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ABSTRACT: Sinus node dysfunction is commonly associated with atrial fibrillation. There is little information about the long-term results of pulmonary vein isolation in relation to sinus node function. The present study was conducted to investigate whether sinus node dysfunction affects the late outcome of pulmonary vein isolation in patients with persistent/permanent atrial fibrillation.
Among 76 consecutive patients with persistent/permanent atrial fibrillation who had undergone cut-and-sew pulmonary vein isolation, 66 patients without evidence of intra-atrial thrombus by transesophageal echography, and who were able to tolerate cardioversion, were enrolled. Sinus node recovery time after cardioversion was examined intraoperatively. All of the patients underwent valvular surgery concomitantly (mitral in 62).
Sinus node dysfunction was detected in 18 patients. These patients had a significantly lower f wave voltage in V(1) of the electrocardiogram and a larger cardiothoracic ratio than patients with normal sinus node function. Hospital mortality was 3%, and 3 late deaths were observed. Follow-up was conducted for up to 72 months (mean 30 months), with a 100% complete follow-up rate. There were no significant differences in actuarial survival and freedom from cardiac events between patients with normal and abnormal sinus node function. No thromboembolic events occurred. A significantly higher proportion of patients with normal sinus node function (82%) were free of atrial fibrillation at 4 years than patients with sinus node dysfunction (25%; P < .0001).
The atrial fibrillation cure rate after pulmonary vein isolation may be influenced by sinus node function in both the early and late stages. Although further examinations are required, pulmonary vein isolation may be an adequate treatment for persistent/permanent atrial fibrillation in patients with normal sinus node function.
The Journal of thoracic and cardiovascular surgery 06/2011; 141(6):1455-60. · 3.41 Impact Factor
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Michiya Hanyu, Takuya Nomoto,
Yoshio Arai,
Takehiko Matsuo,
Akiyoshi Mikuriya,
Shinya Takimoto,
Takeichiro Nakane,
Masahide Kawatou,
Yasumasa Nohno,
Shintaro Kuwauchi,
Hitoshi Okabayashi
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ABSTRACT: We reviewed our cut and sew pulmonary vein isolation (PVI) series for chronic or paroxysmal atrial fibrillation (Af). Intraoperative evaluation of sinus nodal function with electrical defibrillation and atrial pacing and the incision to mitral annulus adding to PVI were important factors to restore sinus rhythm. Ninety-two percent of the patients with the good sinus nodal function restored sinus rhythm. These findings will be useful information for surgical ablation of Af with or without new energy sources.
Kyobu geka. The Japanese journal of thoracic surgery 04/2010; 63(4):291-5.
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The Journal of thoracic and cardiovascular surgery 03/2009; 137(2):503-4. · 3.41 Impact Factor
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ABSTRACT: Wound infection is a rare but life-threatening complication after coronary artery bypass grafting. Risk factors for wound infection after off-pump bypass grafting and the validity of using bilateral internal thoracic arteries harvested in a skeletonized fashion remain unclear, especially in patients with diabetes.
The data of 1500 consecutive patients having off-pump bypass grafting were prospectively collected from our database based on EuroSCORE. This cohort represents 95% of all patients undergoing coronary bypass during that period and 77% of patients undergoing off-pump bypass grafting who received bilateral internal thoracic artery grafts. Univariate and multivariate analyses were performed for patients with and without wound infection and in the diabetic subgroup.
Ninety-eight patients had wound infections: 76, impaired wound healing; 7, superficial sternal wound infection; and 12, deep sternal wound infection. Patients with wound infections had a higher prevalence of female gender, atrial fibrillation, history of congestive heart failure, chronic renal failure, peripheral vascular disease, and diabetes. Patients with a wound infection more frequently had bilateral internal thoracic artery grafting, longer operation time, longer hospital stay, and a higher mortality rate. Blood transfusions were required in 43.9% of patients with wound infections and 28.1% of those without wound infections. On logistic regression analysis, female gender and history of congestive heart failure, chronic renal failure, and diabetes mellitus were independent risk factors for wound infection. In patients with diabetes, female gender, atherosclerosis obliterans, chronic renal failure, and use of bilateral internal thoracic artery grafts were independent risk factors for wound infection.
Risk factors for wound infection after off-pump coronary artery bypass grafting are comparable with those previously reported for conventional bypass grafting. In patients with diabetes, the use of bilateral internal thoracic arteries, even when harvested in a skeletonized fashion, is a risk factor. Thus, appropriate precautions should be taken in patients with diabetes.
The Journal of thoracic and cardiovascular surgery 04/2008; 135(3):540-5. · 3.41 Impact Factor
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The Journal of thoracic and cardiovascular surgery 01/2008; 134(6):1581-2. · 3.41 Impact Factor
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ABSTRACT: We evaluated the effects of coronary artery bypass with off-pump skeletonized bilateral internal thoracic artery grafting in patients with insulin-dependent diabetes.
One hundred eighty-five consecutive patients with insulin-dependent diabetes who underwent isolated coronary artery bypass grafting with bilateral internal thoracic grafts were retrospectively compared according to surgical technique, ie, off-pump grafting with skeletonized internal thoracic artery (n = 162) or on-pump grafting with pedicled internal thoracic artery (n = 23).
The on-pump group was younger (62.3 +/- 9.2 versus 69.9 +/- 8.5 years; p = 0.02) and had fewer distal anastomoses (3.5 +/- 1.0 versus 4.0 +/- 1.1; p = 0.02) than the off-pump group. No 30-day mortality occurred in either group. The incidence of deep sternal infection was significantly lower in the off-pump group than in the on-pump group (0.6% versus 13.0%; p = 0.01). The early angiographic results did not differ between the two groups. The median duration of follow-up was 3.4 years (range, 0.1 to 9.9 years). Rates of survival, freedom from cardiac mortality, and freedom from cardiac-related events (including cardiac-related death, myocardial infarction, percutaneous coronary intervention, repeat coronary artery bypass grafting, and congestive heart failure) did not differ between the two groups. Dialysis, peripheral vascular disease, ejection fraction less than 0.40, and age were independent risk factors of late death.
Overall, our results support the surgical management of coronary artery bypass grafting in insulin-dependent diabetics using off-pump skeletonized bilateral internal thoracic artery grafting.
The Annals of thoracic surgery 08/2007; 84(1):32-6. · 3.74 Impact Factor
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ABSTRACT: We evaluated the perioperative and long-term results of bilateral internal thoracic artery grafting in dialysis patients.
One hundred one consecutive patients on chronic dialysis who underwent isolated coronary artery bypass grafting were retrospectively compared according to the surgical technique, bilateral internal thoracic artery (BITA) grafting (n = 76) or single internal thoracic artery (SITA) grafting (n = 25).
Hospital mortality was 5.3% in the BITA group and 8.0% in the SITA group (p = not significant). The incidence of mediastinitis was not different (7.9% in the BITA group and 8.0% in the SITA group). The median duration of follow-up was 3.1 years (range, 0.1 to 10.9). Survival and freedom from cardiac mortality were not different between the two groups, but the BITA group had a trend toward better results. Freedom from cardiac events (including cardiac-related death, myocardial infarction, percutaneous coronary intervention, redo coronary artery bypass grafting, and congestive heart failure) was superior in the BITA group (p = 0.03). Calcification of the ascending aorta, peripheral vascular disease, insulin-dependent diabetes mellitis, and age were the independent risk factors of late death.
Perioperative results of BITA grafting in dialysis patients were not different from the results of SITA grafting. However, the long-term results of BITA grafting in dialysis patients were better than the results of SITA grafting. Overall, our results support the continued use of BITA grafting in dialysis patients.
The Annals of thoracic surgery 06/2007; 83(5):1666-71. · 3.74 Impact Factor
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Masashi Kai,
Hitoshi Okabayashi,
Yoshiharu Soga,
Michiya Hanyu, Takuya Nomoto,
Jota Nakano,
Hideki Kitamura,
Takehiko Matsuo,
Tomohiro Tsunekawa,
Eitaro Umehara,
Masahide Kawato
The Journal of thoracic and cardiovascular surgery 01/2007; 132(6):1473-5. · 3.41 Impact Factor
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The Journal of thoracic and cardiovascular surgery 11/2005; 130(4):1199-201. · 3.41 Impact Factor
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ABSTRACT: The purpose of this study was to investigate (1) the early and midterm patency rates in saphenous vein grafts that were anastomosed with the Symmetry Aortic Connector System (St Jude Medical, Inc, St Paul, Minn) and (2) risk factors for graft occlusion.
Thirty-one patients underwent off-pump coronary artery bypass grafting for proximal saphenous vein graft anastomoses with the aortic connector system. Intraoperative graft flow was studied with transit time flowmetry, and angiography was performed before discharge in 29 cases. Midterm (at least 1 year after the operation) saphenous vein graft patency was assessed by coronary angiography or 3-dimensional coronary computed tomography in 27 cases.
Postoperative angiography demonstrated a 100% patency rate and no significant stenosis at the connector-anastomosed sites. The 1-year patency rate of the saphenous vein grafts with the aortic connector system was 92.6%, with 2 cases of saphenous vein graft occlusion. Both of these cases had low graft flow and poor left ventricular function documented during the operation.
Once surgical errors had been ruled out, the 1-year patency rate of proximal saphenous vein grafts anastomosed with the aortic connector system was favorable. Poor left ventricular function and low graft flow during the operation were risk factors for midterm graft occlusion. Selection of the target vessel and its runoff may also be an important determinant of long-term patency.
The Journal of thoracic and cardiovascular surgery 11/2005; 130(4):1028-31. · 3.41 Impact Factor
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ABSTRACT: While left ventricular (LV) reduction surgery (LVR) is a novel treatment for severe heart failure, alteration of signal transduction pathways by this surgery is unknown. LV endothelin-1 plays a critical role in LV remodeling following myocardial infarction (MI). Another possible mechanism of remodeling is myocardial cell loss due to apoptosis. The purpose of the present study was to determine whether the LV endothelin-1 level and apoptosis signaling change after LVR. Adult rats were divided into two groups: non-MI group and MI group, and the MI group was subjected to permanent ligation of the left anterior descending artery. Four weeks later, rats in the MI group were subjected to LVR (LVR group) or a sham operation (OMI group). Two weeks after the second operation, echocardiography revealed that LVR improved LV systolic function and remodeling. Upregulation of LV endothein-1 was detected only in the OMI group but not in the non-MI group nor in the LVR group. The percentage of terminal deoxynucleotidyl transfer-mediated end-labeling of fragmented nuclei (TUNEL)-positive cardiac myocytes was significantly higher in the OMI group than in the LVR group or the non-MI group. Western blotting of extracts from the left ventricle showed that bcl-2 and bcl-xL levels were restored and caspase-3 activation was repressed after LVR. Thus, LVR modulates the expression of endothelin-1 and apoptosis signaling in failing hearts. These alterations of signal transduction pathways might contribute to the beneficial effects of LVR on systolic function in heart failure.
Journal of cardiovascular pharmacology 12/2004; 44 Suppl 1:S366-71. · 2.83 Impact Factor
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ABSTRACT: Left ventricular aneurysm repair (LVR) reduces LV wall stress and improves LV function. However, as we reported previously, the initial improvement of LVR was short-term because of LV remodeling but could be maintained longer with postoperative use of an angiotensin-converting enzyme (ACE) inhibitor. Atrial natriuretic peptide (ANP) has been used to treat patients with heart failure by natriuretic and vasodilatory actions. Recent reports have suggested that ANP inhibits the rennin-angiotensin system. In this study, the effects of ANP after LVR were evaluated.
Rats that had an LV aneurysm 4 weeks after left anterior descending artery ligation underwent LVR by plicating the LV aneurysm and were randomized into 2 groups: LVR+A group was intravenously administrated with 10 microg/h of carperitide, recombinant alpha-hANP, by osmotic-pump for 4 weeks, and the LVR group was given normal saline. Echocardiography revealed better LV remodeling and function in LVR+A group than in LVR group. Four weeks after LVR, left ventricular end diastolic pressure (LVEDP) and Tau were significantly lower in LVR+A group (LVEDP: 10+/-4 in LVR+A group versus 18+/-6 mm Hg in LVR group, Tau: 13+/-2 versus 17+/-2ms). End-systolic elastance (Ees) was higher in LVR+A group (Ees: 0.34+/-0.2 versus 0.19+/-0.11 mm Hg/microL). The levels of myocardial ACE activity in LVR+A group was significantly lower than in LVR group. The mRNA expressions of brain natriuretic peptide and transforming growth factor beta1 inducing fibrosis significantly decreased in LV myocardium in LVR+A group. Histologically, myocardial fibrosis was significantly reduced in LVR+A group.
Intravenous administration of ANP had beneficial effects on LV remodeling, function, and fibrosis after LVR. ANP could be a useful intravenous infusion drug for postoperative management after LV repair surgery.
Circulation 10/2004; 110(11 Suppl 1):II174-9. · 14.74 Impact Factor
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ABSTRACT: The early results of coronary artery grafting with an aortic connector system were assessed in Japanese patients. From May 2002 through April 2003, 24 consecutive patients underwent off-pump coronary artery bypass using an aortic connector system. Another patient was excluded because the saphenous vein was insufficient for the smallest available aortic connector system. Saphenous veins were harvested from the thigh in 17 (70.8%) patients, and from the lower leg in 7. The size of the aortic connector system was 4.5-5.0 mm in 19 (79.2%) patients. Intraoperative epiaortic echo indicated that a side-clamp was contraindicated in 15 cases. Hemostasis was instantaneous in all patients. There were no hospital deaths and no neurologic morbidity. Pre-discharge angiography revealed 100% patency of the anastomoses. Use of the aortic connector system demonstrated excellent early results with low neurologic morbidity even when employed in the context of an atheromatous ascending aorta. However, smaller sizes of the device are required for some Japanese patients.
Asian cardiovascular & thoracic annals 10/2004; 12(3):236-8.
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ABSTRACT: We reported in a previous study that the initial effects of left ventricular (LV) repair (LVR) for LV aneurysm were not long lasting. Angiotensin-converting enzyme inhibitor (ACE-I) is known to attenuate remodeling after myocardial infarction, and could be effective after LVR.
Left ventricular aneurysms were developed in rats after left anterior descending artery ligation. Rats were divided into 3 groups: sham operation with ACE-I (lisinopril 10 mg/kg/d) (n=10; group A), LVR (by plicating the LV aneurysm) with placebo (n=8; group R), and LVR with ACE-I (n=10; group RA). LV function was evaluated by echocardiography and catheterization. Oxidative stress in the myocardium was estimated by immunohistochemistry for 8-hydroxy-2'-deoxyguanosine. One week after LVR, LV end-diastolic area was smaller and fractional area change was better in the 2 LVR groups. Four weeks after LVR, LV end-diastolic area, and fractional area change deteriorated in group R but not so much in group RA; E-max was higher in group RA (0.79+/-0.20 mm Hg/mL) than in groups A (0.25+/-0.03 mm Hg/mL; P<0.01) and group R (0.27+/-0.03 mm Hg/mL; P<0.01). Oxidative stress was much lower in the 2 ACE-I groups.
LVR improved LV size and systolic function only in the early phase. Adjuvant use of ACE-I was useful for preventing redilation and maintaining LV systolic function, was associated with suppressed oxidative stress, and may make LVR a more effective surgical procedure for LV aneurysm.
Circulation 10/2002; 106(12 Suppl 1):I115-9. · 14.74 Impact Factor
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ABSTRACT: Temporary or persistent heart failure is one of the major complications after myocardial infarction (MI). In order to elucidate the pathogenesis of MI, we studied the spaciotemporal alteration of 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in cardiomyocytes in a rat model of ligation of the left anterior descending branch of the coronary artery. The lethality in this model was 18%. Hearts were dissected at 0, 3, 6, 12, 24, 48 h, and 1, 2, 4, 6 weeks after the operation. The cardiac level of 8-OHdG was evaluated biochemically as well as by immunohistochemistry with monoclonal antibody N45.1. Three to 6h after ligation, the 8-OHdG levels were increased in the cardiomyocytes of MI (six-fold) and peri-MI (four-fold) areas. After 24 h, the myocardium in the MI area was necrotized, and thereafter the 8-OHdG level decreased. 8-OHdG levels in the myocardium of peri-MI areas returned once to a normal level, but were significantly increased at 2-4 weeks along with the appearance of apoptotic cardiomyocytes in this area. The heart after MI has been generally considered as clinically stable after four weeks. However, cardiomyocytes near the infarcted area were oxidatively stressed even after four weeks when the affected lesion was extensive. The present data support the use of supplementary antioxidant therapies to save functional myocardium after MI. (213 words)
Free Radical Research 09/2002; 36(8):853-8. · 2.88 Impact Factor
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Nobuhiro Handa,
Yasuhiro Magata,
Eiji Tadamura,
Takahiro Mukai,
Takeshi Nishina,
Senri Miwa,
Yutaka Sakakibara, Takuya Nomoto,
Junji Konishi,
Kazunobu Nishimura,
Masashi Komeda
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ABSTRACT: In vivo quantitative assessment of positron emission tomography (PET) with 2-deoxy-2-[fluorine 18]fluorodeoxyglucose (FDG) for rat heart has not been explored because of the theoretical limitation of spatial resolution. Our objective was to assess whether FDG uptake measured by PET is correlated with tissue radioactivity of FDG in rat heart directly measured by an automated gamma counter.
Ten Sprague-Dawley rats were used for echocardiographic assessment and FDG-PET. Rats were sacrificed immediately after PET scanning, and the radioactivity of FDG in 4 segmental tissue samples of the middle transverse section was measured. Quantitative PET values in a total of 40 regions of interest, in which partial volume effect was corrected based on the phantom study and wall thickness obtained by echocardiogram, were compared with radioactivity of the corresponding 40 tissue samples. Linear regression analysis revealed that tissue radioactivity of FDG was well correlated with the quantitative PET value (Y = 1.17X; r = 0.985, P <.0001).
Quantitative FDG-PET for rat heart is a reliable approach for assessing glucose metabolism in vivo after correction is made for partial volume effect. These results can be used for various models of heart disease with repeated studies over the disease process in the same animal.
Journal of Nuclear Cardiology 9(6):616-21. · 2.67 Impact Factor
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ABSTRACT: We reported that the initial beneficial effects of left ventricular repair (LVR) surgery for LV aneurysm after myocardial infarction (MI) did not persist because of postoperative LV remodeling in a rat model. The renin-angiotensin system (RAS) plays an important role in postinfarction LV remodeling. Inhibition of RAS may be useful to preserve LV function by preventing remodeling. We studied the effects of two inhibitors of RAS in an attempt to improve the operative results of LVR. LV aneurysms were created in rats after ligating the left anterior descending artery. These rats underwent LVR by plicating the LV aneurysm and were treated by three methods: no treatment, treatment with angiotensin-converting enzyme inhibitor (ACE-I) (lisinopril 10 mg/kg per day), and treatment with angiotensin II receptor blocker (ARB) (candesartan 5 mg/kg per day). One week after LVR, echocardiography revealed smaller LV size and better LV motion than before surgery. Four weeks after LVR, LV size returned to the preoperative value in the untreated group, but not as much in the treated groups. Cardiac catheterization revealed lower LV end-diastolic pressure and higher E-max in the treated groups. There was no difference between ACE-I and ARB groups except for systolic blood pressure. LVR decreased LV size and improved systolic function only in the early phase. Adjuvant therapy of ACE-I or ARB-attenuated LV remodeling and maintained LV function at the same level after LVR. This probably indicates that tissue RAS is associated with postoperative remodeling. Concomitant use of RAS inhibitors may make LVR a longer-lasting procedure for LV aneurysm.
Journal of Cardiac Surgery 18 Suppl 2:S61-8. · 0.87 Impact Factor
