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Maze Y, Tokui T, Murakami M, Yamaguchi D, Inoue R, Hirano K, Nakamura B, Ito H. The effect of posterior pericardiotomy after thoracic aortic surgery. J Cardiothorac Surg 2022; 17:214. [PMID: 36031610 PMCID: PMC9420293 DOI: 10.1186/s13019-022-01967-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative pericardial effusion is common after cardiovascular surgery. We aimed to examine the effectiveness of posterior pericardiotomy in reducing the incidence of postoperative pericardial effusion and postoperative atrial fibrillation after thoracic aortic surgery. Methods This study included 201 patients who underwent thoracic aortic open surgery between January 2014 and November 2021. We compared surgical outcomes between patients who underwent posterior pericardiotomy and those who did not. Results The group that did not undergo posterior pericardiotomy had significantly longer mechanical ventilation duration than the group who did, both in the overall (p = 0.005) and in the propensity-matched cohorts (p = 0.001). The lengths of intensive care unit and hospital stays were significantly longer in the group that did not undergo posterior pericardiotomy compared to the group that did, both in the overall and in the propensity-matched cohorts. The occurrence of postoperative atrial fibrillation and stroke did not differ significantly between the two groups. The amount of pericardial drainage was not significantly lower in the group that underwent posterior pericardiotomy in the overall cohorts (p = 0.09), but the difference was significant in the propensity-matched cohorts (p = 0.04). The amount of mediastinal drainage was significantly lower in the group that underwent posterior pericardiotomy, both in the overall cohorts (< 0.001) and in the propensity-matched cohort (< 0.001). Late pericardial tamponade occurred significantly more frequently in the group that did not undergo posterior pericardiotomy than in the group that did, both in the overall (p = 0.03) and in the propensity-matched cohorts (p = 0.03). Conclusions Posterior pericardiotomy has no effect on reducing postoperative atrial fibrillation after thoracic aortic surgery. However, posterior pericardiotomy reduced the occurrence of late pericardial tamponade, length of ICU stay, length of hospital stay, and mechanical ventilation duration after surgery.
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Maze Y, Tokui T, Murakami M, Nakamura B, Inoue R, Hirano R, Hirano K. Clinical outcomes of limited repair and conservative approaches in older patients with acute type A aortic dissection. J Cardiothorac Surg 2022; 17:78. [PMID: 35428343 PMCID: PMC9013093 DOI: 10.1186/s13019-022-01819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we aimed to examine the surgical outcomes of acute type A aortic dissection in older patients. Methods From January 2012 through December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥ 80 years old) and below-80 (≤ 79 years old) age groups. Additionally, we compared the outcomes between the surgical and conservative treatment groups. Results The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group patients and 57.3% of the below-80 group patients (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment subgroup was 19.2% ± 8.0% in the older group, which was not significantly different from that of the surgical treatment subgroup (p = 0.103). Conclusion The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be a reasonable treatment of choice for older patients.
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Ito H, Bessho S, Nakamura B, Toba S, Shomura Y, Takao M. Transmitral extraction of a huge left ventricular mural thrombus using a novel mitral leaflet retractor. Clin Case Rep 2022; 10:e05427. [PMID: 35369383 PMCID: PMC8859405 DOI: 10.1002/ccr3.5427] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hisato Ito
- Department of Thoracic and Cardiovascular Surgery Mie University Tsu Japan
| | - Saki Bessho
- Department of Thoracic and Cardiovascular Surgery Mie University Tsu Japan
| | - Bun Nakamura
- Department of Thoracic and Cardiovascular Surgery Mie University Tsu Japan
| | - Shuhei Toba
- Department of Thoracic and Cardiovascular Surgery Mie University Tsu Japan
| | - Yu Shomura
- Department of Thoracic and Cardiovascular Surgery Mie University Tsu Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery Mie University Tsu Japan
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Maze Y, Tokui T, Murakami M, Kawaguchi T, Inoue R, Nakamura B, Hirano K, Chino S, Nakajima K, Kato N. Treatment Strategies for Improving the Surgical Outcomes of Ruptured Abdominal Aortic Aneurysm: Single-Center Experience in Japan. Ann Vasc Dis 2022; 15:8-13. [PMID: 35432648 PMCID: PMC8958394 DOI: 10.3400/avd.oa.21-00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
Objective: We aimed to examine the surgical outcomes of ruptured abdominal aortic aneurysm cases at our hospital and considered strategies for improvement. Material and Methods: We examined the preoperative characteristics of hospital mortality, postoperative complications, and long-term outcomes of 91 surgical cases of ruptured abdominal aortic aneurysm performed between January 2009 and December 2020 at our hospital. Results: Of the 91 cases, 24 died at the hospital (mortality, 26.3%). Mortality was mostly due to hemorrhage/disseminated intravascular coagulation and intestinal necrosis. Ten patients required preoperative aortic clamp by thoracotomy or insertion of intra-aortic balloon occlusion, and eight of them died. Ten patients required open abdominal management due to abdominal compartment syndrome, and five of them died. There was no significant difference between the two groups in terms of the long-term results of the open repair and abdominal endovascular aneurysm repair (EVAR). Conclusion: To improve the surgical outcomes of ruptured abdominal aortic aneurysms, it is necessary to start surgery immediately. Therefore, the choice of surgical method (open surgery or EVAR) should be based on the resources and discretion of the hospital. To prevent postoperative intestinal necrosis, risk factors for acute compartment syndrome should be considered, and open abdominal management should be introduced.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Teruhisa Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Bun Nakamura
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital
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Hirano K, Tokui T, Nakamura B, Inoue R, Hirano R, Maze Y, Chino S, Ito H, Shomura Y, Takao M. Understanding Vascular Anatomy is Key to Successful Endovascular Treatment of Pancreaticoduodenal Artery Aneurysms. Ann Vasc Dis 2020; 13:330-334. [PMID: 33384741 PMCID: PMC7751088 DOI: 10.3400/avd.cr.20-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pancreaticoduodenal artery aneurysm (PDAA) is a rare disease without treatment guidelines. We present two patients with PDAA. The first patient was a 70-year-old man with a pseudoaneurysm in the anterior superior pancreaticoduodenal artery (ASPDA), for which we achieved exclusion by endovascular coil embolization. The second patient was a 63-year-old woman with a PDAA in the ASPDA with celiac axis obstruction. Endovascular coil embolization of the aneurysm and the ASPDA was successful without visceral organ ischemia. Endovascular treatment is effective for PDAAs, but careful evaluation of collateral circulation is vital in PDAAs with celiac axis obstruction.
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Affiliation(s)
- Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Bun Nakamura
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Reina Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital
| | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
| | - Yu Shomura
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
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Hirano K, Tokui T, Nakamura B, Inoue R, Inagaki M, Hirano R, Chino S, Maze Y, Kato N, Takao M. Impact of the Frozen Elephant Trunk Technique on Total Aortic Arch Replacement. Ann Vasc Surg 2020; 65:206-216. [DOI: 10.1016/j.avsg.2019.10.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022]
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Hirano K, Tokui T, Nakamura B, Inoue R, Inagaki M, Toyoshima H, Chino S, Watanabe F, Kato N, Maze Y. Hybrid Therapy for Mycotic Aortic Aneurysm with Stent-Graft and Video-Assisted Thoracoscopic Debridement. Ann Vasc Dis 2019; 12:69-73. [PMID: 30931062 PMCID: PMC6434360 DOI: 10.3400/avd.cr.18-00119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Treating mycotic aortic aneurysm with thoracic endovascular aortic repair (TEVAR) remains controversial because of sustained infection post-treatment. In this study, an 83-year-old man, who had a ruptured mycotic thoracic aortic aneurysm, underwent salvage TEVAR. However, because an abscess appeared in the aneurysm on follow-up computed tomography, video-assisted thoracoscopic debridement (VATD) followed by continuous drainage was performed next and was successful in eliminating the infection from the abscess. Although frozen elephant trunk and proximal aortic arch repair were further required owing to another pseudoaneurysm, there was no sign of recurrent infection thereafter. The combination of TEVAR and VATD can be effective in treatment of mycotic aortic diseases in selected patients.
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Affiliation(s)
- Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Bun Nakamura
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Masahiro Inagaki
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Hirokazu Toyoshima
- Department of Infectious Diseases, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Fumiaki Watanabe
- Department of Respiratory Surgery, Matsusaka City Hospital, Matsusaka, Mie, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
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Hirano K, Tokui T, Nakamura B, Inoue R, Inagaki M, Maze Y, Kato N. Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique. Vasc Endovascular Surg 2017; 52:80-85. [PMID: 29121846 DOI: 10.1177/1538574417740486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.
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Affiliation(s)
- Koji Hirano
- 1 Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Toshiya Tokui
- 1 Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Bun Nakamura
- 1 Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Ryosai Inoue
- 1 Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Masahiro Inagaki
- 1 Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Yasumi Maze
- 1 Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Noriyuki Kato
- 2 Department of Radiology, Mie University Hospital, Tsu, Japan
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Inoue R, Nakamura B, Inagaki M, Fujii T, Hirano K, Maze Y, Tokui T. [Successful Surgical Treatment of Primary Cardiac Lymphoma Detected with the Onset of Acute Heart Failure;Report of a Case]. Kyobu Geka 2017; 70:1021-1024. [PMID: 29104202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 83-year-old woman, suffering from rapidly worsening dyspnea and weight gain from a week ago, was referred for evaluation and treatment of cardiac tumor in the right atrium. Echocardiography and enhanced computed tomography revealed a large tumor, more than 6 cm, occupying the right atrium and blocking the tricuspid valve inflow. Electrocardiogram showed bradycardiac atrial fibrillation. We performed partial resection with cardiopulmonary bypass, in order to improve hemodynamics and to make a definite diagnosis. In operation, the tumor infiltrated not only the right atrium but also the right ventricle and the tricuspid annulus. The pathological examination suggested malignant lymphoma, diffuse large B-cell type. The patient was treated chemotherapy postoperatively. She is alive 1 year after the surgery without apparent recurrence.
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Affiliation(s)
- Ryosai Inoue
- Department of Thoracic Surgery, Japanese Red Cross Ise Hospital, Ise, Japan
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Nakamura B, Tokui T, Maze Y, Hirano K, Fujii T, Inagaki M, Inoue R. [Aortic Valve Replacement and Mitral Valve Plasty in a Patient with Left Ventricular Noncompaction Associated with Aortic Regurgitation and Mitral Regurgitation;Report of a Case]. Kyobu Geka 2017; 70:453-455. [PMID: 28595227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Left ventricular noncompaction (LVNC) is believed to represent an arrest in the normal process of myocardial compaction, resulting in persistence of both hyper-trabeculation and intra-trabecular recess within the left ventricle. The clinical features of this disease are left ventricular dilatation and systolic dysfunction, which carry a high mortality. Most patients die in infancy, but some cases of LVNC in adults have been reported. To the best of our knowledge, only 4 cases of LVNC with valvular heart disease in adults have recently been operated. We describe a 51-year-old man with LVNC and severe aortic regurgitation and mild mitral regurgitation, who was successfully operated upon with aortic valve replacement using a tissue valve, and mitral valve plasty with bilateral papillary muscle relocation.
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Affiliation(s)
- Bun Nakamura
- Department of Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
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Nakamura B. [Tetanus vaccination, with special reference to its effects due to the patient's age]. Nihon Densenbyo Gakkai Zasshi 1968; 42:86-9. [PMID: 4973743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Nakamura B. [Several practical problems in infantile vaccination]. Nihon Shonika Gakkai Zasshi 1966; 70:937-82. [PMID: 6009524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Yamada K, Tsuchiya Y, Nakamura B. Studies on the plasminogen proactivator of plasma in children with hemorrhagic disorders. Keio J Med 1966; 15:35-43. [PMID: 5933106 DOI: 10.2302/kjm.15.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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