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Ueda R, Esaki J, Tsubota H, Honda M, Kudo M, Nakatsuma K, Kato M, Okabayashi H. Impact of the Lumbar Arteries on Aneurysm Diameter and Type 2 Endoleak after Endovascular Aneurysm Repair. Ann Vasc Surg 2024; 100:138-147. [PMID: 38141967 DOI: 10.1016/j.avsg.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Prophylactic embolization of the inferior mesenteric artery (IMA) during endovascular aneurysm repair (EVAR) is recommended to prevent type 2 endoleak (T2EL). However, the impact of patent lumbar arteries (LAs) on T2ELs and aneurysm diameter has not been elucidated. METHODS Fifty-seven consecutive patients who underwent EVAR at our institution between January 2013 and September 2022 and whose IMA had been occluded preoperatively or newly occluded postoperatively were included in the study. Predictive factors for aneurysm sac enlargement, sac shrinkage, and T2EL were investigated. RESULTS T2ELs occurred in 22.8% of the patients. The 4-year cumulative incidence rates of sac enlargement and shrinkage were 6.7% and 64.6%, respectively. The number of postoperative patent LAs was identified as a risk factor for T2ELs (95% confidence interval [CI]: 1.54-12.7, P = 0.0065). The number of postoperative patent LAs was found to be a significant predictor of sac enlargement (adjusted hazard ratio [AHR] 3.15, 95% CI: 1.43-6.96, P = 0.0045) and shrinkage (AHR 0.63, 95% CI: 0.43-0.91, P = 0.014). CONCLUSIONS The current study demonstrated that the number of postoperative patent LAs had a significant impact on the development of T2ELs and the change in aneurysm diameter in patients in whom the IMA was occluded after EVAR.
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Affiliation(s)
- Ryoma Ueda
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan.
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Hideki Tsubota
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masanori Honda
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masafumi Kudo
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Hitoshi Okabayashi
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
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Taniguchi T, Morimoto T, Yamaji K, Shirai S, Ando K, Shiomi H, Takeji Y, Ohno N, Kanamori N, Yamazaki F, Koyama T, Kim K, Ehara N, Furukawa Y, Komiya T, Iwakura A, Shirotani M, Esaki J, Sakaguchi G, Fujii K, Nakayama S, Mabuchi H, Tsuneyoshi H, Eizawa H, Shiraga K, Hanyu M, Nakano A, Ishii K, Tamura N, Higashitani N, Kouchi I, Yamada T, Nishizawa J, Jinnai T, Morikami Y, Minatoya K, Kimura T. Life Expectancy of Patients With Severe Aortic Stenosis in Relation to Age and Surgical Risk Score. Ann Thorac Surg 2023; 116:1195-1203. [PMID: 36739072 DOI: 10.1016/j.athoracsur.2023.01.028] [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: 10/16/2022] [Revised: 12/28/2022] [Accepted: 01/14/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a paucity of data regarding shorter life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). METHODS Among 3815 patients with severe AS enrolled in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry, there were 1469 patients (initial AVR: n = 647; conservative strategy: n = 822) with low surgical risk, 1642 patients (initial AVR: n = 433; conservative strategy: n = 1209) with intermediate surgical risk, and 704 patients (initial AVR: n = 117; conservative strategy: n = 587) with high surgical risk. Among 1163 patients who actually underwent surgical AVR as the initial strategy, patients were divided into 4 groups according to age <65 years (n = 185), 65 to 74 (n = 394), 75 to 80 (n = 345), and >80 (n = 239). The expected survival of the general Japanese population was obtained from the Statistics Bureau of Japan. The surgical risk was estimated using The Society of Thoracic Surgery (STS) score. RESULTS The median follow-up was 3.7 years. The cumulative incidences of all-cause death were significantly lower in the initial AVR strategy than in the initial conservative strategy across the 3 STS groups. Shorter life expectancy after surgical AVR was seen especially in younger patients. The observed mortality in low-risk patients was comparable to the expected mortality across all the age-groups, while intermediate-risk patients aged <75 years, and high-risk patients across all age-groups had higher mortality compared with the expected mortality. CONCLUSIONS The risk stratification according to age and STS score might be useful to estimate shorter life expectancy after AVR, and these findings have implications for decision making in the choice of surgical or transcatheter AVR.
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Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Kanamori
- Department of Cardiovascular Medicine, Shimada General Medical Center, Shimada, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri City, Japan
| | - Manabu Shirotani
- Department of Cardiovascular Medicine, Kindai University Nara Hospital, Nara, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, West Kyoto, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Hospital, Osaka Sayama City, Japan
| | - Kosuke Fujii
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiovascular Medicine, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Eizawa
- Department of Cardiovascular Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, Kyoto Medical Center, Kyoto Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan
| | - Akira Nakano
- Department of Cardiovascular Medicine, Hikone Municipal Hospital, Hikone, Japan
| | - Katsuhisa Ishii
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital, Fukushima, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Nobuya Higashitani
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Ichiro Kouchi
- Department of Cardiovascular Medicine, Saiseikai Noe Hospital, Osaka, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga General Hospital, Shiga, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu City, Japan
| | - Toshikazu Jinnai
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Yuko Morikami
- Department of Cardiovascular Medicine, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Watanabe H, Yamamoto K, Shiomi H, Morimoto T, Kato E, Matsumura Y, Nakatsuma K, Takeji Y, Yaku H, Yamamoto E, Yamashita Y, Yoshikawa Y, Fuki M, Yamaji K, Ehara N, Sakamoto H, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3. PLoS One 2022; 17:e0267906. [PMID: 36174029 PMCID: PMC9521921 DOI: 10.1371/journal.pone.0267906] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Aims There is a scarcity of studies comparing percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) with coronary artery bypass grafting (CABG) in patients with multi-vessel coronary artery disease. Methods and results The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04–1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96–1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79–1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05–2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06–3.43, P<0.0001). Conclusions In this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD.
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Affiliation(s)
- Hiroki Watanabe
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Eri Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukiko Matsumura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Fuki
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan
| | - Kenji Ando
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
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Yamaji K, Shiomi H, Morimoto T, Matsumura-Nakano Y, Ehara N, Sakamoto H, Takeji Y, Yoshikawa Y, Yamamoto K, Kato ET, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Domei T, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG Registry. JACC Asia 2022; 2:294-308. [PMID: 36411876 PMCID: PMC9675601 DOI: 10.1016/j.jacasi.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization. OBJECTIVES This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions. METHODS The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke. RESULTS With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P interaction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction. CONCLUSIONS The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
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Affiliation(s)
- Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eri T. Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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5
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Nakane T, Esaki J, Ueda R, Honda M, Okabayashi H. Inhaled nitric oxide improves pulmonary hypertension and organ functions after adult heart valve surgeries. Gen Thorac Cardiovasc Surg 2021; 69:1519-1526. [PMID: 34033007 DOI: 10.1007/s11748-021-01651-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Pulmonary hypertension during cardiac surgery is associated with increased morbidity and mortality. Inhaled nitric oxide serves as a selective pulmonary vasodilator and has other potential extrapulmonary protective roles. Its effects on pulmonary hypertension and organ functions after adult valve surgeries were evaluated. METHODS From April 2017 to March 2000, 30 patients received inhaled nitric oxide therapy for pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery (iNO group). The group was compared with a control group of 65 patients who developed pulmonary hypertension during weaning from cardiopulmonary bypass in valvular surgery and received conventional therapy from April 2014 to March 2017. Intraoperative hemodynamic changes and postoperative Sequential Organ Failure Assessment (SOFA) score were evaluated. RESULTS The inhalation of nitric oxide lowered the pulmonary-to-systemic pressure ratio (Pp/Ps) (p < 0.0001) in the iNO group, and this ratio after the inhalation was significantly lower than that in the control group (p = 0.015). Moreover, norepinephrine requirement was lower in the iNO group than in the control group (p = 0.0060). The SOFA total scores, respiratory scores, coagulation scores, and the increase of renal scores within postoperative 2 days were lower in the iNO group than in the control group (p < 0.0001, p = 0.0002, p = 0.0013, and p = 0.037). CONCLUSIONS Inhaled nitric oxide therapy ameliorated pulmonary hypertension and improved postoperative respiratory, coagulation, and renal functions in adult valve surgeries.
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Affiliation(s)
- Takeichiro Nakane
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan.
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Ryoma Ueda
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Masanori Honda
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Hitoshi Okabayashi
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto, 615-8087, Japan
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6
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Matsumura-Nakano Y, Shiomi H, Morimoto T, Yamaji K, Ehara N, Sakamoto H, Takeji Y, Yoshikawa Y, Yamamoto K, Imada K, Tada T, Taniguchi R, Nishikawa R, Tada T, Uegaito T, Ogawa T, Yamada M, Takeda T, Eizawa H, Tamura N, Tambara K, Suwa S, Shirotani M, Tamura T, Inoko M, Nishizawa J, Natsuaki M, Sakai H, Yamamoto T, Kanemitsu N, Ohno N, Ishii K, Marui A, Tsuneyoshi H, Terai Y, Nakayama S, Yamazaki K, Takahashi M, Tamura T, Esaki J, Miki S, Onodera T, Mabuchi H, Furukawa Y, Tanaka M, Komiya T, Soga Y, Hanyu M, Ando K, Kadota K, Minatoya K, Nakagawa Y, Kimura T. Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3). Am J Cardiol 2021; 145:25-36. [PMID: 33454340 DOI: 10.1016/j.amjcard.2020.12.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 10/12/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 01/14/2023]
Abstract
There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.
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Affiliation(s)
- Yukiko Matsumura-Nakano
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Uegaito
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Miho Yamada
- Department of Cardiology, Hamamatsu Rosai Hospital; Hamamatsu, Japan
| | - Teruki Takeda
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Eizawa
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiichi Tambara
- Department of Cardiovascular Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | | | - Moriaki Inoko
- Department of Cardiology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital; Hamamatsu, Japan
| | | | - Hiroshi Sakai
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Yamamoto
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Denryoku Hospital, Osaka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasuhiko Terai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaru Tanaka
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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7
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Nakatsu T, Minakata K, Tanaka S, Minatoya K, Nishizawa J, Ohno N, Esaki J, Ueyama K, Koyama T, Hanyu M, Tamura N, Komiya T, Saito Y, Kanemitsu N, Soga Y, Shiraga K, Nakayama S, Nonaka M, Sakaguchi G, Nishimura K, Yamanaka K. Intermediate-term outcomes of aortic valve replacement with bioprosthetic or mechanical valves in patients on hemodialysis. J Thorac Cardiovasc Surg 2019; 157:2177-2186.e3. [DOI: 10.1016/j.jtcvs.2018.08.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
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8
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Hirao S, Hara H, Hori Y, Esaki J. Comparison of 5-Year Outcomes after Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Very Old Patients with Triple-Vessel or Left Main Coronary Artery Disease. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678780] [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: 10/27/2022]
Affiliation(s)
- S. Hirao
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - H. Hara
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Y. Hori
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - J. Esaki
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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9
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Miyake M, Izumi C, Taniguchi T, Morimoto T, Amano M, Nishimura S, Kitai T, Kato T, Kadota K, Ando K, Furukawa Y, Inada T, Inoko M, Ishii K, Sakaguchi G, Yamazaki F, Koyama T, Komiya T, Yamanaka K, Nishiwaki N, Kanemitsu N, Saga T, Ogawa T, Nakayama S, Tsuneyoshi H, Iwakura A, Shiraga K, Hanyu M, Ohno N, Fukumoto A, Yamada T, Nishizawa J, Esaki J, Minatoya K, Nakagawa Y, Kimura T. Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis. Circ J 2018; 82:2663-2671. [DOI: 10.1253/circj.cj-18-0416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | | | | | - Takeshi Kitai
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | | | | | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | | | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Kindai University Nara Hospital
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital
| | - Toshihiko Saga
- Department of Cardiovascular Surgery, Kindai University Hospital
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital
| | | | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Japanese Red Cross Wakayama Medical Center
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center
| | | | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga Medical Center for Adults
| | | | - Jiro Esaki
- Department of Cardiovascular Surgery, Japanese Red Cross Otsu Hospital
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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10
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Amano M, Izumi C, Taniguchi T, Morimoto T, Miyake M, Nishimura S, Kitai T, Kato T, Kadota K, Ando K, Furukawa Y, Inada T, Inoko M, Ishii K, Sakaguchi G, Yamazaki F, Koyama T, Komiya T, Yamanaka K, Nishiwaki N, Kanemitsu N, Saga T, Ogawa T, Nakayama S, Tsuneyoshi H, Iwakura A, Shiraga K, Hanyu M, Ohno N, Fukumoto A, Yamada T, Nishizawa J, Esaki J, Minatoya K, Nakagawa Y, Kimura T. Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 20:353-360. [DOI: 10.1093/ehjci/jey105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/16/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Masashi Amano
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Shunsuke Nishimura
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Takeshi Kitai
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan
| | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuo Yamanaka
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan
| | - Noboru Nishiwaki
- Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Naoki Kanemitsu
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Toshihiko Saga
- Department of Cardiovascular Surgery, Kindai University Hospital, Osakasayama, Japan
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Atsushi Fukumoto
- Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga Medical Center for Adults, Moriyama, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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11
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Esaki J, Leshnower BG, Binongo JN, Lasanajak Y, McPherson L, Thourani VH, Chen EP. Reoperative aortic root replacement: Outcome in a contemporary series. J Thorac Cardiovasc Surg 2017; 154:800-808.e3. [DOI: 10.1016/j.jtcvs.2017.04.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/01/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
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12
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Esaki J, Leshnower BG, Binongo JN, Lasanajak Y, McPherson L, Halkos ME, Guyton RA, Chen EP. Clinical Outcomes of the David V Valve-Sparing Root Replacement Compared With Bioprosthetic Valve-Conduits for Aortic Root Aneurysms. Ann Thorac Surg 2016; 103:1824-1832. [PMID: 27964919 DOI: 10.1016/j.athoracsur.2016.09.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/28/2016] [Revised: 09/03/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. Limited insight exists when the results of VSRR are compared with those of conventional root replacement with use of a bioprosthetic composite conduit (BIO). This study compares the operative and midterm results of VSRR and BIO. METHODS A retrospective review from 2002 to 2015 at a United States academic center identified 282 patients who underwent VSRR and 425 patients who underwent BIO. Propensity-score matching was performed based on 20 preoperative characteristics, and 123 matched pairs were identified. RESULTS The mean age (VSRR 53.5 ± 11.1, BIO 53.0 ± 13.0; p = 0.74) and left ventricular ejection fraction (VSRR 54.5 ± 9.2%, BIO 54.4 ± 9.4%; p = 0.99) were equivalent in both groups. The incidence of bicuspid valves (VSRR 26.0%, BIO 27.6%; p = 0.77), Marfan syndrome (VSRR 6.5%, BIO 4.9%; p = 0.58), type A dissection (VSRR 13.0%, BIO 13.0%; p = 0.99), reoperation (VSRR 15.4%, BIO 20.3%; p = 0.32) and arch replacement (VSRR 60.2%, BIO 63.4%; p = 0.60) were similar between the groups. Operative mortality was 5.7% in VSRR and 0.8% in BIO (p = 0.07). There were no significant differences in postoperative renal failure (VSRR 0.8%, BIO 0.0%; p = 0.99) or stroke (VSRR 3.3%, BIO 0.8%; p = 0.37) between the groups. The 7-year survival (VSSR 82.4%, BIO 83.0%; p = 0.53), 7-year freedom from reoperation (VSRR 97.4%, BIO 95.8%; p = 0.48), and 7-year freedom from greater than moderate aortic insufficiency (AI) (VSRR 98.1%, BIO 100.0%; p = 0.47) were similar between groups. CONCLUSIONS VSRR and BIO result in equivalent operative mortality and morbidity with similar midterm survival and valve durability. VSRR is an effective alternative to BIO for aortic root pathologic conditions; however, careful patient selection is paramount.
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Affiliation(s)
- Jiro Esaki
- Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi Lasanajak
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - LaRonica McPherson
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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13
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Esaki J, Leshnower BG, Binongo JN, Lasanajak Y, McPherson L, Halkos ME, Guyton RA, Chen EP. The David V Valve-Sparing Root Replacement Provides Improved Survival Compared With Mechanical Valve-conduits in the Treatment of Young Patients With Aortic Root Pathology. Ann Thorac Surg 2016; 102:1522-1530. [PMID: 27353485 DOI: 10.1016/j.athoracsur.2016.04.091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/07/2015] [Revised: 04/16/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Valve-sparing root replacement (VSRR) is an attractive therapy for aortic root aneurysms; however, there is a paucity of data comparing VSRR with conventional root replacement using a mechanical valve-conduit (MECH). This study evaluates and compares outcomes of VSRR and MECH. METHODS A retrospective review from 2002 to 2015 at a US academic center identified 444 patients who underwent VSRR (282 patients) or MECH (162 patients). Propensity score matching was performed, based on 22 preoperative and intraoperative characteristics, and 87 matched pairs were identified. RESULTS There was no difference in mean age between the groups (VSRR 45.0 years, MECH 44.2 years, p = 0.59). The incidence of Marfan syndrome (VSRR 10.3%, MECH 12.6%, p = 0.63), type A acute aortic dissection (VSRR 25.3%, MECH 27.6%, p = 0.73), reoperation (VSRR 23.0%, MECH 21.8%, p = 0.86), and arch replacement (VSRR 54.0%, MECH 52.9%, p = 0.88) were similar in both groups. Ejection fraction was similar (VSRR 52.8% ± 10.9%, MECH 52.4% ± 11.7%, p = 0.83). Operative mortality was 2.3% with VSRR and 8.0% with MECH (p = 0.10). There were no significant differences in renal failure requiring dialysis (VSRR 1.1%, MECH 4.6%, p = 0.24), permanent neurologic dysfunction (VSRR 2.3%, MECH 6.9%, p = 0.16), and pacemaker implantation (VSRR 1.1%, MECH 1.1%, p = 0.99) between the groups. Survival at 7 years was significantly improved in patients who underwent VSSR (VSRR 85.5%, MECH 73.6%, p = 0.03). CONCLUSIONS In comparison with patients undergoing MECH, there is improved midterm survival among patients undergoing VSRR, with similar operative mortality and morbidity. For appropriately selected patients, VSRR provides an attractive and potentially superior alternative to MECH.
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Affiliation(s)
- Jiro Esaki
- Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yi Lasanajak
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - LaRonica McPherson
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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Tsubota H, Marui A, Esaki J, Bir S, Ikeda T, Sakata R. Remote Postconditioning may Attenuate Ischaemia–Reperfusion Injury in the Murine Hindlimb Through Adenosine Receptor Activation. Eur J Vasc Endovasc Surg 2010; 40:804-9. [DOI: 10.1016/j.ejvs.2010.08.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 08/14/2010] [Indexed: 01/19/2023]
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Bir SC, Esaki J, Marui A, Sakaguchi H, Kevil CG, Ikeda T, Komeda M, Tabata Y, Sakata R. Therapeutic treatment with sustained-release platelet-rich plasma restores blood perfusion by augmenting ischemia-induced angiogenesis and arteriogenesis in diabetic mice. J Vasc Res 2010; 48:195-205. [PMID: 21099226 DOI: 10.1159/000318779] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 05/28/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this investigation was to establish the effectiveness of sustained-release platelet-rich plasma (PRP) on perfusion and neovascularization in diabetic murine hind limb ischemia. METHODS After surgery in streptozotocin-induced diabetic mice, the mice were randomly assigned to the following 4 experimental groups: control (C), 100 μl of the sustained-release form of platelet-poor plasma (PPP), 100 μl of the solution form of PRP (PRP-sol), and 100 μl of the sustained-release form of PRP (PRP-sr). Endpoint evaluations were: blood perfusion by laser Doppler perfusion imaging (LDPI), vascular density by anti-vWF, and mature vessel density by anti-smooth muscle actin antibody. RESULTS This study demonstrated that a sustained release of PRP increases the perfusion of ischemic tissue as measured by LDPI (57 ± 12; 56 ± 9; 72 ± 7, and 98 ± 4 for the C, PPP, PRP-sol, and PRP-sr groups, respectively; p < 0.05), capillary density (151 ± 16; 158 ± 12; 189 ± 39, and 276 ± 39 for groups C, PPP, PRP-sol, and PRP-sr, respectively; p < 0.05), and mature vessel density (28 ± 2; 31 ± 3; 52 ± 10, and 85 ± 13 for the C, PPP, PRP-sol, and PRP-sr groups, respectively; p < 0.05). CONCLUSION A sustained release of PRP containing potent angiogenic growth factors restores blood perfusion by stimulating angiogenesis and arteriogenesis.
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Affiliation(s)
- Shyamal Chandra Bir
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Bir SC, Esaki J, Marui A, Yamahara K, Tsubota H, Ikeda T, Sakata R. Angiogenic properties of sustained release platelet-rich plasma: characterization in-vitro and in the ischemic hind limb of the mouse. J Vasc Surg 2009; 50:870-879.e2. [PMID: 19679427 DOI: 10.1016/j.jvs.2009.06.016] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 06/15/2009] [Accepted: 06/20/2009] [Indexed: 01/13/2023]
Abstract
BACKGROUND While single growth factor has limitation to induce optimal neovascularization, platelet-rich plasma (PRP) is an autologous reserver of various growth factors. However, little is known about the mechanism of PRP-related neovascularization.The objective of this investigation was to characterize the angiogenic and growth factor content of PRP and to determine, in vitro, its effect on endothelial cell proliferation. Additionally, this experiment sought to determine the effectiveness of different compositions of PRP (solution versus sustained release) on perfusion and neovascularization in a murine model of hind limb ischemia. METHODS Different growth factors were measured by enzyme-linked immunosorbent assay (ELISA). In vivo study, we used gelatin hydrogel as a sustained release carrier for growth factors in PRP. We induced hind limb ischemia by excising right femoral artery in wild type C57BL6 mice. After surgery, mice were randomly assigned to four experimental groups; control (C), 100 muL of sustained release form of platelet-poor plasma (PPP), 100 muL of solution form of PRP (PRP-sol), 100 muL of sustained release form of PRP (PRP-sr); each formulation was administered via an intramuscular injection to the ischemic hind limb. Endpoint evaluations were blood perfusion by laser Doppler perfusion image, vascular density by anti Von Willebrand factor (vWF), and mature vessel density by anti smooth muscle actin (SMA) antibody. Green fluorescent protein (GFP+) transgenic mice were generated by transplantation of bone marrow derived mononuclear cells to wild type C57BL6 mice, and finally CD34+ cell in the ischemic site of transgenic mice was detected by staining with anti-CD34 antibody. RESULTS In vitro study showed that PRP containing different growth factors induces endothelial cell proliferation and capillary tube formation. In vivo study demonstrated that sustained release of PRP increased perfusion of ischemic tissue as measured by laser Doppler perfusion imaging (LDPI) (57 +/- 12, 56 +/- 9, 72 +/- 7, 98 +/- 4 for groups C, PPP, PRP-sol, and PRP-sr, respectively; P < .05); capillary density (151 +/- 16, 158 +/- 12, 189 +/- 39, 276 +/- 39 for groups C, PPP, PRP-sol, and PRP-sr, respectively, P < .05) and mature vessel density (28 +/- 2, 31 +/- 3, 52 +/- 10, 85 +/- 13 for groups C, PPP, PRP-sol, and PRP-sr, respectively, P < .05) . Sustained release PRP also increases CD34+ cells in the ischemic site of transgenic mice (6 +/- 3 vs 18 +/- 5/mm(2) for groups control and PRP-sr respectively, P < .05). CONCLUSION Sustained release of PRP containing potent angiogenic growth factors restores blood perfusion presumably by stimulating angiogenesis, arteriogenesis, as well as vasculogenesis in the mouse hind limb ischemia. CLINICAL RELEVANCE PRP is a natural reserver of various growth factors that can be collected autologously and is costeffective. Thus for clinical use, no special considerations concerning antibody formation and infection risk are needed.Some clinical devices to automatically prepare PRP are available at present. PRP are consistently being used clinically inthe department of orthopedics and plastic surgery (oral, maxillary facial) for a long time. On the basis of researchevidence, some publications have reported positive results in either bone or soft tissue healing. However, some researchconcludes that there is no or little benefit from PRP. This is likely due to faster degradation of growth factors in PRP sincesome authors suggest using sustained release form of PRP to deliver optimal effect of PRP. Gelatin hydrogel is also beingused clinically as a slow, sustained release of carrier for growth factors in our center recently.
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Affiliation(s)
- Shyamal Chandra Bir
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Esaki J, Sakaguchi H, Marui A, Bir SC, Arai Y, Huang Y, Tsubota H, Kanaji T, Ikeda T, Sakata R. Local Sustained Release of Prostaglandin E1 Induces Neovascularization in Murine Hindlimb Ischemia. Circ J 2009; 73:1330-6. [DOI: 10.1253/circj.cj-08-0999] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jiro Esaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Hisashi Sakaguchi
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Shyamal Chandra Bir
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Yuhong Huang
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Hideki Tsubota
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | | | - Tadashi Ikeda
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
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Bir SC, Fujita M, Marui A, Hirose K, Arai Y, Sakaguchi H, Huang Y, Esaki J, Ikeda T, Tabata Y, Komeda M. New therapeutic approach for impaired arteriogenesis in diabetic mouse hindlimb ischemia. Circ J 2008; 72:633-40. [PMID: 18362437 DOI: 10.1253/circj.72.633] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 11/09/2022]
Abstract
BACKGROUND The combined treatment of sustained-release basic fibroblast growth factor (Sr-bFGF) and a 5-hydroxytryptamine(2A) blocker, sarpogrelate, was evaluated to see whether it reversed the impaired collateral circulation in diabetic (DM) mouse hindlimb ischemia. METHOD AND RESULTS Diabetic and normal mice with ischemic hindlimb were randomly assigned to 1 of 5 experimental groups (no treatment, sarpogrelate 50 mg . kg(-1) . day(-1), 20 microg or 50 microg Sr-bFGF and a combined treatment of 20 microg Sr-bFGF and sarpogrelate), and treated for 4 weeks. Tissue blood perfusion (TBP), vascular density (angiogenesis) and the number of mature vessels (arteriogenesis) were checked by the use of standard methods. Although angiogenesis was comparable (161+/-14 vs 154+/-12 vessels/mm(2)), the laser Doppler perfusion image index (LDPII) (0.43+/-0.11 (SD) vs 0.63+/-0.08, p<0.05) and arteriogenesis (8+/-3 vs 12+/-4 vessels/mm(2), p<0.05) were significantly lower in DM mice than those in normal mice. The dose of Sr-bFGF for the sufficient number of mature vessels (>or=45 vessels/mm(2)) and LDPII (>or=0.9) was 20 microg for the normal mice, and 50 microg for the DM mice, which was reduced with the aid of sarpogrelate. Conclusions A combined therapy of Sr-bFGF and sarpogrelate is effective for neovascularization to reverse the impaired arteriogenesis and TBP in DM mice.
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Affiliation(s)
- Shyamal Chandra Bir
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sakaguchi H, Marui A, Hirose K, Nomura T, Arai Y, Bir SC, Huang Y, Esaki J, Tabata Y, Ikeda T, Komeda M. Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin. J Thorac Cardiovasc Surg 2008; 135:25-31. [PMID: 18179914 DOI: 10.1016/j.jtcvs.2007.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/12/2007] [Accepted: 06/20/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus graft infection is one of the most serious complications of vascular surgery. Vancomycin is a potent antibiotic against methicillin-resistant S. aureus; however, systemic administration of vancomycin is not very effective against methicillin-resistant S. aureus graft infection. Therefore, we investigated whether a local sustained release of vancomycin prevents methicillin-resistant S. aureus graft infection. METHODS We have developed a poly-L-lactide-co-caprolactone sheet that enabled sustained release of vancomycin for 2 weeks. An expanded polytetrafluoroethylene vascular graft patch (1.5 mm2) was sutured at the anterior wall of the incised murine abdominal aorta. Methicillin-resistant S. aureus (1.0 x 10(3) colony-forming units) was inoculated onto the graft surface. Thereafter, the graft was treated as follows (n = 6 each): no treatment (control group), local injection of an aqueous solution of vancomycin (vancomycin solution group) and local implantation of poly-L-lactide-co-caprolactone containing vancomycin (vancomycin-PLCA group). After 7 days, the graft and blood were sampled and cultured. RESULTS The methicillin-resistant S. aureus counts in the grafts of the vancomycin-PLCA group were significantly lower than those of the other groups. Blood cultures of the vancomycin-PLCA group were all negative, whereas those of the other groups were all positive for infection. The survival rate in the vancomycin-PLCA group at 28 days was considerably higher than that in the control group (83.3% vs 16.7%). CONCLUSIONS A local sustained-release sheet containing vancomycin reduced methicillin-resistant S. aureus counts in the infected vascular grafts, prevented sepsis, and drastically improved survival rates. This can be used as a highly effective and less-invasive adjunctive treatment method for preventing prosthetic methicillin-resistant S. aureus graft infection.
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Affiliation(s)
- Hisashi Sakaguchi
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Huang Y, Marui A, Sakaguchi H, Esaki J, Arai Y, Hirose K, Bir SC, Horiuchi H, Maruyama T, Ikeda T, Tabata Y, Komeda M. Sustained Release of Prostaglandin E1 Potentiates the Impaired Therapeutic Angiogenesis by Basic Fibroblast Growth Factor in Diabetic Murine Hindlimb Ischemia. Circ J 2008; 72:1693-9. [DOI: 10.1253/circj.cj-07-0960] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuhong Huang
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Akira Marui
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Hisashi Sakaguchi
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Shyamal Chandra Bir
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Hisanori Horiuchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Tadashi Ikeda
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University
| | - Masashi Komeda
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
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Esaki J, Marui A, Tabata Y, Komeda M. Controlled release systems of angiogenic growth factors for cardiovascular diseases. Expert Opin Drug Deliv 2007; 4:635-49. [DOI: 10.1517/17425247.4.6.635] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Esaki J, Koshiji T, Okamoto M, Tsukashita M, Ikuno T, Sakata R. Gastroepiploic Artery Grafting Does Not Improve the Late Outcome in Patients With Bilateral Internal Thoracic Artery Grafting. Ann Thorac Surg 2007; 83:1024-9. [PMID: 17307452 DOI: 10.1016/j.athoracsur.2006.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 10/04/2006] [Accepted: 10/06/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bilateral internal thoracic artery grafting in coronary artery bypass surgery has a better long-term outcome than single internal thoracic artery grafting. However, the efficacy of gastroepiploic artery (GEA) grafting in addition to bilateral internal thoracic artery grafting is still not well-established. METHODS From 1989 to 1999, 311 patients underwent coronary artery bypass grafting using in situ bilateral internal thoracic arteries anastomosed to the left coronary arteries and either an in situ GEA or a saphenous vein graft (SVG) anastomosed to the right coronary artery. Ninety-nine patients using the in situ GEA (GEA group) were compared with 212 patients using the SVG (SVG group) anastomsed to the right coronary artery. Young patients and patients with hyperlipidemia were more prevalent in the GEA group. RESULTS The seven-year survival rate in the GEA group and the SVG group were 94.7% and 87.2%, respectively (p = 0.068). In a multivariate analysis, the age, renal failure, and a low ejection fraction (<0.40) were all significant predictors of survival. The GEA was not a significant predictor. The seven-year freedom rates from cardiac events were similar in both groups (GEA group, 76.5%; SVG group, 78.6%; p = 0.455). The seven-year freedom rates from recurrent angina were also similar between the groups (GEA group, 85.3%; SVG group, 88.8%; p = 0.700). CONCLUSIONS In comparison with SVG grafting, GEA grafting to the right coronary artery did not significantly improve the late outcomes in patients with bilateral internal thoracic artery grafting.
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Affiliation(s)
- Jiro Esaki
- Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto, Japan.
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Yamada H, Takeyama H, Fukutani H, Watanabe E, Saka Y, Suzuki K, Kameyama Y, Esaki J, Yamazaki H, Mori Y. [Serotype and susceptibilities to eight antibiotics of fifty strains of Pseudomonas aeruginosa isolated from clinical specimens and changes in susceptibilities of Pseudomonas aeruginosa to various antibiotics during a period between 1983 and 1986]. Jpn J Antibiot 1988; 41:469-77. [PMID: 3145990] [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: 01/04/2023]
Abstract
Efficacies of 8 antibiotics against Pseudomonas aeruginosa in the relation to serotypes and clinical sources were investigated on 50 strains isolated from patients at Nagoya Ekisaikai Hospital between August and September, 1986. Disk sensitivity test was carried out simultaneously for 5 antibiotics including piperacillin (PIPC), cefoperazone (CPZ), cefsulodin (CFS), ceftazidime (CAZ) and amikacin (AMK), using the single-disk method. We also examined changes in susceptibilities of P. aeruginosa to 5 antibiotics including PIPC, CFS, fosfomycin, gentamicin (GM) and AMK during last 4 years (1983-1986). The results are summarized as follows. 1. CAZ and AMK proved to have high antibacterial potencies, and their MIC80's (concentrations to inhibit growth of 80% of objective bacteria) were both 6.25 micrograms/ml. Following these two the order of potencies were; CFS, cefpiramide (CPM), PIPC, CPZ, netilmicin (NTL), and cefmenoxime (CMX). Sixty two percent of the strains of P. aeruginosa showed high resistances (MIC greater than 50 micrograms/ml) to CPM, CPZ, NTL and CFS, 58% to PIPC, and 2% to AMK. 2. With regard to serotypes, strains belonging to type E were less susceptible than those belonging to types G and I. Type E strains showed high resistance to all antibiotics except CAZ and AMK. 3. Strains obtained from pura and secreta were relatively susceptible, while those from urines were resistant, to these antibiotics tested, in general. 4. Good correlation between MIC's obtained with the agar dilution method (MIC less than or equal to 12.5 micrograms/ml) and these with the disk sensitivity test (greater than ¿ was observed. chi 2 statistical analysis showed that the results obtained with the 2 methods were closely related (P less than 0.01). 5. P. aeruginosa showed fairly high susceptibility to AMK through the recent 4 years (1983-1986). On the other hand, highly resistant strains against CFS, PIPC, FOM and GM increased rapidly during this period.
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Affiliation(s)
- H Yamada
- Department of Internal Medicine, Nagoya Ekisaikai Hospital
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Yamada H, Takeyama H, Watanabe E, Fukutani H, Saka Y, Suzuki K, Kameyama Y, Esaki J, Yamazaki H, Mori Y. [In vitro combination effects of astromicin and beta-lactam antibiotics against CFS-sensitive and CFS-resistant Pseudomonas aeruginosa. In vitro synergistic activity]. Jpn J Antibiot 1988; 41:478-84. [PMID: 3145991] [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: 01/04/2023]
Abstract
We investigated in vitro synergistic activity of astromicin (ASTM) combined with beta-lactam antibiotics (cefsulodin (CFS), cefoperazone (CPZ), ceftazidime (CAZ), piperacillin (PIPC) and fosfomycin (FOM) against fresh clinical isolated Pseudomonas aeruginosa, which consisted of 13 CFS sensitive (MIC less than or equal to 3.13 micrograms/ml) and 19 CFS resistant (MIC greater than or equal to 400 micrograms/ml) strains according to the FIC index. Against CFS-sensitive P. aeruginosa, ASTM showed good synergistic activities when combined with PIPC (54%), CAZ (38%), CPZ (23%) and CFS (8%). Against CFS-resistant P. aeruginosa, ASTM also showed high synergistic activities when combined with CAZ (63%), CPZ (47%), PIPC (37%) and CFS (11%). Among the CFS-resistant P. aeruginosa, one clinical isolate showed a high sensitivity (MIC0.78 micrograms/ml) against ASTM alone.
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Affiliation(s)
- H Yamada
- Department of Internal Medicine, Nagoya Ekisaikai Hospital
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