記述言語：英語   掲載種別：研究論文（学術雑誌）  

Nonbacterial thrombotic endocarditis (NBTE) on the aortic valve involves fibrin and platelet aggregate formation, potentially leading to embolic events. We present a case of NBTE on the aortic valve following coronary angiography (CAG) in a 54-year-old man with multiple comorbidities. Surgical thrombectomy was performed owing to acute cerebral infarcts. This case highlights the significance of considering that mechanical trauma from catheterization during CAG can trigger thrombus formation.

DOI： 10.1093/jscr/rjae212

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study investigates short-term outcomes following surgical interventions for atrial fibrillation (Af), including the Cox-maze Ⅳ procedure (maze procedure) and pulmonary vein isolation (PVI), performed concurrently with other cardiac surgeries. Additionally, we aim to determine the indications for surgical intervention for Af. METHOD: We retrospectively studied a total of 1,580 patients, out of which 274 had preoperative Af, that underwent cardiac surgery between January 2015 and April 2023. Patients who underwent emergency surgery, died in the hospital postoperatively, or received pacemaker implantation were excluded. Patients were first divided into two groups:the intervention group (n=135, 53.6%) and the non-intervention group( n=117, 46.4%), further categorized by whether they were in sinus rhythm at discharge. The intervention group was then subdivided into the maze procedure group( n=54), and the PVI group (n=76). RESULTS: Within the maze procedure group, significant differences were observed between the sinus rhythm and non-sinus rhythm groups in terms of age, preoperative Af duration, and aortic valve intervention status. In the PVI group, patients with persistent Af, longer preoperative Af duration, and larger left atrium diameter( LAD) were less likely to return to sinus rhythm. Smaller LAD was also a significant factor for returning to sinus rhythm in the non-intervention group. Multivariate analysis for all patients revealed that an LAD smaller than 50 mm was the strongest predictor for returning to sinus rhythm post operation( p<0.01). CONCLUSION: For patients with persistent Af, the maze procedure is favored over PVI as a surgical intervention. When LAD exceeds 50 mm, the likelihood of returning to sinus rhythm is diminished.

PubMed

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記述言語：日本語   出版者・発行元：北海道外科学会  

気管切開術後の患者に対し,小切開低侵襲心臓手術(MICS ;Minimally invasive cardiac surgery)は創部感染予防の点から有効な治療法の一つである。症例は70代男性。僧帽弁閉鎖不全症に伴った急性心不全の診断にて,他院で加療中であった。心不全の増悪を認め,気管切開ののち当院循環器内科に紹介となった。当初はMitra Clipによる治療を行う予定であったが,入院後に39-40度の発熱が持続。感染性心内膜炎の可能性を否定できないため外科的治療の方針となった。MICSを用いた右小開胸下僧帽弁形成術が行われ、術後経過は良好であった。MICSを用いることで気管切開後の患者に対して低侵襲に外科的治療を行うことができ,創部感染の危険性を低減できる可能性が示唆された。

DOI： 10.60440/hokkaidojsurg.69.1_30

CiNii Books

CiNii Research

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I033684816

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The minimally invasive cardiac surgery off-pump coronary artery bypass (MICSOPCAB) is technically difficult; therefore, previous studies have indicated that MICSOPCAB should be contraindicated in patients with impaired left ventricular (LV) function. In this study, we investigated the feasibility of MICSOPCAB in patients with impaired LV function. METHODS: The 226 patients underwent MICSOPCAB between August 2017 and September 2022. Our study defined impaired LV function as ejection fraction (EF) in echocardiography 40% or less. The patients were divided into Low EF group (n = 39) and Normal EF group (n = 187). RESULTS: The Low EF group was in a more critical preoperative condition than Normal EF group (41.0% in the Low EF group vs. 14.4% in the Normal EF group; p < 0.001). For preoperative transthoracic echocardiography, LV end-diastolic diameter (5.5 ± 0.9 cm in the Low EF group vs. 5.0 ± 0.8 cm in the Normal EF group; p < 0.001) and LV end-systolic diameter (4.4 ± 1.0 cm in the Low EF group vs. 3.4 ± 1.0 cm in the Normal EF group; p < 0.001) were significantly larger in the Low EF group. No differences were found in the operative time (180 [160-240] min in the Low EF group vs. 205 [165-253] min in the Normal EF group; p = 0.231) and the median number of distal anastomoses (2 [1-2] in the Low EF group vs. 2 [1-3] in the Normal EF group; p = 0.073). Intensive care unit stay was longer in the Low EF group than in the Normal EF group (2 [1-2] in the Low EF group vs. 1 [1-2] in the Normal EF group; p = 0.010). Perioperative transfusion was more common in the Low EF group than in the Normal EF group (69.7% vs. 49.2%; p = 0.023). There were no differences in major complications, hospital stay, and 30-day mortality. The Kaplan-Meier curve showed no significant difference in postoperative major adverse cardiac or cerebrovascular events rates between the two groups (p = 0.185). CONCLUSION: In this study, MICSOPCAB can be performed in patients with low EF having short- and mid-term outcomes similar to patients with normal EF. Therefore, low EF should not be contraindicated in MICSOPCAB.

DOI： 10.3389/fsurg.2024.1324343

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: At our institution, we perform off-pump coronary artery bypass (OPCAB) as a standard procedure. Moreover, patients with favorable coronary anatomy and condition are selected for minimally invasive cardiac surgery (MICS)-OPCAB. We retrospectively compared early outcomes, focusing on safety, between MICS-OPCAB and conventional off-pump techniques for multivessel coronary artery bypass grafting (CABG). METHODS: From August 2017 to September 2022, 1,220 patients underwent multivessel coronary artery grafting at our institution. They were divided into the MICS-OPCAB group (MICS group = 163 patients) and the conventional OPCAB group (MS group = 1057 patients). Propensity score matching (1 : 1 ratio) was applied to the MICS-OPCAB and MS groups (149 patients per group) based on 23 preoperative clinical characteristics. RESULTS: After matching, there were no significant differences in preoperative characteristics between the groups. The MICS group had a lower total graft number (2.3 ± 0.6 vs. 2.9 ± 0.8, p < 0.001) and fewer distal anastomoses (2.7 ± 0.8 vs. 3.2 ± 0.9, p < 0.001). There were no significant differences in hospital stay, intensive care unit stay, postoperative complications, and 30-day mortality. The MICS group had less drain output (MICS 350 ml [250-500], MS 450 ml [300-550]; p = 0.013). Kaplan-Meier analysis revealed no significant differences in postoperative MACCE (major adverse cardiac or cerebrovascular events)-free and survival rates between the groups (MACCE-free rate p = 0.945, survival rate p = 0.374). CONCLUSION: With proper patient selection, MICS-OPCAB can provide good short to mid-term results, similar to those of conventional OPCAB.

DOI： 10.3389/fcvm.2024.1391881

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: This study aims to clarify the good inflow site for saphenous vein grafts (SVG) in minimally invasive off-pump coronary artery bypass grafting (mini-CABG), between the ascending aorta, the internal thoracic arteries (ITAs) and the left axillary artery (LAA). METHODS: This retrospective study included 126 patients who underwent Mini-CABG at our center between January 2014 and July 2023. Patients were divided into three groups according to the SVG inflow site for patency comparison: Aorta group (n = 56), LAA group (n = 23), and ITA group (n = 47). RESULTS: There were 84 males, with mean age of 65.9 ± 7.0 years. There were no significant differences in preoperative characteristics between groups. Mean operation times were 254.6 ± 72.2, 213.7 ± 57.6, and 253.0 ± 81.2 min, and the average numbers of distal anastomoses were 2.9 ± 0.9, 2.4 ± 0.7 and 2.9 ± 1.1 in the Aorta, ITA and LAA groups respectively. Days in intensive care, hospital stay, and major complications did not differ between the groups. Early patency of SVG did not significantly differ among groups: 93.0% in the Aorta group, 98.0% in the ITA group, and 100% in the LAA group. Mean follow-up period was 136.7 ± 295.7 days, and follow-up coronary CTA revealed 18 SVG occlusions (Aorta group n = 8, ITA group n = 5, LAA group n = 5). The Kaplan-Meier curve for SVG patency rates did not show any significant differences among the three groups. CONCLUSION: The ascending aorta, the ITAs, and the LAA serve as reliable inflow sites with similar results in mini-CABG.

DOI： 10.3389/fcvm.2024.1397396

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The procedure called the "aorta no-touch" (NT) or anaortic technique in off-pump coronary artery bypass grafting (OPCAB) is designed to reduce the perioperative risk of stroke. We have observed an increased frequency of anaortic OPCAB procedures at our institution. The main purpose of the present study is to investigate the effectiveness of anaortic OPCAB in reducing the perioperative risk of stroke. METHODS: From April 2011 to July 2023, a total of 2,236 patients underwent isolated OPCAB at our single center. The patients were divided into the anaortic group (NT, n = 762) and the aortic group (A, n = 1,474). The NT group was propensity score-matched (PSM) with the A group at a 1:1 ratio (NT n = 640; A n = 640), and matching was performed based on 26 covariates with preoperative clinical characteristics. RESULTS: In both the unmatched and matched cohorts of the NT and A groups, there were no significant differences observed in new stroke rates (NT vs. A; unmatched, 1.0% vs. 1.2%, p = 0.624; matched, 0.9% vs. 1.3%, p = 0.789). The univariable logistic analysis did not identify the anaortic technique as an independent factor negatively associated with new stroke events (OR = 0.81, 95% CI = 0.35-1.86, p = 0.624). CONCLUSION: The present study did not find the anaortic technique to reduce the perioperative risk of stroke in OPCAB. Hence, further large studies are needed to identify patient cohorts in which anaortic OPCAB is significantly beneficial.

DOI： 10.3389/fcvm.2024.1393921

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although total arch replacement would be performed in a patient with acute type A aortic dissection and concomitant aortic aneurysm in the distal aortic arch, total arch replacement may be too invasive in elderly patients with significant morbidities. A 92-year-old female with acute type II DeBakey aortic dissection and concomitant distal aortic arch aneurysm was successfully treated with hemi-arch replacement followed by thoracic endovascular aortic repair. Hybrid two-stage repair of DeBakey type II aortic dissection complicated by distal arch aneurysm using thoracic endovascular aortic repair after hemi-arch replacement may be effective.

DOI： 10.1093/jscr/rjad648

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cases that are inoperable owing to poor preoperative conditions are sometimes encountered. However, there are some cases that are led to radical treatment by performing bridge therapy. Here, we presented a case of a patient with complex cardiac disease in an inoperable state who underwent bridging therapy that led to successful surgical treatment. A 73-year-old male who received hemodialysis treatment and had severe aortic valve stenosis and coronary artery disease planned surgical treatment. However, he was deemed inoperable owing to his low cardiac function and hemodynamic instability. Therefore, to escape from a fatal condition, we first performed balloon aortic valvuloplasty and percutaneous coronary intervention as palliative procedures. Subsequently, his cardiac function and hemodynamic stability remarkably improved; therefore, after 1 month, we performed a successful radical surgical treatment. Even in inoperable patients, bridging therapy leading to radical treatment is possible.

DOI： 10.59958/hsf.5779

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Minimally invasive mitral valve surgery (MIMVS) is widespread and has become a standard procedure in cardiac surgery [Chitwood 1997; Carpentier 1996]. Therefore, MIMVS is a common procedure for patients with degenerative disease [Raanani 2010; Iribarne 2010] as well. However, the safety of MIMVS in patients with rheumatic heart disease (RHD) has not thoroughly been investigated, due to the low prevalence of RHD in developed countries, where MIMVS is standardized [Miceli 2015]. Here, we investigated the safety of MIMVS for patients with RHD at Lampang Hospital in Thailand.

DOI： 10.1532/hsf.5391

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

With an incidence of 3 in 100 million, giant coronary artery aneurysm (CAA) with coronary artery fistula (CAF) is a very rare condition. To prevent rupture, giant CAA with CAF should be swiftly treated. We present a Jehovah's Witness patient with giant CAA and coronary-pulmonary artery fistula. We resected the giant CAA in one piece, while ligating the CAF, without allogeneic blood transfusion. Due to rarity of these conditions, many thoracic surgeons lack direct experience in its surgical procedures. Herein, we share footage of this surgery as an example of how to safely resect CAA with minimal bleeding.

DOI： 10.1055/s-0042-1757877

PubMed

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The best treatment for ventricular functional mitral regurgitation still remains unclear. Papillary muscle tugging approximation (PMTA) is a technique known to preserve function of the sub-valvular apparatus, keeping it functionally in synch with the left ventricle systolic and diastolic dynamics. Herein, we present a case of mitral valve replacement with PMTA in a patient with severely impaired left ventricular function 14 years post initial mitral valve repair, which significantly improved during a course of 4 years after the reoperation without any complications.

DOI： 10.1093/jscr/rjac339

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehab539

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education. METHODS: Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A). RESULTS: Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, p = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, p = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, p = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, p = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, p = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups. CONCLUSIONS: The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.

DOI： 10.1055/s-0040-1713354

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Coronary artery fistula (CAF) is a relatively rare congenital abnormality of the coronary arteries; typically, patients who undergo surgery for CAFs are relatively young because it is a congenital disease. Here we present a case of an aneurysmal coronary-to-pulmonary artery fistula rupture in a 96-year-old female. Considering her extreme high age and missing preoperative diagnostics, only local hemostasis without anatomical repair was performed but the patient is still doing well 1 year after the operation.

DOI： 10.1007/s11748-020-01488-y

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Transcatheter aortic valve replacement has become a popular choice for cases with severe aortic stenosis. However, when severe mitral regurgitation is comorbid in high-risk patients with severe aortic stenosis, therapeutic options must be weighed for each case. Here we present a very frail 88-year-old patient with severe aortic stenosis and severe mitral valve regurgitation who underwent a successful awake minimally invasive mitral valve repair after transcatheter aortic valve replacement.

DOI： 10.1055/s-0040-1718774

PubMed

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記述言語：日本語   出版者・発行元：北海道外科学会  

症例は70歳代女性、胸腹部大動脈瘤破裂で前医より緊急搬送された。クラウド型遠隔医療システムを用いて、前医にて撮像されたCTを転送し、患者到着前から治療戦略を決定することで迅速に手術を行うことができた。CTでは並列に起始する腹腔動脈(CA)、上腸間膜動脈(SMA)を巻き込み、腎動脈直上に及ぶ最大径78mmの大動脈瘤とその周囲への造影剤の漏出を認めた。大動脈造影にてCAより中枢側に破裂孔を認め、ステントグラフト(SG)をCA・SMA直上の瘤内に留置した。退院直前のCTにて瘤径の拡大を認めたため術後67日に胸腹部人工血管置換術を行った。術後肺炎を契機に敗血症を発症しSG挿入術から265日後に死亡した。手術前・周術期死亡率の高い本疾患において、クラウド型遠隔医療システムを用いることで迅速にSG挿入術を行い、破裂孔閉鎖を行うことができた。次の治療につなぐことが出来た点において胸腹部大動脈瘤破裂治療の選択肢になりうると考えられる。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01375&link_issn=&doc_id=20210115020012&doc_link_id=%2Fdc7hksrg%2F2020%2F006502%2F013%2F0164-0168%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2020%2F006502%2F013%2F0164-0168%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Unloading of the left ventricle (LV) is essential for the treatment of LV free-wall rupture (LVFWR), and it is well-known that the LV can be optimally unloaded with the Impella system. However, there has been no report on applying the Impella system for the treatment of LVFWR. Here, we report a patient with FWR after massive myocardial infarction who was successfully treated with non-suture repair via median sternotomy and implantation of Impella CP (Abiomed, Danvers, MA).

DOI： 10.1093/jscr/rjaa263

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pulmonary vein stenosis or occlusion is a rare but one of the most devastating complications after catheter ablation for cardiac arrhythmias, and surgical repair is an option in severe cases. The sutureless technique, which avoids direct suture of vessel walls, was initially described for congenital pulmonary vein stenosis and has been widely performed due to its good restenosis-free rate. CASE PRESENTATION: A 52-year-old male developed left pulmonary vein occlusion after catheter ablation for atrial fibrillation. The surgical repair with sutureless technique using the left atrial appendage was performed without any complications. Postoperative computed tomography demonstrated the revascularization of the pulmonary vein. CONCLUSIONS: The sutureless technique using the left atrial appendage is significantly reasonable particularly in case of left pulmonary vein stenosis or occlusion after catheter ablation for atrial fibrillation since it reduces the risks of restenosis and thromboembolism.

DOI： 10.1186/s40792-020-00930-w

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We experienced two cases of postoperative iatrogenic aorto-right atrial fistula (ARAF) after tricuspid valve repair (TVR) using minimally invasive cardiac surgery (MICS) technique. In both the cases, the flow of ARAF passed through the sinus of Valsalva near the noncoronary cusp (NCC)/right coronary cusp (RCC) commissure or NCC to right atrium. The quality of the fine needle used in the MICS technique may be inferior to that used in conventional surgery; ARAF after TVR could be a unique pitfall with the MICS technique.

DOI： 10.1055/s-0040-1718552

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hemoptysis after thoracic endovascular/open aortic repair is relatively rare but a well-known complication, and normally diagnosed with aortobronchial fistula (ABF). Here, we present a patient who suffered from recurrent massive hemoptyses even after multiple thoracic endovascular aortic repairs (TEVARs), where hemoptysis was ultimately controlled by pneumonectomy. In this case, the bleeding source was not the aorta but the lung parenchyma itself, indicating the importance of raising awareness that the cause of massive hemoptysis after TEVAR may not always be an ABF.

DOI： 10.1177/1179547620939078

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記述言語：英語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An emergency thoracic endovascular aortic repair (TEVAR) with zone 2 landing without revascularization of the left subclavian artery was performed due to the impending rupture of a distal arch aneurysm in an old patient presenting hemoptysis. Two months later, the patient had recurrent massive hemoptyses and continued after additional zone 0 TEVAR. The lung parenchyma was considered to be the bleeding source and transcatheter pulmonary artery embolization was performed, and the episodes of massive hemoptysis appeared to have ceased. However, the patient died of sudden recurrent massive hemoptysis 40 days later. Inflammation and/or infection of the lung parenchyma adjunct to the aortic aneurysm could be cause of fatal hemoptysis, and aggressive therapy such as lung resection should be considered in such patients.

DOI： 10.1177/1179547619896577

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開催年月日： 2022年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2022年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2022年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2022年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2021年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2021年6月

記述言語：日本語   会議種別：口頭発表（一般）  

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