Shinichi Takamoto

Mitsui Memorial Hospital, Edo, Tōkyō, Japan

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Publications (481)1095.38 Total impact

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    ABSTRACT: Postoperative atrial fibrillation (POAF) increases considerably the chances of morbidity and mortality after cardiac surgery. The objective of this study was to identify the major risk factors responsible for POAF after thoracic aortic surgery in order to define preventive measures. We analyzed 12,260 records (between January 1, 2004, and December 31, 2008) obtained from the Japan Adult Cardiovascular Surgery Database. Patients with history of AF were excluded. Data were collected for 12 preoperative and 10 operative risk factors that had been proven or believed to influence POAF. The relationship between the risk factors and outcome was assessed by the Fisher exact test, Student t test, and multiple logistic regression analysis. The patients' mean age (± standard deviation) was 67.5 ± 12.7 years, and 27% of the subjects were women. The incidence of POAF was 17.1%. The following risk factors were associated with increased POAF: age (p < 0.0001), history of smoking (p < = 0.020), hypertension (p = 0.020), congestive heart failure (p < 0.0001), urgent operation (p = 0.023), and concomitant with nonelective coronary artery bypass (p = 0.022). Postoperative mortality and postoperative stroke were significantly increased in patients with POAF (p < 0.0001 in both cases). The odds ratios for the POAF risk factors were as follows: replacement of the ascending aorta, 1.67; aortic arch, 1.62; aortic root, 1.42; concomitant with valve operation, 1.35; age, 1.27; and urgent operation, 1.22. Several risk factors contribute to the incidence of POAF after thoracic aortic surgery. We found that POAF significantly increased 30-day operative mortality (p < 0.0001). Our findings can be used to develop a risk stratification system for the prediction of POAF. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of Thoracic Surgery 11/2014; · 3.63 Impact Factor
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    ABSTRACT: The Japan Cardiovascular Surgery Database (JCVSD) is a nationwide benchmarking project to improve the quality of cardiovascular surgery in Japan. This study aimed to develop new JACVD risk models not only for operative mortality but also for each postoperative complication for coronary artery bypass grafting (CABG) operations, valve operations, and thoracic aortic operations. We analyzed 24,704 isolated CABG operations, 26,137 valve operations, and 18,228 thoracic aortic operations. Risk models were developed for each operation for operative death, permanent stroke, renal failure, prolonged ventilation (>24 hours), deep sternal wound infection, and reoperation for bleeding. The population was divided into an 80% development sample and a 20% validation sample. The statistical model was constructed by multiple logistic regression analysis. Model discrimination was tested using the area under the receiver operating characteristic curve (C index). The 30-day mortality rates for isolated CABG, valve, and thoracic aortic operations were 1.5%, 2.5%, and 6.0%, respectively, and operative mortality rates were 2.4%, 3.8%, and 8.4%, respectively. The C indices for the end points of isolated CABG, valve, and aortic thoracic operations were 0.6358 for (deep sternal infection) to 0.8655 (operative mortality), 0.6114 (reoperation for bleeding) to 0.8319 (operative death), and 0.6311 (gastrointestinal complication) to 0.7591 (operative death), respectively. These risk models increased the discriminatory power of former models. Thus, our models can be said to reflect the current state of Japan. With respect to major complications, useful feedback can now be provided through the Japan Cardiovascular Surgery Database Web-based system. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of Thoracic Surgery 11/2014; · 3.63 Impact Factor
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    ABSTRACT: The purpose of this study was to develop risk models for congenital heart surgery short-term and midterm outcomes from a nationwide integrated database drawn from hospitals in Japan. The Japan Congenital Cardiovascular Surgery Database collects clinical information from institutions throughout Japan specializing in congenital heart surgery. Variables and definitions used in the Japan Congenital Cardiovascular Surgery Database are almost identical to those of the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery database for congenital heart surgery. We used logistic regression to develop risk models, which were then validated through spilt-sample validation. In addition to procedural complexity categories by Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, we incorporated patient characteristics to predict surgical outcome. Among 8923 congenital heart operations performed at 69 sites with cardiac surgical programs, 30-day mortalities by RACHS-1 category were as follows: I, 0.1% (n = 1319); II, 0.5% (n = 3211); III, 2.2% (n = 3285); IV, 4.3% (n = 818); and V and VI, 8.6% (n = 290). From the test data set (n = 7223), we developed 3 risk models (30-day mortality, 90-day mortality, and 90-day and in-hospital mortality) with 11 variables, including age category, RACHS-1 category, preoperative risk factors, number of surgical procedures, unplanned reoperations, status of surgery, surgery type, asplenia, and prematurity (<35 weeks). For the performance metrics of the risk models, C statistic values of 30-day, 90-day, and 90-day and in-hospital mortalities for the test data set were 0.85, 0.85, and 0.84, respectively. When only the RACHS-1 score was used for discrimination, the C statistic values of 30-day, 90-day, and 90-day and in-hospital mortalities for the validation data set were 0.73, 0.73, and 0.77, respectively. The proposed risk scores and categories have high discrimination power for predicting mortality, demonstrating improvement relative to existing consensus-based methods. Risk models incorporating these measures may be useful for comparing mortality outcomes cross institutions or countries with mixed cases. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Thoracic and Cardiovascular Surgery 11/2014; 148(5):2201-6. · 3.99 Impact Factor
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    ABSTRACT: The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.
    The Korean journal of thoracic and cardiovascular surgery. 10/2014; 47(5):437-43.
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    ABSTRACT: Antegrade cerebral perfusion and hypothermic circulatory arrest, with or without retrograde cerebral perfusion, are 2 major types of brain protection that are used during aortic arch surgery. We conducted a comparative study of these methods in patients undergoing total arch replacement to evaluate the clinical outcomes in Japan, based on the Japan Adult Cardiovascular Surgery Database. A total of 16,218 patients underwent total arch replacement between 2009 and 2012. Patients with acute aortic dissection or ruptured aneurysm, or who underwent emergency surgery were excluded, leaving 8169 patients for analysis. For the brain protection method, 7038 patients had antegrade cerebral perfusion and 1141 patients had hypothermic circulatory arrest/retrograde cerebral perfusion. A nonmatched comparison was made between the 2 groups, and propensity score analysis was performed among 1141 patients. The matched paired analysis showed that the minimum rectal temperature was lower in the hypothermic circulatory arrest/retrograde cerebral perfusion group (21.2°C ± 3.7°C vs 24.2°C ± 3.2°C) and that the duration of cardiopulmonary bypass and cardiac ischemia was longer in the antegrade cerebral perfusion group. There were no significant differences between the antegrade cerebral perfusion and hypothermic circulatory arrest/retrograde cerebral perfusion groups with regard to 30-day mortality (3.2% vs 4.0%), hospital mortality (6.0% vs 7.1%), incidence of stroke (6.7% vs 8.6%), or transient neurologic disorder (4.1% vs 4.4%). There was no difference in a composite outcome of hospital death, bleeding, prolonged ventilation, need for dialysis, stroke, and infection (antegrade cerebral perfusion 28.4% vs hypothermic circulatory arrest 30.1%). However, hypothermic circulatory arrest/retrograde cerebral perfusion resulted in a significantly higher rate of prolonged stay in the intensive care unit (>8 days: 24.2% vs 15.6%). Hypothermic circulatory arrest/retrograde cerebral perfusion and antegrade cerebral perfusion provide comparable clinical outcomes with regard to mortality and stroke rates, but hypothermic circulatory arrest/retrograde cerebral perfusion resulted in a higher incidence of prolonged intensive care unit stay. Antegrade cerebral perfusion might be preferred as the brain protection method for complicated aortic arch procedures. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Thoracic and Cardiovascular Surgery 09/2014; · 3.99 Impact Factor
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    ABSTRACT: Background:The optimal brain protection strategy for use during acute type A aortic dissection surgery is controversial.Methods and Results:We reviewed the results for 2 different methods: antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP), during ascending aortic repair for acute type A aortic dissection for the period between 2008 and 2012 nationwide. Cases involving root repair, arch vessel reconstruction and/or concomitant procedures were excluded. Using the Japan Adult Cardiovascular Surgery Database, a total of 4,128 patients (ACP, n=2,769; RCP, n=1,359; mean age, 69.1±11.8 years; male 41.9%) were identified. The overall operative mortality was 8.6%. Following propensity score matching, among 1,320 matched pairs, differences in baseline characteristics between the 2 patient groups diminished. Cardiac arrest time (ACP 116±36 vs. RCP102±38 min, P<0.001), perfusion time (192±54 vs. 174±53 min, P<0.001) and operative time (378±117 vs. 340±108 min, P<0.001) were significantly shorter in the RCP group. There were no significant differences between the 2 groups regarding the incidence of operative mortality or neurological complications, including stroke (ACP 11.2% vs. RCP 9.7%). Postoperative ventilation time was significantly longer in the ACP group (ACP 128.9±355.7 vs. RCP 98.5±301.7 h, P=0.018). There were no differences in other early postoperative complications, such as re-exploration, renal failure, and mediastinitis.Conclusions:Among patients undergoing dissection repair without arch vessel reconstruction, RCP had similar mortality and neurological outcome to ACP.
    Circulation Journal 08/2014; · 3.69 Impact Factor
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    ABSTRACT: The benefits of off-pump coronary artery grafting (OPCAB) have been demonstrated. Especially in patients with a high number of comorbidities, redo coronary artery bypass grafting (CABG) remains a difficult entity of CABG, because patients are likely to have multiple risk factors and often have diseased patent grafts with adhesions. The aim of the present study was to evaluate the effects of the OPCAB technique in redo CABG on mortality and morbidity using data from the Japan Cardiovascular Surgery Database (JCVSD). We analysed 34 980 patients who underwent isolated CABG between 2008 and 2011, as reported in the JCVSD. Of these, 1.8% of patients (n = 617/34980) had undergone redo CABG, including those who underwent OPCAB (n = 364; 69%) and on-pump CABG (n = 253; 41%). We used propensity score (PS) matching with 13 preoperative risk factors to adjust for differences in baseline characteristics between the redo OPCAB and on-pump redo CABG groups. By one-to-one PS matching, we selected 200 pairs from each group. There were no significant differences in patient background between the redo OPCAB and on-pump redo CABG groups after PS matching. There was no significant difference in the mean number of distal anastomoses after matching (2.41 ± 1.00 vs 2.21 ± 1.04, P = 0.074); nevertheless, the mean operation time was significantly shorter in the redo OPCAB than the on-pump redo CABG group (353.7 vs 441.3 min, P < 0.00010). Patients in the redo OPCAB group had a lower 30-day mortality rate (3.5 vs 7.0%, P = 0.18), a significantly lower rate of composite mortality or major morbidities (11.0 vs 21.5%, P = 0.0060), a significantly lower rate of prolonged ventilation (>24 h) (7.0 vs 15.0%, P = 0.016), a significantly shorter duration of intensive care unit (ICU) stay (ICU stay ≥8 days) (7.0 vs 14.5%, P = 0.023) and a significantly decreased need for blood transfusions (71.5 vs 94.0%, P < 0.00010) than patients in the on-pump redo CABG group. The off-pump technique reduced early operative mortality and the incidences of major complications in redo CABG.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2014; · 2.40 Impact Factor
  • Acta ophthalmologica 02/2014; · 2.44 Impact Factor
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    ABSTRACT: The study aim was to collect Japanese data and stratify the operative risk of valve replacement in patients with end-stage renal failure who required dialysis. The Japan Adult Cardiovascular Surgery Database from 167 participating sites was used; a total of 1,616 records obtained between January 2004 and December 2011 was analyzed. Aortic valve replacement was performed in 1,390 of these patients (86%), mitral valve replacement in 372 (23%), and tricuspid valve replacement in eight (0.5%). The operative mortality and morbidity were 13.7% and 32%, respectively. Mechanical valves were frequently used even in patients aged >65 years (49%). Patients with bioprosthetic valves were significantly older and more likely to have comorbidities than those with mechanical valves. The operative mortality (11% versus 17%, p <0.01) and major morbidity (29% versus 37%, p <0.01) were significantly higher in patients with bioprosthetic valves. In multivariate analysis, the type of valve prosthesis was not predictive of death. Significant variables with high odds ratios included chronic lung disease (3.72), peripheral artery disease (2.24), and urgent/emergency status (2.33). The contemporary results of valve replacement for dialysis patients obtained in Japan are acceptable. Mechanical valves are frequently used, regardless of patient age. From the standpoint of an operative risk model, careful preoperative assessment is more important than the choice of valve prosthesis in dialysis patients.
    The Journal of heart valve disease 11/2013; 22(6):850-8. · 0.73 Impact Factor
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    ABSTRACT: We evaluated the current results and the predictors of in-hospital complications for a pericardiectomy procedure for constrictive pericarditis in Japan. A total of 346 patients who underwent isolated pericardiectomy for constrictive pericarditis nationwide between 2008 and 2012 were identified from the Japan Adult Cardiovascular Surgery Database. The patients were a mean age of 65.7 ± 11.7 years. The operative approach was through a median sternotomy in 90% of the patients. Cardiopulmonary bypass was used in 28.9%. The operative mortality rate was 10.0%, and the composite operative mortality or major morbidity (stroke, reoperation for bleeding, need for mechanical ventilation for more than 24 hours postoperatively due to respiratory failure, renal failure with newly required dialysis or mediastinitis) was 15.0%. Logistic regression analysis revealed that the predictive factors for composite operative mortality or major morbidity were preoperative chronic lung disease (odds ratio [OR], 4.75; p < 0.001), New York Heart Association functional class IV (OR, 3.85; p < 0.001), previous cardiac operation (OR, 2.68; p = .006), preoperative renal failure (OR, 2.62; p = .014), and cardiopulmonary bypass during the operation (OR, 2.46; p = .015). The frequency of using cardiopulmonary bypass was 2.9% in the patients treated through a left thoracotomy approach vs 31.8% in the patients treated through a median sternotomy approach (p < 0.0001). Pericardiectomy is associated with high morbidity and mortality rates. Careful consideration should be given to these risk factors in the process of patient selection and perioperative management.
    The Annals of thoracic surgery 06/2013; · 3.45 Impact Factor
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    ABSTRACT: BACKGROUND: Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. METHODS: We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular surgery cases, 17,441 thoracic aortic surgery cases, 4,726 valvular surgery plus CABG cases, and 1,800 thoracic aortic surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as in-hospital or 30-day mortality. Risk factors for DSWI were also examined. RESULTS: The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve surgery, 2.8% after valve surgery plus CABG, 1.9% after thoracic aortic surgery, and 3.4% after thoracic aortic surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups. CONCLUSIONS: The incidence of DSWI after cardiac surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac surgery.
    Journal of Cardiothoracic Surgery 05/2013; 8(1):132. · 1.02 Impact Factor
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    ABSTRACT: OBJECTIVES: To evaluate early outcomes of bilateral internal mammary artery (BIMA) compared with single IMA (SIMA) in patients who underwent isolated coronary artery bypass grafting (CABG). METHODS: Patients who received isolated CABG with SIMA or BIMA were retrospectively reviewed using the Japan Adult Cardiovascular Surgery Database from 210 institutions for 2008 and 2009. We performed a one-to-one matched analysis on the basis of estimated propensity scores for patients receiving either SIMA or BIMA and obtained two cohorts with 3851 patients in each group balanced for baseline characteristics out of 8136 SIMA and 4093 BIMA patients. We compared procedures actually performed, early outcomes including 30-day operative mortality and details of postoperative complications between the groups using Pearson's chi-square test, with P< 0.05 being statistically significant. RESULTS: Preoperative profiles in both groups included 20% females and 50% diabetes mellitus patients with a mean age of 67 years. Off-pump CABG was similar in both groups, being performed 75% of the time, with the mean number of anastomosis being 3.1 and 3.4 in the SIMA and BIMA groups, respectively (P< 0.0001). Thirty-day operative mortality was 1.2% in both groups, and the overall incidence of postoperative complications also was similar, although deep sternal infection was more frequent with BIMA (1.3 of SIMA and 2.3% of BIMA patients; P= 0.0001), while prolonged ventilation and renal failure were more frequent with SIMA (P< 0.05). CONCLUSIONS: The use of BIMA did not affect either short-term survival as postoperative mortality was low in both groups, or overall morbidity despite higher incidence of deep sternal infection.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2013; · 2.40 Impact Factor
  • International journal of cardiology 03/2013; · 6.18 Impact Factor
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    ABSTRACT: Background: although the outcome of thoracic aortic surgery has improved remarkably, mortality remains high, and mental distress is often present. Psychological outcomes of coronary artery disease have been increasingly researched but few studies have been conducted in thoracic aortic surgery patients. Objective: to compare the psychological outcomes of patients undergoing thoracic aortic surgery with those of patients undergoing coronary artery bypass grafting. Methods: a questionnaire was mailed to 190 patients who underwent thoracic aortic surgery or coronary artery bypass, at 1-5 years postoperatively. Psychological outcomes were assessed using the hospital anxiety and depression scale. Results: 128 patients responded; 49 had aortic surgery and 79 had coronary artery bypass. The incidence of borderline or significant anxiety was 14% in thoracic aortic surgery patients and 16% in coronary bypass patients; depression was present in 28% and 20%, respectively. Psychological outcome scores in the 2 groups did not differ significantly. Emergency surgery was associated with depression after aortic surgery, and symptoms such as chest pain and fatigue were associated with both anxiety and depression after coronary artery bypass. Conclusions: some psychological problems remain in the midterm following thoracic aortic surgery. While we expected a more psychologically compromised outcome in the thoracic aortic surgery group, psychological outcomes were quite similar to those in coronary artery bypass patients. The similarity of the profiles of both groups suggests that thoracic aortic surgery patients have a parallel course of midterm psychological improvement following surgery.
    Asian cardiovascular & thoracic annals 02/2013; 21(1):22-30.
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    ABSTRACT: The aim of this study was to evaluate the short-term operative results of patients with Marfan syndrome who underwent thoracic or abdominal aortic surgery in a 4-year period in Japan. Data were collected from the Japan Cardiovascular Surgery Database (JCVSD). We retrospectively analyzed the data of 845 patients with Marfan syndrome who underwent cardiovascular surgery between January 2008 and January 2011. Logistic regression was used to generate risk models. The early mortality rate was 4.4% (37/845). Odds ratios (OR), 95% confi dence intervals (CI), and P values for structures and processes in the mortality prediction model were as follows: renal insufficiency (OR, 11.37; CI, 3.7234.66; P < 0.001); respiratory disorder (OR, 11.12; CI, 3.20-38.67; P < 0.001); aortic dissection (OR, 13.02; CI, 2.8060.60; P = 0.001); pseudoaneurysm (OR, 11.23; CI, 1.38-91.66; P = 0.024); thoracoabdominal aneurysm (OR, 2.67; CI, 1.22-5.84; P = 0.014); and aortic rupure (OR, 4.23; CI, 1.26-14.23; P = 0.002). The mortality prediction model had a Cindex of 0.82 and a Hosmer-Lemeshow P value of 0.56. In conclusion, this study demonstrated that renal insuffi ciency and respiratory disorder had great impact on the operative mortality of Marfan patients undergoing cardiovascular surgery. Because patients with aortic dissection or aortic rupture showed high operative mortality, close follow-up to avoid emergency operation is mandatory to improve the operative results. Achieving good results from surgery of the thoracoabdominal aorta was quite challenging, also in Marfan patients.
    International Heart Journal 01/2013; 54(6):401-4. · 1.13 Impact Factor
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    ABSTRACT: Intraoperative assessment of a repaired mitral valve is of paramount importance for reparative mitral surgery. From September 2010 through November 2012, 20 consecutive patients underwent mitral valve plasty for mitral regurgitation. The patients who underwent surgery after June 2012 received assessment of the repair with the heart beating (HB group, n = 10), and the patients who underwent the operation before May 2012 were assessed for the repair only under cardioplegic heart arrest (non-HB group, n = 10). Intermittent cold retrograde blood cardioplegia was used in all patients. In the HB-group, after completion of the procedures, pump blood without a crystalloid additive was delivered into the coronary sinus. The function of the mitral valve was assessed under beating conditions. There were no differences between the two groups in aortic cross clamp time and operation time, although operative and concomitant procedures were slightly more complicated in the HB group than in the non-HB group. Postoperative echocardiography revealed none or mild mitral regurgitation in all the patients in both groups. Reopening of the closed left atrium for additional repair was necessary only in one patient in the HB group and 3 patients in the non-HB group. In conclusion, the method of perfusing the myocardium retrogradely via the coronary sinus with warm blood is safe and effective for assessing the competency of the mitral valve in a beating heart.
    International Heart Journal 01/2013; 54(4):192-5. · 1.13 Impact Factor
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    ABSTRACT: Marfan syndrome (MFS) is an inherited connective tissue disorder mainly caused by the fibrillin-1 mutation. Deficient fibrillin-1 is thought to result in the failed sequestration of transforming growth factor β (TGFβ) and subsequent activation of the TGFβ signaling pathway, suggesting that the circulating TGFβ level may be elevated in MFS, although its accurate measurement is complex due to ex vivo release from platelet stores upon platelet activation. We measured the plasma TGFβ1 levels of 32 Japanese MFS patients (22 medically untreated, 10 treated, 20 males, 30.1 ± 9.6 years old) and 30 healthy volunteers (19 males, 29.5 ± 5.8 years old) by ruthenium-based electrochemiluminescence platform (ECL). PF4 was also measured by enzyme immunoassay (EIA) as a platelet degranulation marker. There was no significant difference in the mean plasma TGFβ1 level between the MFS group (1.31 ± 0.40 ng/mL) and controls (1.17 ± 0.33 ng/mL) (P = 0.16, NS). Also, there was no significant difference between the untreated (1.24 ± 0.37 ng/mL) and treated (1.46 ± 0.45 ng/mL) MFS patients (P = 0.15, NS). We also measured PF4, which showed wide deviations but no significant difference between the two groups (P = 0.50). A difference in circulating TGFβ1 levels between MFS patients and controls was not detected in this Japanese population. Circulating TGFβ1 is not a diagnostic and therapeutic marker for Japanese MFS patients, although our findings do not eliminate the possible association of TGFβ with the pathogenesis of MFS.
    International Heart Journal 01/2013; 54(1):23-6. · 1.13 Impact Factor
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    Tetsuro Morota, Shinichi Takamoto
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    ABSTRACT: We developed a novel large-diameter graft "Triplex(®)" that uses a non-biodegradable material as a coating material. This time, in order to demonstrate the physical properties of Triplex(®) grafts, we conducted physical tests in accordance with the international guidelines, using the collagen coated vascular grafts (Hemashield, Boston Scientific, Natick, Massachusetts, USA) as the controls. The grafts were tested with regard to strength (burst strength, circumferential tensile strength, longitudinal tensile strength), suture retention strength, integral water permeability, water leakage (needle puncture, after using clamp), and change in luminal diameter following pacing stress according to ISO7198 and FDA guidance. As indicated by the results, we experimentally demonstrated that uniquely designed vascular graft Triplex(®) led to less blood leakage from the vascular graft and less leakage from the needle puncture, although it has fundamental physical properties comparable to those of the vascular grafts using biodegradable material that has been utilized conventionally in clinical settings. Triplex (®)is expected to play its role as a clinically beneficial next-generation vascular graft.
    Annals of Vascular Diseases 01/2013; 6(1):67-73.
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    ABSTRACT: The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities.
    The Journal of thoracic and cardiovascular surgery 06/2012; 143(6):1364-9. · 3.41 Impact Factor

Publication Stats

3k Citations
1,095.38 Total Impact Points

Institutions

  • 2009–2014
    • Mitsui Memorial Hospital
      Edo, Tōkyō, Japan
  • 2011–2013
    • Keio University
      • Department of Cardiology
      Tokyo, Tokyo-to, Japan
  • 2012
    • Nagoya University
      • Division of Cardiac Surgery
      Nagoya-shi, Aichi-ken, Japan
  • 2001–2012
    • Tokyo Medical University
      • Department of Thoracic Surgery
      Tokyo, Tokyo-to, Japan
    • Toranomon Hospital
      Edo, Tōkyō, Japan
    • Teikyo University Hospital
      Edo, Tōkyō, Japan
  • 1998–2012
    • The University of Tokyo
      • • Department of Surgical Sciences
      • • Faculty & Graduate School of Engineering
      • • Faculty & Graduate School of Medicine
      Tokyo, Tokyo-to, Japan
  • 2001–2010
    • Kyorin University
      • Department of Cardiovascular Surgery
      Edo, Tōkyō, Japan
  • 2008
    • St. Marianna University School of Medicine
      • Department of Cardiovascular Surgery
      Kawasaki, Kanagawa-ken, Japan
  • 2006–2008
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan
  • 2007
    • National and Kapodistrian University of Athens
      • Division of Thoracic Surgery
      Athens, Attiki, Greece
    • Tokyo University of Pharmacy and Life Science
      • Department of Microbiology
      Edo, Tōkyō, Japan
  • 2004–2007
    • Asahi General Hospital
      Asahi, Chiba, Japan
    • Hitachi, Ltd.
      Edo, Tōkyō, Japan
    • University of Tsukuba
      Tsukuba, Ibaraki, Japan
  • 2005
    • National Center for Child Health and Development
      Edo, Tōkyō, Japan
  • 1987–2004
    • Saitama Medical University
      • • Department of Cardiovascular Surgery
      • • Department of Surgery
      Saitama, Saitama-ken, Japan
  • 2003
    • Tokyo Metropolitan Tama Medical Center
      Edo, Tōkyō, Japan
    • Japanese Red Cross
      Edo, Tōkyō, Japan
  • 1994–2002
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
  • 2000–2001
    • Shinshu University
      • Department of Medicine
      Shonai, Nagano, Japan
  • 1999
    • Tenri Yorozu Hospital
      Тэнри, Nara, Japan
  • 1997
    • Osaka University
      • School of Medicine
      Suita, Osaka-fu, Japan
    • Takatsuki Red Cross Hospital
      Takatuki, Ōsaka, Japan
  • 1993
    • Showa General Hospital
      Edo, Tōkyō, Japan
  • 1981
    • Harvard Medical School
      • Department of Medicine
      Boston, MA, United States