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ABSTRACT: A 44-year-old woman underwent resection of a massive facial arteriovenous malformation under profound hypothermia and low-flow
cardiopulmonary bypass. A left ventricular vent through a small left anterior thoracotomy avoided ventricular distention associated
with peripheral cannulation. Low-dose aprotinin was used to improve hemostasis. These techniques thus show promise for the
safe application of profound hypothermic cardiopulmonary bypass in noncardiovascular operations.
Key wordsprofound hypothermia–circulatory arrest–arteriovenous malformation
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 48(3):186-189.
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ABSTRACT: Objective: We reviewed our experience of minimal access surgery to elucidate the efficacy and safety of this approach and determine
the factors affecting hospital stay. Methods: Seventy-seven patients (age, 11.8±11.0 years), with body weight of more than 10 kg, were operated using various forms of
minimal access approach for repair of simple congenital heart defects [atrial septal defect (ASD) in 40, ventricular septal
defect in 37]. These included lower partial sternotomy (n=68) and mini-thoracotomy (n=9, ASD only) with limited skin incision
of 4–11 cm. The anesthetic protocol was modified to wean all patients from ventilator soon after operation. The protocol of
discharge from hospital (critical pass) was 14 days in the early period (n=30) and 10 days in the late period (n=47). Results: There were no hospital or late death, and no hospital re-admission. None of patients required blood transfusion. The endotracheal
tube was extubated in the operating room in 48 cases (62%). Twenty-four patients (31%) failed to fulfill conditions of the
critical pass. Univariate analysis of factors affecting unfavorably the critical pass demonstrated that the median approach,
retention of pericardia] effusion and social reasons were statistically significant, while an opened pleura and aortic cross-clamp
time were marginally significant Multivariate analysis indicated that the retention of pericardial effusion was the only significant
factor that failed critical pass [p=0.007, odds ratio (OR) 5.7,95% confidence interval (CI) 1.61–19.8]. In addition, a pericardio-pleural
fenestration was the only significant factor that affected favorably the pericardial effusion (p=0.035, OR 0.2,95%CI 0.47–0.89)
by multivariate analysis. Conclusions: Our experience demonstrated that minimal access surgery of the simple congenital heart defects provided excellent cosmetic
results. Retention of pericardial effusion, possibly due to pericarditis, was a major risk factor of the prolonged hospital
stay. The pericardio-pleural fenestration could reduce the risk of retention of effusion.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 52(3):127-134.
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ABSTRACT: We previously reported that, in a short-term thoracic inferior vena cava (IVC) replacement, a highporosity expanded polytetrafluoroethylene
(ePTFE) graft (fibril length 60μm) performed well without altering the short-term patency, and that the healing of the high-porosity
ePTFE graft was accelerated by an omentum wrap. The purpose of this study was to examine the long-term performance of the
high-porosity ePTFE graft with or without an omentum wrap. Eighteen grafts were placed as a thoracic IVC replacement in dogs.
Nine of the grafts were wrapped in an omental pedicle flap while the other 9 were not. At 1 month and 6 months, the grafts
were harvested and examined for a pathological analysis. During the observation period, one dog died of a viral infection,
while the other 17 dogs survived. At 1 month and 6 months, the patency rates of the 17 grafts were 100% regardless of the
presence or absence of an omentum wrap. The healing of the grafts without omentum wrap was incomplete 6 months after implantation;
granulation tissue was present in the center of the pseudointima. The grafts healed completely by the addition of an omentum
wrap. Our data suggest that, with an omentum wrap, the high-porosity ePTFE graft is fully expected to show a good long-term
function.
Key WordsHigh-porosity polytetrafluoroethylene graft–Omentum wrap–Thoracic inferior vena cava reconstruction
Surgery Today 04/2012; 30(7):631-635. · 1.22 Impact Factor
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ABSTRACT: The effect of covalent bonding of fibronectin on the patency and graft healing of high-porosity expanded polytetrafluoroethylene
(ePTFE) grafts was evaluated. Bilateral carotid grafting was performed in ten mongrel dogs using high-porosity (60μm) ePTFE
grafts, 4 cm in length and 4mm in internal diameter, that either had been pretreated by the covalent bonding of fibronectin
(fibronectin grafts) or were untreated (control grafts). The grafts were harvested 4 to 6 weeks after surgery and subjected
to macroscopic and lightmicroscopic observations. There was no significant difference in patency between the fibronectin grafts
and the control grafts with rates of 80% and 70%, respectively. The thrombusfree area score was significantly greater in the
fibronectin grafts than in the control grafts, at 86.9% vs 34.0%. Furthermore, the pseudointima was better replaced by fibrous
tissue in the fibronectin grafts than in the control grafts, being lined with a layer of endothelial-like cells. More transmural
tissue ingrowth was evident in the fibronectin grafts than in the control grafts. The covalent bonding of fibronectin improves
graft healing by stimulating transmural tissue ingrowth in high-porosity ePTFE grafts.
Key Wordscovalent bonding of fibronectin–high-porosity expanded polytetrafluoroethylene graft
Surgery Today 04/2012; 30(5):426-431. · 1.22 Impact Factor
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ABSTRACT: To prevent pulmonary embolism due to deep venous thrombosis (DVT), we have treated 611 patients undergoing orthopedic surgery of the lower extremities with our protocol including pre- and postoperative ultrasonic venous screening and anticoagulant therapy if necessary. A total of 118 patients (19.3%) developed DVT. Among demographic and clinical factors, the site of operation (knee joint surgery: odds ratio 5.17), age (>60: odds ratio 3.91), and operation time (>120 minutes: odds ratio 4.52) were identified as significant risk factors of development of DVT. One patient received an infusion of urokinase for DVT of femoral vein, but no patients developed serious postoperative bleeding or pulmonary thromboembolisms. (*English Translation of J Jpn Coll Angiol, 2010, 50: 95-100.).
Annals of Vascular Diseases 01/2012; 5(3):328-33.
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ABSTRACT: Perfluoro-octyl bromide (PFOB), one of the perfluorochemical oxygen transporters, improved postischemic cardiac dysfunctions. Also norepinephrine (NE) is one of the important inducible factors on reperfusion arrhythmias (ventricular fibrillation [VF]). We used these methods to evaluate the relationship between PFOB emulsion and NE release on reperfusion arrhythmias.
The perfusion of isolated guinea pig hearts was employed: each of four groups of 6-7 hearts were used with Krebs-Henseleit solution (KHS) as control, and KHS with 5%, 15%, or 30% PFOB emulsion. The hearts were perfused in a constant pressure Langendorff model, stabilized for 30 min, followed by 30 min preischemia, then 30 min ischemia and 45 min reperfusion at normothermia.
PFOB emulsion dose-dependently limited VF and inhibited NE release in reperfusion. Only 30% PFOB emulsion showed the significant improvement of VF (p=0.05). In hemodynamic parameters, only 5% PFOB emulsion showed a significant decrease in reperfusion, but there was no difference in coronary flow rate (CFR). No differences among the four groups were demonstrated in cardiac oxygen metabolic parameters.
It was most likely that a high concentration of PFOB emulsion attenuated reperfusion arrhythmia by decreasing NE release.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 01/2009; 14(6):363-8.
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ABSTRACT: Under myocardial reperfusion conditions, hemoglobin (Hb)-based artificial blood showed effectiveness for post-ischemic dysfunction. However, there are no studies about the effects of this product on reperfusion arrhythmias (ventricular fibrillation, VF) associated with norepinephrine (NE) release. This study was to evaluate the effects of the timing of the administration of pegylated liposomal Hb (LHb, P(50)=40-45 mmHg, 1 mg/mL) on NE release and VF.
Isolated guinea pig hearts (n=6 in each group) were randomly divided into four groups in Krebs-Henseleit solution being supplemented or not with LHb as follows: pre-ischemia (PRE), reperfusion (REP), or PRE+REP groups. The hearts were perfused for 30 min (preischemic period) and then subjected to 30 min of global ischemia, followed by 30 min of reperfusion with a normothermic Langendorff apparatus at 30 mm Hg aortic pressure in a constant pressure model.
No differences were documented among the four groups in heart rate, left ventricular-developed pressure, or coronary flow rate. However, the REP group significantly decreased the duration of VF and NE release, but it did not inhibit the incidence of VF.
These results suggest that the administration of LHb, especially with the timing of reperfusion, might prevent reperfusion arrhythmias linked to the inhibition of NE release.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 01/2008; 13(6):391-5. · 0.69 Impact Factor
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ABSTRACT: Endothelin (ET)-1 is an endogenous vasoconstrictor which modulates norepinephrine (NE) release in myocardial ischemia reperfusion. Recent studies have demonstrated the pro- or anti-arrhythmic effects in reperfusion. The present studies were undertaken to test the hypothesis that ET receptors located in sympathetic nerve terminals modulate NE release associated with reperfusion arrhythmias (ventricular fibrillation; VF). Immunohistochemical studies showed that both ETA and ETB receptors exist in the sympathetic nerve varicosities, which were stained positive for tyrosine hydroxylase (TH) in the left ventricular wall in guinea pigs. Isolated guinea pig hearts were subjected to 20 min of normothermic global ischemia followed by 30 min reperfusion. Exogenously applied ET-1 (0.1 and 1 nM) dose-dependently increased NE release and the duration of VF, but these responses were significantly suppressed with the Na(+)/H(+) exchanger inhibitor, 5-(N-ethyl-N-isopropyl)-amiloride (10 microM). The ETA receptor antagonist (BQ123, 1 microM) and nonselective ET receptor antagonist (PD142893, 1 microM) significantly attenuated NE release and VF, whereas the ETB receptor antagonist (BQ788,300 nM) markedly elevated NE release but did not affect VF. These studies provide the first evidence that both ETA and ETB receptors, located in the sympathetic nerve varicosities, modulate NE release, at least in part, in association with reperfusion arrhythmias.
Archiv für Kreislaufforschung 04/2007; 102(2):154-62. · 7.35 Impact Factor
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ABSTRACT: Calcitonin gene-related peptides (CGRP), which are potent vasodilators, are elevated during cardiopulmonary bypass (CPB) in humans. We evaluated the plasma levels of CGRP in dogs during CPB with hemofiltration with and without hemodilution. Female beagles were divided into control (n=5) and hemodilution (n=5) groups. The CPB with hemofiltration was performed with or without hemodilution. For the measurement of CGRP, blood samples were collected pre-CPB, during CPB, and post-CPB. The concentrations of CGRP in the hemofiltration solution were measured. Although the CPB elevated the plasma CGRP levels in both groups, its elevation was significant in the hemodilution group when compared to the pre-CPB levels. CGRP levels returned to normal post-CPB. Significant differences were found between the two groups in the CGRP amount in hemofiltration. The results show that hemofiltration should be used during CPB to decrease the plasma levels of CGRP.
Research in Veterinary Science 03/2007; 82(1):110-4. · 1.65 Impact Factor
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ABSTRACT: A 69-year-old woman had severe aortic stenosis with a circumferentially calcified aorta from the ascending aorta to the aortic arch, and moderately impaired left ventricular function. Implantation of an apicoaortic valved conduit was performed as aortic clamping was not feasible. The early results were excellent.
Asian cardiovascular & thoracic annals 09/2006; 14(4):e76-9.
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ABSTRACT: Thoracic aortic aneurysm repair with the stented elephant trunk technique seems to be associated with an increased risk of spinal cord injury. We investigated whether severe atherosclerosis of the distal landing zone or extensive deployment of the stented elephant trunk is associated with increased risk of spinal cord injury.
Twenty-five patients underwent thoracic aortic aneurysm repair with the stented elephant trunk technique. The study population included 19 men and had a mean age of 73 +/- 7 years. All patients underwent a median sternotomy with cardiopulmonary bypass and selective cerebral perfusion. The elephant trunk was fixed with a Z-stent distal to the aneurysm during hypothermic circulatory arrest. Thirteen patients underwent concomitant total aortic arch replacement.
Six (24%) patients had spinal cord injury. The presence of severe atherosclerosis at the distal landing zone demonstrated a tendency to increase the incidence of spinal cord injury (36% vs 9%, P = .1218). More distal deployment of the stented elephant trunk was significantly associated with increased risk of spinal cord injury (T8.0 +/- 0.6 vs T6.5 +/- 1.1, P = .0043). Univariate logistic regression analysis identified a history of abdominal aortic aneurysm repair (P = .0296) and the vertebral level of the distal landing zone (P = .0249) as significant independent risk factors for spinal cord injury, and only the latter was significant in multivariate analysis (P = .0396). The combination of a distal landing zone of T7 or greater and a history of abdominal aortic aneurysm repair was the strongest predictor for spinal cord injury (71% vs 6%, P = .0047).
Spinal cord injury after stented elephant trunk deployment might be related to occlusion of the excessive intercostal arteries or thromboembolism. Patients with a history of abdominal aortic aneurysm repair who require extensive deployment of the stented elephant trunk seem to be at a higher risk for spinal cord injury.
The Journal of thoracic and cardiovascular surgery 03/2006; 131(2):336-42. · 3.41 Impact Factor
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ABSTRACT: The purpose of the present study was to evaluate the stability of a high-porosity expanded polytetrafluoroethylene (ePTFE) graft, which has been shown to possess excellent biocompatibility and tissue integration.
The graft used in the present study was a high-porosity ePTFE graft , which had an average internodal distance of approximately 60 microm and a random node architecture with tortuous path channels extending from the outer to the inner surface. Eleven beagle dogs (each group n = 3 or 4) weighing 10-12 kg were used. The graft, with a 6 mm inside diameter and a 30-40 mm length, was implanted into the canine abdominal aorta and retrieved after 2-80 weeks. The deformation of the graft was evaluated by conventional computed tomography (CT). The radial tensile strength, longitudinal tensile strength, and suture retention strength of the graft were measured after 2-80 weeks.
CT studies showed no anastomotic aneurysm or deformation of the graft. Physical tests demonstrated no significant deterioration in suture retention strength, radial tensile strength or longitudinal tensile strength for periods ranging from 2-80 weeks compared to pre-implantation grafts.
The graft possesses adequate stability that ensures safe and effective clinical use.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 03/2006; 12(1):37-41. · 0.69 Impact Factor
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ABSTRACT: Bileaflet mechanical valve closing sounds have splits, the duration of which is not constant in normally functioning valves. However, no reports have discussed the influences of valve malfunction on the split interval, neither have any studies discussed the fact that mechanical valve closing sound signals must be analyzed using a time-frequency analysis because they are nonstationary signals. The continuous wavelet transform (CWT), a time-frequency analyzing method using mother wavelets modified by scale numbers, was selected in this study for analyzing bileaflet valve closing sounds because it is easy to understand and has no limitations such as the cross-terms in the Wigner-Ville distribution or the tradeoff between time and frequency resolutions of the short-time Fourier transform. This study compares the properties of the mother wavelets of various CWTs and selects one that is suitable for detection of the clear split in bileaflet mechanical valve closing sound signals. This article also establishes a standard frequency analyzing system for bileaflet mechanical valve sounds. A preliminary study with chirp Doppler signals for comparing the frequency properties of the mother wavelets of various CWTs suggested that Ishikawa's modified Morlet CWT has better time and frequency resolution at the highest frequency scale. Morlet/power CWT analysis of normal in vivo bileaflet valve closing sounds of the ST. Jude Medical (SJM), ATS, and Carbomedics (CM) valves demonstrated clear splits of very short interval at the highest level of frequency. Detection of the disappearance of the split by using this analytical method may be the key to identifying bileaflet mechanical valve malfunction in outpatient departments.
Journal of Artificial Organs 02/2006; 9(1):42-9. · 1.59 Impact Factor
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ABSTRACT: Despite some controversial studies, an enlarged left atrium has an impact on postoperative complications, and surgical correction should be considered, particularly in patients with a markedly enlarged left atrium. We present herein 2 patients with a giant left atrium (left atrial dimensions of 107 and 93 mm on echocardiograms), and describe an effective and simple procedure, the "spiral resection" method, to reduce any part of the dilated wall of the left atrium with a single incision.
The Annals of thoracic surgery 02/2006; 81(1):378-80. · 3.74 Impact Factor
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ABSTRACT: The early increase in serum S100beta after cardiopulmonary bypass (CPB) seems to be derived from an extracerebral source. To exclude contamination, we investigated the arterio-jugular differences in S100beta levels in patients receiving selective cerebral perfusion (SCP). We also evaluated the brain-protective effect of SCP by comparing the arterial S100beta levels with those in patients undergoing coronary artery bypass grafting (CABG).
We measured arterial and jugular venous levels of S100beta in ten patients undergoing aortic arch repair with SCP for up to 12 h postoperatively (SCP group). We also measured arterial levels of S100beta in nine patients undergoing CABG (CPB group).
There was no incidence of hospital death or stroke. The arterial levels of S100beta in both groups were comparable and peaked just after the conclusion of CPB. The arterial and jugular venous levels of S100beta were almost equivalent. The arterio-jugular differences in S100beta levels were negligible, even in our SCP-group patient with postoperative delirium, who had a peak value three times higher than the other patients.
The arterio-jugular differences in S100beta did not clarify the origin of their increase. Thus, measuring the jugular venous levels of S100beta in patients without postoperative clinical neurological deterioration would be of little benefit. However, SCP seems to protect the brain against S100beta release as effectively as conventional CPB.
Surgery Today 02/2006; 36(1):6-11. · 1.22 Impact Factor
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Journal of Vascular Surgery 11/2005; 42(4):805. · 3.21 Impact Factor
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ABSTRACT: Although hemodilution is usually utilized during cardiopulmonary bypass (CPB), hemodilution can cause adverse effects such as hypotension and hypoxia. The purpose of this study was to evaluate a novel perfluoro-octyl bromide (PFOB) emulsion, one of perfluorochemicals (PFCs) emulsions, administered during hemodilution CPB.
Fifteen dogs were subjected to CPB for 2 hours under mild hypothermia. Animals were divided into three groups; control group, hemodilution group and PFOB group. During the experiment, hemodynamics, complete blood count and blood chemistry were monitored. In addition, serum complement titer (CH50), bradykinin and histamine concentrations were also measured.
Heart rate (HR) was markedly elevated in the hemodilution groups (p<0.05). Mean arterial pressure (MAP) did not change in the three groups. White blood cell (WBC) and platelet (PLT) count did not significantly differ among the three groups. Plasma lactate concentration was markedly elevated only in hemodilution group during late phase of CPB (p<0.05). In the hemodilution group, CH50, bradykinin and histamine, were markedly elevated during the CPB and just after CPB (p<0.05).
The present study demonstrated possible benefits of the new PFC emulsion during cardiac surgery by counteracting the adverse effects of hemodilution during CPB.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 09/2005; 11(4):238-44. · 0.69 Impact Factor
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ABSTRACT: Mitral valve replacement in the presence of extensive calcification of the mitral annulus is a technical challenge. Dense calcification of the annulus can cause a great difficulty in the insertion of a prosthetic valve and later periprosthetic leakage. A radical calcium debridement may cause left circumflex coronary artery injury, atrioventricular rupture, and thromboembolic events. We report a case of a 65-year-old woman suffering from mitral regurgitation with a severely calcified mitral annulus. She underwent mitral valve replacement using a collar-reinforced prosthetic valve, which allowed the surgeon to safely insert a prosthetic valve, avoiding the calcification completely without any major complications. We recommend this method as a feasible technique for mitral valve replacement in the presence of heavily calcified or disrupted fragile mitral annulus.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 09/2005; 11(4):260-3. · 0.69 Impact Factor
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ABSTRACT: We used a canine model to assess the efficacy of an angiotensin-converting enzyme inhibitor (perindopril) at modulating intimal/medial hyperplasia in vein bypass grafts. Fourteen beagle dogs were divided into medicated and control groups and underwent bilateral grafting of external jugular veins into the common carotid artery. Samples of normal veins were obtained from the control group during vein grafting. Vein grafts were harvested 1 week and 4 weeks after surgery in both groups. Subsequently, intimal/medial thickness was measured by staining with hematoxylin and eosin; antibodies for proliferating cell nuclear antigen were employed to determine the degree of cellular proliferation; apoptotic cells were detected using the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling method. In the medicated group, the intimal/medial cross-sectional area was significantly smaller and increased 8- to 9-fold in comparison to the control group, which increased 12- to 20-fold. There was a significantly higher rate of cell proliferation in the control group, whereas the medicated group showed a significantly higher rate of apoptotic cells. These data support the efficacy of perindopril at reducing intimal/medial hyperplasia in arterialized vein grafts during a short postoperative period.
Annals of Vascular Surgery 08/2005; 19(4):499-506. · 1.03 Impact Factor
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ABSTRACT: We report our strategy and results of spinal cord protection in Crawford I and II thoracoabdominal aortic replacement. :
Retrospective analysis of 43 elective operations. Before 1994, we reconstructed segmental arteries during a single period of blood flow interruption in 11 of 12 patients, using distal aortic perfusion and evoked spinal cord potential (ESCP) monitoring. Deep hypothermia was used in one. Since 1994, we used multi-segmental sequential repair, in which T8-L1 arteries were sequentially reconstructed irrespective of evoked potential change, in 20 of 31 patients. In the remaining 11, deep hypothermia was used. Cerebrospinal fluid drainage (CSFD) was introduced in 1996 (n=26), and continuous infusion of naloxone in 1999 (n=17).
In patients undergoing distal aortic perfusion without multi-segmental sequential repair, six spinal cord injuries including two deaths occurred. Change in evoked potentials was observed in nine of 10 monitored patients. With multi-segmental sequential repair, only one spinal cord injury occurred, and three of 11 monitored patients showed evoked potential change. With deep hypothermia, no spinal cord injury occurred. Multivariate analysis identified operation without multi-segmental sequential repair as a risk factor for spinal cord injury (p=0.008).
Evolving strategy resulted in an improved outcome. Both multi-segmental sequential repair and deep hypothermia were more effective than our previous technique.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 07/2005; 11(3):178-85. · 0.69 Impact Factor
