junji Yanagisawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Results of off-pump coronary artery bypass grafting with off-pump first strategy in octogenarian. J Card Surg 2021; 36:4611-4616. [PMID: 34613636 PMCID: PMC9291825 DOI: 10.1111/jocs.16055] [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: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Background and Aim Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on‐ or off‐pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off‐pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off‐pump coronary artery bypass‐first strategy to all generations since 2008. This study investigated early and long‐term results of surgical revascularization for octogenarians by a team with an off‐pump‐first strategy. Methods All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age < 80 years) and an old group (age ≥ 80 years). Peri‐operative results were investigated retrospectively in both groups and long‐term results for the old group were assessed. Results Among the 707 patients, 97% underwent off‐pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In‐hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow‐up of 1318 days, actual 1‐, 3‐, and 5‐year survival rates for octogenarians were 92.1%, 81.2%, and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions An experienced team with an off‐pump‐first strategy could provide valid therapeutic options for octogenarians.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
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Oozawa K, Okawa Y, Hirata S, Tashiro M, Taniguchi K. Professional dental care provision systems for persons with disabilities by prefecture in Japan. Community Dent Health 2021; 38:182-186. [PMID: 34223715 DOI: 10.1922/cdh_00004oozawa05] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The number of persons with disabilities has increased and aged. Although it is important to maintain good oral health to extend healthy life expectancy, it is difficult for such people. This study aimed to analyze regional disparities in dental care provision systems for disabled people and to propose measures for the establishment of an appropriate system. BASIC RESEARCH DESIGN To examine regional disparities in dental care provision systems for persons with disabilities, the number of practicing dentists and dental clinics per 100,000 population, dentists certified by the Japanese Society for Disability and Oral Health, and institutions with certified dentists per 100,000 disabled persons for each prefecture were calculated. The Gini coefficient of each was also calculated to visualize and analyze regional disparities. RESULT The Gini coefficients were 0.09 and 0.07 for practicing dentists and dental clinics and 0.32 and 0.28 for the certified dentists and institutions with the certified dentists, respectively. Dental institutions for the disabled abounded in the three metropolitan areas: Tokyo, Aichi, and Osaka, and their density tended to be lower in northern and southern Japan. In prefectures with few such institutions, there was no correlation between the number of institutions and prefectural residents' income, and some prefectures had similar incomes but had many institutions. CONCLUSION The distribution of dental care to the disabled is highly uneven in Japan, therefore, a system needs to be established to address this issue.
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Affiliation(s)
- K Oozawa
- Department of Social Dentistry, Tokyo Dental College, Japan
| | - Y Okawa
- Department of Dental Hygiene, Faculty of Health Care Science, Chiba Prefectural University of Health Sciences, Japan
| | - S Hirata
- Department of Social Dentistry, Tokyo Dental College, Japan
| | - M Tashiro
- Department of Social Dentistry, Tokyo Dental College, Japan
| | - K Taniguchi
- Department of Social Dentistry, Tokyo Dental College, Japan
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Ogawa S, Okawa Y. Reply to Spiliopoulos et al. Eur J Cardiothorac Surg 2021; 59:929. [PMID: 33067625 DOI: 10.1093/ejcts/ezaa342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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12
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Reply: Surgical repair of thoracoabdominal aortic aneurysm accompanied by Leriche syndrome using a quadrifurcated graft without a distal anastomosis. J Card Surg 2021; 36:1170-1171. [PMID: 33533103 DOI: 10.1111/jocs.15367] [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] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
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Ehara M, Yamada S, Shibata K, Kameshima M, Fujiyama H, Matsui Y, Higashida Y, Shimada A, Ito T, Sano T, Okumura H, Masaoka K, Okawa Y. Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2864] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear.
Purpose
We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis.
Methods
This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories.
Results
The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p<0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p<0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p<0.001).
Conclusion
Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Ehara
- Nagoya Heart Center, Nagoya, Japan
| | - S Yamada
- Nagoya University, Nagoya, Japan
| | | | | | | | - Y Matsui
- Nagoya Heart Center, Nagoya, Japan
| | | | | | - T Ito
- Nagoya Heart Center, Nagoya, Japan
| | - T Sano
- Nagoya Heart Center, Nagoya, Japan
| | | | | | - Y Okawa
- Nagoya Heart Center, Nagoya, Japan
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Motoji Y, Kato T, Seki J, Tsumura K, Tomita S, Okawa Y. A Case of Collapsed Stent Graft, Severe Lower Limb Ischemia, and Ruptured Abdominal Aortic Aneurysm Due to Type B Acute Aortic Dissection 3 Years after Endovascular Aneurysm Repair. Ann Vasc Dis 2020; 13:308-311. [PMID: 33384735 PMCID: PMC7751076 DOI: 10.3400/avd.cr.19-00142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/13/2022] Open
Abstract
We report a case of stent graft occlusion, severe lower extremity ischemia, and ruptured abdominal aortic aneurysm due to type B acute aortic dissection 3 years after endovascular aneurysm repair. He admitted our hospital because of abrupt back pain and dysesthesia of bilateral lower limb. Contrast-enhanced computed tomography (CT) scan showed type B acute aortic dissection and occlusion of the stent graft due to dynamic compression by the false lumen. Emergent right axillo-bifemoral bypass operation was done for his critical limb ischemia. Immediately after the successful operation, he fell into shock vital and dissecting abdominal aortic aneurysm rupture was revealed by CT scan. We performed the stump occlusion of the infrarenal abdominal aorta and the bilateral common iliac arteries by abdominal midline incision. Postoperative myonephropathicmetabolic syndrome due to the left ischemia resulted in amputation of his left lower leg for lifesaving. While EVAR cases are increasing, various its complications come to be reported. We consider that this case report might be cautious about the indication of EVAR for the younger generation. (This is a translation of Jpn J Vasc Surg 2019; 28: 367–371.)
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Affiliation(s)
- Yusuke Motoji
- Department of Cardiovascular Surgery, Gifu Heart Center
| | | | - Jun Seki
- Department of Cardiovascular Surgery, Gifu Heart Center
| | | | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center
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15
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Ogawa S, Okawa Y. Reply to Seo and Cho. Eur J Cardiothorac Surg 2020; 59:ezaa281. [PMID: 32968757 DOI: 10.1093/ejcts/ezaa281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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16
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Surgical repair of thoracoabdominal aortic aneurysm accompanied by Leriche syndrome using a quadrifurcated graft without a distal anastomosis. J Card Surg 2020; 35:3166-3168. [DOI: 10.1111/jocs.14907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery Nagoya Heart Center Nagoya Aichi Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery Nagoya Heart Center Nagoya Aichi Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery Nagoya Heart Center Nagoya Aichi Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery Nagoya Heart Center Nagoya Aichi Japan
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17
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Aortic Valve Replacement by a Transaxillary Anterior Minithoracotomy Approach. Ann Thorac Surg 2020; 110:e237-e239. [PMID: 32315645 DOI: 10.1016/j.athoracsur.2020.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
A modified transaxillary approach for aortic valve disease to obtain the same exposure as the anterior minithoracotomy approach and to preserve the pectoralis major muscle is presented. When the patient's right shoulder is adducted horizontally, or the right arm is flexed anteriorly 90 degrees and adducted to the left, the right axilla comes close to the chest midline. That means that a right anterior thoracotomy can be made through the right axilla when the arm position is adjusted appropriately. The modified new approach is safe and faster than the conventional transaxillary approach, and it provides cosmetic advantages to the patient.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan.
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
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18
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Ogawa S, Tsunekawa T, Hosoba S, Goto Y, Kato T, Kitamura H, Tomita S, Okawa Y. Bilateral internal thoracic artery grafting: propensity analysis of the left internal thoracic artery versus the right internal thoracic artery as a bypass graft to the left anterior descending artery. Eur J Cardiothorac Surg 2020; 57:701-708. [PMID: 31638700 DOI: 10.1093/ejcts/ezz290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/25/2019] [Accepted: 09/17/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To compare different configurations of the bilateral internal thoracic arteries for the left coronary system and examine early and late outcomes, including mid-term graft patency. METHODS We reviewed 877 patients who underwent primary isolated coronary artery bypass grafting using in situ bilateral internal thoracic arteries [in situ right internal thoracic artery (RITA)-to-left anterior descending artery (LAD) grafting, n = 683; in situ left internal thoracic artery (LITA)-to-LAD grafting, n = 194]. We compared mid-term patency between the grafts. Propensity score matching was performed to investigate early and long-term outcomes. RESULTS The 2-year patency rate for RITA-to-LAD and LITA-to-LAD grafts were similar. Multivariate analysis revealed that RITA-to-non-LAD anastomosis (P = 0.029), postoperative length of stay (P = 0.003) and chronic obstructive pulmonary disease (P = 0.005) were associated with graft failure. After statistical adjustment, 176 propensity-matched pairs were available for comparison. RITA-to-LAD grafting enabled a more distal anastomosis. Kaplan-Meier analysis revealed that the incidences of death, repeat revascularization and myocardial infarction were significantly higher in the LITA-to-LAD group among both the unmatched and matched samples (P = 0.045 and 0.029, respectively). CONCLUSIONS The mid-term patency and outcomes of RITA-to-LAD grafting are good and reduces future cardiac event, in contrast to LITA-to-LAD grafting.
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Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | | | - Soh Hosoba
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Takayoshi Kato
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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19
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Tamaki M, Kitamura H, Koyama Y, Sawada K, Kawaguchi Y, Tokuda T, Okawa Y, Konakano K. Thoracic endovascular aneurysm repair to treat recurrent lower limb ischemia secondary to occlusion of axillofemoral bypass. Int J Surg Case Rep 2020; 68:190-192. [PMID: 32182580 PMCID: PMC7090095 DOI: 10.1016/j.ijscr.2020.02.053] [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: 12/11/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 11/24/2022] Open
Abstract
One of the complications of type B aortic dissection is organ ischemia. TEVAR was performed for entry closure. TEVAR improved malperfusion.
Introduction A case of malperfusion in which the patient presented with aortic dissection is presented. Presentation of case A 69-year-old man with an acute aortic dissection (Stanford type B) had lower limb ischemia. Axillary-femoral bypass was performed, and his lower limb ischemia improved. Eight months after the onset of acute aortic dissection, he again had lower limb ischemia. Contrast-enhanced computed tomography showed axillary-femoral bypass occlusion and true lumen collapse, compressed by the increased false lumen pressure in the aorta. Thoracic endovascular aortic repair (TEVAR) was performed for entry closure. His lower limb ischemia was improved by TEVAR. Discussion One of the complications of type B aortic dissection is malperfusion. Endovascular therapy is a first step in treating the malperfusion of type B aortic dissection. It is important to seal the entry for the treatment of malperfusion. Conclusion If there is an entry, it is important to seal it for the treatment of malperfusion.
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Affiliation(s)
- Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan.
| | - Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Koshi Sawada
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Kazuya Konakano
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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20
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Kitamura H, Okawa Y, Maeda M. A porcine prosthetic valve preserved for 28 years within a severely stenotic Rastelli conduit. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04897-0] [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: 11/08/2022]
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21
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Okawa Y, Hirata S. Geographic distribution of dental specialists permitted to advertise dental practices in Japan. Community Dent Health 2019; 36:240-243. [PMID: 31680491 DOI: 10.1922/cdh_4521okawa04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the geographic distribution of dental specialists permitted to advertise dental practices in Japan. METHOD We identified the populations of 349 secondary medical zones nationwide from the 2015 population census, as well as the number of dentists in five specialties, namely oral surgeons, pedodontists, periodontists, dental anesthesiologists, and dental radiologists, who had been permitted to advertise dental practices, from a 2016 survey of physicians, dentists, and pharmacists. We determined the placement rate, Lorenz curve, and Gini coefficient for dentists in each specialty in order to describe their geographic distributions. RESULTS The placement rates of at least one of these types of dentist in each secondary medical zone were 73.9% for oral surgeons, 66.2% for pedodontists, 60.5% for periodontists, 31.8% for dental anesthesiologists, and 18.3% for dental radiologists. The Gini coefficients were 0.397, 0.400, 0.491, 0.650, and 0.761, respectively. CONCLUSION The dentists in each specialty were few in number and were unequally distributed among the zones, but less so for oral surgeons and pedodontists. Dental anesthesiologists and radiologists were located primarily at university hospitals in urban areas and, therefore, were more unequally distributed.
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Affiliation(s)
- Y Okawa
- Department of Dental Hygiene, Faculty of Health Care Science, Chiba Pref ectural University of Health Sciences
| | - S Hirata
- Department of Social Dentistry, Tokyo Dental College
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22
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Tokuda T, Tamaki M, Kitamura H, Koyama Y, Sawada K, Kawaguchi Y, Konakano K, Okawa Y. A mycotic aortic aneurysm treated by thoracic endovascular aneurysm repair. J Surg Case Rep 2019; 2019:rjz288. [PMID: 31700602 PMCID: PMC6827553 DOI: 10.1093/jscr/rjz288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/19/2019] [Accepted: 08/28/2019] [Indexed: 11/15/2022] Open
Abstract
An 88-year-old man was admitted with general fatigue. Computed tomography (CT) showed a descending aortic aneurysm. The laboratory data indicated severe infection. Despite negative blood cultures, broad-spectrum intravenous antibiotic therapy was started. Though antibiotic therapy was continued for about 2 weeks, the aneurysm extended 20 mm. Thoracic endovascular aortic repair was performed, and antibiotic therapy was continued for 4 weeks after the procedure, followed by oral antibiotics for 1 year. CT showed regression of the aneurysm 15 months after reconstruction. Antibiotic therapy, preoperatively and postoperatively, is important for a mycotic aortic aneurysm.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Koshi Sawada
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Kazuya Konakano
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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23
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Motoji Y, Kato T, Kawamura I, Seki J, Tsumura K, Okawa Y, Tomita S. [Cardiac Tumor on All Cusps of the Aortic Valve;Report of a Case]. Kyobu Geka 2019; 72:630-633. [PMID: 31353358] [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: 06/10/2023]
Abstract
An 80-year-old woman was incidentally found to have a cardiac tumor on the aortic valve by echocardiography. Papillary fibroelastoma(PFE) was strongly suspected, and urgent operation was performed to prevent embolism. Two tumors were identified arising from the left and right cusps with wide stalks, and aortic valve replacement was performed. By pathological examination, the tumors were diagnosed as PFEs. A small tumor was also found on the non-coronary cusp, which was considered as possible PFE or Lambl's excrescence. In the case of multiple PFEs on one valve, valve replacement, instead of simple excision of tumors, should be considered.
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Affiliation(s)
- Yusuke Motoji
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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24
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Ogawa S, Maeda M, Hosoba S, Goto Y, Okawa Y. Management of Bilateral Partial Anomalous Pulmonary Venous Connection. Ann Thorac Surg 2018; 107:e309-e310. [PMID: 30403977 DOI: 10.1016/j.athoracsur.2018.09.047] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/28/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022]
Abstract
Bilateral partial anomalous venous connections are rare. Here, we present a patient who underwent the modified Warden procedure to reroute the superior vena cava with the partial anomalous veins to the left atrium and reconstruct the innominate vein and superior vena cava with a polytetrafluoroethylene conduit to the right atrial appendage. The procedure was successfully performed without using foreign materials in the pulmonary venous route. Furthermore, it prevented the obstruction of blood flow.
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Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
| | - Masanobu Maeda
- Ichinomiya Medical Treatment and Habilitation Center, Ichinomiya, Japan
| | - Soh Hosoba
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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25
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Kitamura H, Yamada S, Adachi T, Shibata K, Tamaki M, Okawa Y, Usui A. Effect of Perioperative Neuromuscular Electrical Stimulation in Patients Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial. Semin Thorac Cardiovasc Surg 2018; 31:361-367. [PMID: 30395965 DOI: 10.1053/j.semtcvs.2018.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Sumio Yamada
- Department of Health Science, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Shibata
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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26
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Tsunekawa T, Sawada M, Kato T, Motoji Y, Kinoshita T, Hirakawa A, Okawa Y, Tomita S. The Prevalence and Distribution of Occlusive Lesions of the Cerebral Arteries in Patients Undergoing Coronary Artery Bypass Graft Surgery. Semin Thorac Cardiovasc Surg 2018. [PMID: 29518536 DOI: 10.1053/j.semtcvs.2018.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/17/2022]
Abstract
Intracranial cerebral atherosclerosis is a significant predictor of stroke after coronary artery bypass grafting (CABG). However, there is limited information on intracranial occlusive lesions in patients undergoing CABG. The purpose of the study was to elucidate the precise prevalence and distribution of occlusive lesions of the extracranial and intracranial arteries in patients undergoing CABG. Between 2009 and 2016, 205 patients underwent preoperative magnetic resonance angiography and elective CABG. The prevalence and the distribution of occlusive lesions were retrospectively examined by preoperative magnetic resonance angiography. Association between postoperative central nervous system (CNS) complications and the occlusive lesions was analyzed. Fifty-six patients (27.3%) and 60 patients (29.3%) had occlusive lesions of the extracranial and intracranial arteries, respectively. Twenty-eight patients (13.7%) had both extracranial and intracranial occlusive lesions. Thirty-one (15.1%) and 45 (22.0%) patients had severe stenosis or occlusion of the extracranial and intracranial arteries, respectively. The intracranial internal carotid artery was the most commonly affected intracranial artery (60 vessels; 62.5%), followed by the middle cerebral arteries (20 vessels; 20.8%). Sixteen patients (7.8%) suffered from postoperative CNS complications, including 2 permanent strokes. The etiology of the stroke was attributable to a predefined intracranial lesion in 1 patient. In multivariate analysis, the presence of intracranial occlusive lesions was found to have an independent association with the development of CNS complications (odds ratio 4.05; 95% confidence interval 1.13-14.6). The prevalence of intracranial occlusive lesions was higher than that of extracranial lesions in patients undergoing CABG. There was a solid trend toward the anterior distribution of the intracranial occlusive lesions.
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Affiliation(s)
| | - Motoshi Sawada
- Department of Neurosurgery, Matsunami General Hospital, Gifu, Japan
| | - Takayoshi Kato
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Yusuke Motoji
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | | | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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27
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Tamaki M, Kitamura H, Kimura A, Okawa Y. Successful surgical repair of rapid growth infected mitral annular aneurysm caused by methicillin-resistant Staphylococcus aureus. Chirurgia (Bucur) 2017. [DOI: 10.23736/s0394-9508.17.04640-x] [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: 11/08/2022]
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28
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Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, Tsuchikane E, Suzuki T, Otsuka T, Kohsaka S, Tada N, Yamanaka F, Naganuma T, Araki M, Shirai S, Watanabe Y, Hayashida K, Yashima F, Inohara T, Kakefuda Y, Arai T, Yanagisawa R, Tanaka M, Kawakami T, Maekawa Y, Takashi K, Yoshitake A, Iida Y, Yamazaki M, Shimizu H, Yamada Y, Jinzaki M, Tsuruta H, Itabashi Y, Murata M, Kawakami M, Fukui S, Sano M, Fukuda K, Hosoba S, Sato H, Teramoto T, Kimura M, Sago M, Tsunaki T, Watarai S, Tsuzuki M, Irokawa K, Shimizu K, Kobayashi T, Okawa Y, Miyasaka M, Enta Y, Shishido K, Ochiai T, Yamabe T, Noguchi K, Saito S, Kawamoto H, Onishi H, Yabushita H, Mitomo S, Nakamura S, Yamawaki M, Akatsu Y, Honda Y, Takama T, Isotani A, Hayashi M, Kamioka N, Miura M, Morinaga T, Kawaguchi T, Yano M, Hanyu M, Arai Y, Tsubota H, Kudo M, Kuroda Y, Kataoka A, Hioki H, Nara Y, Kawashima H, Nagura F, Nakashima M, Sasaki K, Nishikawa J, Shimokawa T, Harada T, Kozuma K. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation 2017; 135:2013-2024. [DOI: 10.1161/circulationaha.116.025630] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [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: 09/22/2016] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
Abstract
Background:
The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.
Methods:
We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.
Results:
Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
P
=0.007), albumin (ρ=−0.22,
P
<0.001), gait speed (ρ=−0.28,
P
<0.001), and grip strength (ρ=−0.26,
P
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
P
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
P
<0.001).
Conclusions:
In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.
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Affiliation(s)
- Tetsuro Shimura
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Masanori Yamamoto
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Seiji Kano
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Ai Kagase
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Atsuko Kodama
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Yutaka Koyama
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Etsuo Tsuchikane
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Takahiko Suzuki
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Toshiaki Otsuka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Shun Kohsaka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Norio Tada
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Futoshi Yamanaka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Toru Naganuma
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Motoharu Araki
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Shinichi Shirai
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Yusuke Watanabe
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Kentaro Hayashida
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
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- Keio University School of Medicine, Tokyo, Japan
| | - Motoaki Sano
- Keio University School of Medicine, Tokyo, Japan
| | | | - Soh Hosoba
- Toyohashi Heart Center, Toyohashi, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yui Akatsu
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yosuke Honda
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Takuro Takama
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yugo Nara
- Teikyo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | - Ken Kozuma
- Teikyo University School of Medicine, Tokyo, Japan
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Tamaki M, Kitamura H, Koyama Y, Kimura A, Okawa Y. Left main coronary malperfusion from acute non-communicating aortic dissection. Gen Thorac Cardiovasc Surg 2017; 66:172-174. [PMID: 28386811 DOI: 10.1007/s11748-017-0772-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
Abstract
A 64-year-old man was admitted with sudden back and chest pain. He had undergone aortic valve replacement 5 years earlier. Enhanced computed tomography showed acute type A non-communicating aortic dissection. He was initially treated with supportive medical therapy. Since he was restless, he was placed on a respirator. He went into sudden shock 6 h after onset. Percutaneous cardiopulmonary support was administered, and coronary arteriography showed progression of the dissection to the left main trunk. Percutaneous coronary intervention was performed. He recovered from shock and then underwent ascending aorta replacement. He was discharged from hospital without any major complications.
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Affiliation(s)
- Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
| | - Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Arishige Kimura
- Department of Cardiovascular Surgery, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
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Goto Y, Koyama Y, Hosoba S, Ogawa S, Fukaya S, Okawa Y. Total arch replacement through a median sternotomy for Kommerell's diverticulum. Asian Cardiovasc Thorac Ann 2017; 26:615-618. [PMID: 28076961 DOI: 10.1177/0218492316688417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Kommerell's diverticulum with a right aortic arch and aberrant left subclavian artery is a rare anomaly, and the optimal operative strategy has not yet been established. In particular, the approach to the diverticulum is controversial, with the greatest concern being whether or not to add a right thoracotomy to the median sternotomy for distal anastomosis. We successfully performed total arch replacement through a median sternotomy only, by referring to preoperative computed tomography. We think that if the aneurysm is in a shallow position from the tracheal bifurcation, total arch replacement is possible with a midline incision only.
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Affiliation(s)
| | | | - Soh Hosoba
- 1 Toyohashi Heart Center, Toyohashi, Japan
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Ogawa S, Okawa Y, Sawada K, Goto Y, Hosoba S, Fukaya S. MicroRNA and hyperglycemic memory in the diabetic heart. J Thorac Dis 2017; 8:E1473-E1474. [PMID: 28066634 DOI: 10.21037/jtd.2016.11.68] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Koshi Sawada
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Soh Hosoba
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Syunsuke Fukaya
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Ogawa S, Okawa Y, Sawada K, Goto Y, Fukaya S, Suzuki T. Effect of dipeptidyl peptidase-4 inhibitor in patients undergoing bypass surgery. Asian Cardiovasc Thorac Ann 2016; 24:863-867. [DOI: 10.1177/0218492316677384] [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] [Indexed: 12/19/2022]
Abstract
Objectives Patients with diabetes mellitus often have more complicated postoperative courses and worse outcomes after coronary artery bypass grafting than those without this condition. Dipeptidyl-peptidase-4 inhibitors are a new class of oral medication for treating type 2 diabetes mellitus. We investigated how these drugs influence the postoperative course after coronary artery bypass in patients with type 2 diabetes mellitus. Methods We retrospectively reviewed the clinical records of 177 patients with type 2 diabetes who has undergone coronary artery bypass surgery between 2009 and 2013; 107 were treated with dipeptidyl-peptidase-4 inhibitors postoperatively, and 70 who did not receive dipeptidyl-peptidase-4 inhibitors served as a control group. The rates of overall survival and major adverse cardiac and cerebrovascular events were compared between groups. Results Analysis of all-cause deaths showed that survival at 4 years was 92.8% and 83.6%, respectively, for the treated and control groups ( p = 0.052). There was a lower incidence of major adverse cardiac and cerebrovascular events in the treated group (85.6% vs. 73.1%, p = 0.042). Cox regression analysis of the entire population revealed that dipeptidyl-peptidase-4 inhibitor use (hazard ratio 0.46, p = 0.048) and deep sternal wound infection (hazard ratio 11.89, p = 0.003) were independent predictors of major adverse cardiac and cerebrovascular events. Conclusions Dipeptidyl-peptidase-4 inhibitors reduced the incidence of major adverse cardiac and cerebrovascular events and improved the long-term prognosis after coronary artery bypass in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Koshi Sawada
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Syunsuke Fukaya
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Takahiko Suzuki
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Ogawa S, Okawa Y, Sawada K, Motoji Y, Goto Y, Kimura A, Tamaki M, Koyama Y, Yamamoto M, Otsuka T, Kato T, Fukaya S, Tsunekawa T, Kitamura H, Tomita S, Suzuki T. Impact of glucose control on early vein graft failure after coronary artery bypass grafting: one-month angiographic results. Interact Cardiovasc Thorac Surg 2016; 24:216-221. [DOI: 10.1093/icvts/ivw343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 09/02/2016] [Indexed: 01/20/2023] Open
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Okawa Y, Obata T, Kobayashi H, Ohno T. Influence of the degree of freedom in molecular motion in gelatin gelation. The Imaging Science Journal 2016. [DOI: 10.1080/13682199.2000.11784360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kato T, Tsunekawa T, Motoji Y, Hirakawa A, Okawa Y, Tomita S. The side-to-side fashion for individual distal coronary anastomosis using venous conduit. Heart Vessels 2016; 32:385-389. [PMID: 27631536 DOI: 10.1007/s00380-016-0890-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Abstract
Regarding to coronary artery bypass grafting (CABG), the end-to-side anastomosis (ESA) has been performed as a gold standard. Recently, the effectiveness of the distal side-to-side anastomosis (SSA) in CABG using internal mammary artery has been reported. The benefit of SSA comparing to ESA also has been disclosed by computing simulation. However, use of SSA by venous conduit for individual CABG has not been reported. In this study, we investigated feasibility of SSA. From January 2013 to October 2014, we conducted 114 CABGs. There were 92 venous distal anastomoses without sequential anastomotic site (61 SSA and 31 ESA). The anastomosis was evaluated before discharge and at 1 year after the procedure by angiography or multi-detector row computed tomographic coronary angiography. The median values for time to anastomosis were 13 min in the two group (p = 0.89). There was no revision of anastomosis in both groups. Additional stitches for hemostasis were required significantly less in SSA than ESA (18.0 vs 45.2 %, respectively, p < 0.05). Early angiographic patency; 96.6 % for SSA vs 93.5 % for ESA (p = 0.50), and percentage of good anastomotic figure; 91.2 % for SSA vs 87.1 % for ESA (p = 0.54) were similar in both groups. The angiographic patency at 1 year were 92.9 % for SSA and 81.0 % for ESA (p = 0.16). There was no predictive factor for early and late graft failure. Our study showed feasibility of SSA using venous conduit in individual CABG based on early and mid-term angiographic results. This anastomotic fashion is easy to perform and maybe beneficial in blood flow pattern.
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Affiliation(s)
- Takayoshi Kato
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, Gifu, 500-8384, Japan.
| | - Tomohiro Tsunekawa
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, Gifu, 500-8384, Japan
| | - Yusuke Motoji
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, Gifu, 500-8384, Japan
| | - Akihiro Hirakawa
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, Gifu, 500-8384, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, Gifu, 500-8384, Japan
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Kanegae M, Kou S, Okawa Y, Kobayashi H, Ohmo T, Ohki T, Kitayama T. Ultrasonic Degradation of High Molecular Weight Components of Gelatin. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/00223638.1992.11737203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kobayashi T, Ohno T, Isono Y, Okawa Y, Kobayashi H, Asano H. On the Rates of Gelation and the Setting Points of Gelatin Solutions. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/00223638.1992.11737201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Itoh M, Okawa Y, Kobayashi H, Ohno T, Okamotot Y, Katoh T. The Effect of the Thermal History on the Gelation of Gelatin solution. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/00223638.1994.11738542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kobayashi T, Ohno T, Kobayashi H, Okawa Y, Endo C, Hongo T. Study on the Gelling Behaviour of Low Concentration Gelatin Solutions in the Cooling Process. The Imaging Science Journal 2016. [DOI: 10.1080/13682199.1997.11736408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kitamura H, Kimura A, Okawa Y, Maeda M. Fate of Hancock valve in tricuspid position 36 years after implantation. Gen Thorac Cardiovasc Surg 2016; 64:636-7. [PMID: 27369546 DOI: 10.1007/s11748-016-0683-7] [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: 05/11/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
Mid- to long-term durability of bioprosthesis in tricuspid position is acceptable. However, little is known about more extended long-term structural valve changes of Hancock valve. In present report, we describe Hancock valve images 36 years after implantation.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
| | - Arishige Kimura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Sunadabashi 1-1-14, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Masanobu Maeda
- Department of Cardiac Surgery, Aichi Children's Health and Medical Center, Obu, Japan
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Abstract
Mobile abnormal structures in the aortic valve are difficult to diagnose in some cases. We describe a rare clinical case of fibrous strand rupture in a dialysis patient, which was surgically treated. Preoperative echocardiography showed a mobile structure attached to the noncoronary cusp, and intraoperative findings revealed rupture of the fibrous strand in this cusp. If aortic regurgitation without obvious cause is noted in cases of abnormal mobile structures, fibrous strand rupture could be a differential diagnosis.
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Affiliation(s)
- Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Koshi Sawada
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Shimizu K, Yamamoto M, Koyama Y, Kodama A, Sato H, Kano S, Teramoto T, Kimura M, Sawada K, Goto Y, Ogawa S, Baba H, Tsuchikane E, Okawa Y, Suzuki T. Usefulness of routine aortic valve calcium score measurement for risk stratification of aortic stenosis and coronary artery disease in patients scheduled cardiac multislice computed tomography. Int J Cardiol Heart Vasc 2015; 9:95-99. [PMID: 28785716 PMCID: PMC5497337 DOI: 10.1016/j.ijcha.2015.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 10/07/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
Abstract
Objectives This study sought to investigate the clinical utility of aortic valve calcium score (AVCS) determined by using cardiac multislice computed tomography (MSCT). Methods Data of 1315 consecutive patients who underwent both conventional echocardiography and MSCT were reviewed. Degree of aortic stenosis (AS) was assessed according to mean pressure gradient (mPG) measured by echocardiography. Extent of coronary artery disease (CAD) derived by MSCT also was evaluated in 1173 patients who did not undergo prior coronary treatment. Both AVCS and coronary calcium score (CCS) were defined by Agatston units (AU) according to MSCT findings. Results A total of 613 of 1315 patients were defined as AVCS positive (mean, 100 AU [range, 31.0–380.0 AU]). AVCS showed significant correlations with mPG (Spearman's ρ = 0.81, p < 0.001), and CCS (ρ = 0.53, p < 0.001). Differential adequate cut-off values of AVCS were proved for predicting severe AS with mPG ≥ 40 mmHg (1596.5 AU; AUC, 0.88; sensitivity, 89.7%; specificity, 77.0%), and for predicting moderate AS with mPG ≥ 20 mmHg (886.5 AU; area under the curve [AUC], 0.91; sensitivity, 92.4%; specificity, 78.3%). Mean AVCS was higher with increased extent of CAD (none, 0 AU [range, 0–30 AU]; single vessel, 8.5 AU [range, 0–104 AU]; multivessel, 142 AU [range, 10–525 AU]; p < 0.001). The optimal cut-off value of AVCS for predicting multivessel disease was 49 AU (AUC, 0.77; sensitivity, 68.8%; specificity, 78.0%). Conclusions AVCS might be a surrogate marker not only for AS grading but also for CAD progression. Therefore, routine AVCS assessment could be useful for risk stratification.
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Affiliation(s)
- Kazuki Shimizu
- Department of Radiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Masanori Yamamoto
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Atsuko Kodama
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Hirotomo Sato
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Seiji Kano
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Tomohiko Teramoto
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Masashi Kimura
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Koshi Sawada
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Shinji Ogawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Hiroshi Baba
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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Ogawa S, Okawa Y, Sawada K, Goto Y, Yamamoto M, Koyama Y, Baba H, Suzuki T. Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis. Eur J Cardiothorac Surg 2015; 49:420-6. [PMID: 25825261 DOI: 10.1093/ejcts/ezv106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Received: 11/02/2014] [Accepted: 02/24/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA. METHODS The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed. The study population consisted of 95 patients who received CIT and 126 patients who received IST. Furthermore, a one-to-one matched analysis based on estimated propensity scores for patients who received CIT or IST yielded two groups comprising 58 patients each. The proportion of patients with DSWI, overall survival rates and major adverse cardiac events were compared between the two groups in the overall and the propensity-matching cohort. RESULTS The prevalence of DSWI requiring debridement and closure was significantly reduced in the CIT group compared with that in the IST group [1/95 (1.1%) vs 9/126 (7.1%), P = 0.031]; these results were not attenuated even after propensity-matching analysis [0/58 (0%) vs 6/58 (10.3%), P = 0.031]. The mean preoperative glucose levels were similar between the two groups (157.5 ± 54.6 vs 176.1 ± ±70 mg/dl, P = 0.063), whereas the mean glucose values were significantly lower on the first and second operative days in the CIT group than in the IST group (132.9 ± 44.1 vs 197.8 ± 78.6 mg/dl, P < 0.0001; 153.5 ± 58.8 vs 199.6 ± 89.1 mg/dl, P < 0.0001, respectively). The glucose variability levels within 24 h postoperatively were significantly higher in the IST group (46.1 ± 19.4 vs 66.4 ± 26.8 mg/dl, P < 0.0001). The 30-day and 1-year survival rates were similar between the two groups (100 vs 99.2%, P = 0.384; 96.6 vs 94.4%, P = 0.454). No results were changed in the propensity-matching models. CONCLUSIONS The CIT approach reduced the variability in glucose concentration and resulted in fewer instances of DSWI after CABG with BIMA grafts.
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Affiliation(s)
- Shinji Ogawa
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Koshi Sawada
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | | | - Yutaka Koyama
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Hiroshi Baba
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Takahiko Suzuki
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Koyama Y, Goto Y, Ogawa S, Baba H, Okawa Y. [Excision of a left atrial myxoma through right minithoracotomy in a patient with multiple myeloma; report of a case]. Kyobu Geka 2014; 67:1195-1197. [PMID: 25434550] [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: 06/04/2023]
Abstract
We present a case of a 63-year-old female who underwent an excision of a left atrial myxoma. Previously, she had been diagnosed with multiple myelomas and received radiation therapy and chemotherapy. A left atrial myxoma was found at an annual medical check-up. The myxoma was removed via a right minithoracotomy with peripheral cannulation to minimize bleeding complications and surgical site infection. She was transferred to the referring hospital on postoperative day 7 due to recurrence of multiple myelomas. She was doing well 14 months after the operation. Right minithoracotomy is a useful approach to minimizing the risks of bleeding and infection in patients with multiple myelomas.
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Affiliation(s)
- Yutaka Koyama
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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47
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Koyama Y, Sawada K, Goto Y, Ogawa S, Baba H, Okawa Y. Early and mid-term results of isolated aortic valve replacement for aortic stenosis in octogenarians. Gen Thorac Cardiovasc Surg 2014; 63:216-21. [PMID: 25399410 DOI: 10.1007/s11748-014-0498-3] [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: 09/28/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE As transcatheter aortic valve implantation (TAVI) may become a potential treatment for high-risk patients with aortic stenosis (AS), evaluation of outcomes after open aortic valve replacement (AVR) in elderly patients is warranted. We documented early and late outcomes after isolated AVR in octogenarians compared with younger age groups. METHODS From January 2007 to December 2012, 136 patients underwent isolated AVR for AS (mean age 71.3 years, 39% males) and were classified into two groups (octogenarians and non-octogenarians). Twenty-four percent were aged 80 years or older. Forty-six percent of all patients were in New York Heart Association functional class III-IV. The estimated Society of Thoracic Surgeons and Japan operative mortalities were 3.4 and 2.5%, respectively. RESULT The 30-day mortality was 0%. One in-hospital death occurred from low output syndrome and congestive heart failure in the non-octogenarian group. Postoperative morbidity was not statistically significant different between the age groups. All of the patients-with the exception of one case of in-hospital death and one patient who was transferred to another hospital-were discharged (postoperative length of stay, 16.4 days). The actuarial survival for 3 years by age group was 89.8% in octogenarians compared with 93.2% in non-octogenarians. CONCLUSION Recent results show that isolated AVR for severe AS can be performed with a low operative mortality and morbidity regardless of age. TAVI may be an alternative for high-risk patients, but isolated AVR remains the standard intervention for AS even in increased age.
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Affiliation(s)
- Yutaka Koyama
- Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobutori, Oyama-cho, Toyohashi, Aichi, 441-8530, Japan,
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Abstract
OBJECTIVES Atrial fibrillation after cardiac surgery is associated with increases in the risk of complications, length of intensive care unit stay, and cost of care. Beta blockers are effective for controlling myocardial ischemia and arrhythmia and suppressing inflammatory cytokines. The purpose of this study was to examine the effect of administrating a short-acting beta-adrenoceptor antagonist, landiolol, on postoperative atrial fibrillation. METHODS 136 patients undergoing off-pump coronary artery bypass grafting were single-blindly assigned randomly to landiolol (n = 68) and non-landiolol (control, n = 68) groups. In the landiolol group, the beta blocker was administered from the beginning of the operation until postoperative day 2. The primary endpoint was the incidence of atrial fibrillation until postoperative day 7, and the secondary endpoints were the postoperative levels of troponin I, creatine kinase MB-isoenzyme, and C-reactive protein. RESULTS The incidence of atrial fibrillation was significantly lower in the landiolol group compared to the control group (13/68, 19% vs. 25/68, 37%, p = 0.02, logrank test). Landiolol also significantly reduced the postoperative peak C-reactive protein level compared to the control group (132 ± 55.4 vs. 161 ± 50.9 mgċL(-1), p = 0.004). CONCLUSION Low-dose continuous infusion of landiolol reduced the incidence of postoperative atrial fibrillation, and significantly suppressed inflammation.
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Affiliation(s)
- Shinji Ogawa
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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49
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Kato T, Tomita S, Tamaki M, Okawa Y. Aneurysm of the sinus of Valsalva dissecting into the intraventricular septum. Asian Cardiovasc Thorac Ann 2014; 24:172-4. [PMID: 25178471 DOI: 10.1177/0218492314549585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aneurysm of the sinus of Valsalva is an uncommon entity and especially rare when it dissects into the intraventricular septum. This uncommon clinical manifestation often takes a drastic clinical course with life-threatening arrhythmia, coronary ischemia, rupture, and heart failure. We present the case of a 36-year-old man with an aneurysm of the sinus of Valsalva dissecting into the intraventricular septum, which induced severe aortic insufficiency and heart block.
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Affiliation(s)
- Takayoshi Kato
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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50
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Ranga A, Gobaa S, Okawa Y, Mosiewicz K, Negro A, Lutolf MP. 3D niche microarrays for systems-level analyses of cell fate. Nat Commun 2014; 5:4324. [PMID: 25027775 PMCID: PMC4104440 DOI: 10.1038/ncomms5324] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 06/08/2014] [Indexed: 01/10/2023] Open
Abstract
The behaviour of mammalian cells in a tissue is governed by the three-dimensional (3D) microenvironment and involves a dynamic interplay between biochemical and mechanical signals provided by the extracellular matrix (ECM), cell-cell interactions and soluble factors. The complexity of the microenvironment and the context-dependent cell responses that arise from these interactions have posed a major challenge to understanding the underlying regulatory mechanisms. Here we develop an experimental paradigm to dissect the role of various interacting factors by simultaneously synthesizing more than 1,000 unique microenvironments with robotic nanolitre liquid-dispensing technology and by probing their effects on cell fate. Using this novel 3D microarray platform, we assess the combined effects of matrix elasticity, proteolytic degradability and three distinct classes of signalling proteins on mouse embryonic stem cells, unveiling a comprehensive map of interactions involved in regulating self-renewal. This approach is broadly applicable to gain a systems-level understanding of multifactorial 3D cell-matrix interactions.
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Affiliation(s)
- A Ranga
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
| | - S Gobaa
- 1] Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland [2]
| | - Y Okawa
- 1] Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland [2]
| | - K Mosiewicz
- 1] Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland [2]
| | - A Negro
- 1] Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland [2]
| | - M P Lutolf
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne 1015, Switzerland
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