Takuro Tsukube

Publications (17)69.38 Total impact

• Article: Impact of controlled pericardial drainage on critical cardiac tamponade with acute type a aortic dissection.

  Taro Hayashi, Takuro Tsukube, Teruo Yamashita, Tomonori Haraguchi, Ritsu Matsukawa, Shuichi Kozawa, Kyoichi Ogawa, Yutaka Okita
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  ABSTRACT: Cardiac tamponade is associated with fatal outcomes for patients with acute type A aortic dissection, and the presence of cardiac tamponade should prompt urgent aortic repair. However, treatment of the patient with critical cardiac tamponade who cannot survive until surgery remains unclear. We analyzed our experience of controlled pericardial drainage (CPD) managing critical cardiac tamponade. Between September 2003 and May 2011, 175 patients with acute type A aortic dissection were treated surgically, including 43 (24.6%) who presented with cardiac tamponade on arrival. Eighteen patients, who did not respond to intravenous volume resuscitation, underwent CPD in the emergency department. An 8F pigtail drainage catheter was inserted percutaneously, and drainage volume was controlled by means of several cycles of intermittent drainage to maintain blood pressure at ≈90 mm Hg. After CPD, all of the patients were transferred to the operating room, and immediate aortic repair was performed. Systolic blood pressure before CPD was 64.3±8.2 mm Hg and elevated significantly in all of the cases after CPD. Systolic blood pressure after CPD was 94.8±10.5 mm Hg, and increase in systolic pressure was 30.5±11.7 mm Hg. Total volume of aspirated pericardial effusion was 40.1±30.6 mL, and 10 patients required only ≤30-mL aspiration volume. All of the patients underwent aortic repair successfully. In-hospital mortality was 16.7%; however, there was no complications or mortality related to CPD. Preoperative pericardial drainage with control of volume is a safe and effective procedure for acute type A aortic dissection complicated by critical cardiac tamponade. In our patient population, timely controlled pericardial drainage is warranted.
  Circulation 09/2012; 126(11 Suppl 1):S97-S101. · 14.74 Impact Factor
• Article: Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.

  Takuro Tsukube, Taro Hayashi, Toshihiro Kawahira, Tomonori Haraguchi, Ritsu Matsukawa, Shuichi Kozawa, Kyoichi Ogawa, Yutaka Okita
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  ABSTRACT: Management of acute type A aortic dissection (AADA) complicated by coma remains controversial. We analyzed our experience in managing AADA complicated by coma to determine the relationship of duration of preoperative coma to postoperative neurological recovery. Between September 2003 and October 2010, 181 patients with AADA were treated, including 27 presenting with coma (Glasgow Coma Scale <11) on arrival. Twenty-one patients were repaired immediately (immediate group); time from onset of symptoms to operating room was <5 hours. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative therapeutic hypothermia with magnesium treatment was performed. Six patients initially were managed medically, and 3 of them were followed by eventual repair because time from onset was >5 hours (delayed group). The preoperative National Institutes of Health Stroke Scale score was 31.4 ± 6.6 in the immediate group and 28.3 ± 9.5 in the delayed group. Hospital mortality was 14% in the immediate group and 67% in the delayed group. Full recovery of consciousness was achieved in 86% of patients in the immediate group and in 17% in the delayed group. In immediate group, the postoperative National Institutes of Health Stroke Scale score significantly improved to 6.4 ± 8.4, cumulative survival rate was 71.8% in 3 years, and independence in daily activities was achieved in 52% (11/21). Aortic repair, if performed immediately from the onset of symptoms, showed satisfactory recovery of consciousness and neurological function in patients with AADA complicated by coma. In this patient population, immediate aortic repair is warranted.
  Circulation 09/2011; 124(11 Suppl):S163-7. · 14.74 Impact Factor
• Article: Curved nitinol stent-graft placement for treating blunt thoracic aortic injury: an early experience.

  Masato Yamaguchi, Koji Sugimoto, Takuro Tsukube, Takeki Mori, Toshihiro Kawahira, Taro Hayashi, Masahiko Nakamura, Ryota Kawasaki, Rajdeep S Sandhu, Kazuro Sugimura, Syuichi Kozawa, Yutaka Okita
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  ABSTRACT: Blunt trauma-induced aortic injury traditionally has been treated with early open surgical repair. However, recently endovascular stent-graft technology is considered a less-invasive therapeutic alternative, and flexible stent-grafts, such as the Matsui-Kitamura stent-graft (MKSG), are being used widely. We report our experience with the curved MKSG in treating thoracic aortic injuries. Nine patients with traumatic thoracic aortic injury underwent endovascular surgery (8, emergency; 1, elective) with curved MKSG. The study variables were Injury Severity Score, endovascular surgery duration, aortic and stent-graft diameter, stay in the intensive care unit, follow-up period, and mortality. An MKSG was constructed using the Matsui-Kitamura stent and a polyester fabric graft. The stent-graft was placed using the transfemoral approach and the wire-tug technique. The mean Injury Severity Score was 42.3; 5 patients required 6 emergency procedures before the endovascular procedure (pneumothorax or hemothorax drainage, 5; transarterial embolization, 1). In 8 patients (88.9%), we achieved complete pseudoaneurysm exclusion or hemostasis in the injured portion. There were no postoperative complications; blood loss was minimal, and the intensive care unit stay was 13.4 days. The overall hospital mortality was 22.2% (n = 2; causes of death were unrelated to MKSG placement). Neither intervention-related mortality during follow-up (mean, 237.7 days) nor late endovascular graft-related complications (endoleak or graft migration) were noted. Although this study is limited by a small sample size and short follow-up period, no collapse or stent-graft fractures were noted. Thus, MKSG placement for traumatic thoracic aortic injury appears a safe and effective therapy.
  The Annals of thoracic surgery 10/2008; 86(3):780-6. · 3.74 Impact Factor
• Article: Perforation of the Valsalva sinus after implantation of Medtronic Freestyle aortic bioprosthesis.

  Nobuchika Ozaki, Yutaka Hino, Yuji Hanafusa, Teruo Yamashita, Kenji Okada, Takuro Tsukube, Yutaka Okita
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  ABSTRACT: We report on structural valve deterioration in patients with the Medtronic Freestyle aortic bioprosthesis (Medtronic, Inc, Minneapolis, MN), including spontaneous perforation of the Valsalva sinus. These occurred in four prosthesis in 3 patients using the modified subcoronary method or full root technique. One patient died of ruptured pseudoaneurysm and the others survived reoperation well. Careful follow-up is required after Freestyle bioprosthesis implantation.
  The Annals of thoracic surgery 01/2007; 82(6):2282-5. · 3.74 Impact Factor
• Article: Surgery for gastric cancer combined with cardiac and aortic surgery.

  Yoshihiko Tsuji, Naoto Morimoto, Hiroshi Tanaka, Kenji Okada, Hitoshi Matsuda, Takuro Tsukube, Yoshihisa Watanabe, Yutaka Okita
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  ABSTRACT: Therapeutic strategies for patients who require procedures for both cardiac or aortic diseases and gastric cancer are controversial. Prognostic factors for them should be clearly identified. Retrospective review of 14 patients who underwent surgical intervention for both gastric cancer and cardiac or aortic diseases between January 1, 2000, and June 30, 2004. Tertiary referral university hospital. Cardiac and aortic diseases included coronary artery disease in 5 patients, thoracic aortic aneurysms in 3 patients, and abdominal aortic aneurysms in 6 patients. Coronary artery bypass graftings were performed with an off-pump procedure, and aneurysms were replaced with prosthetic grafts in all of the cases. The surgical stages of gastric cancers were stage I in 8 patients, stage II in 2 patients, stage III in 3 patients, and stage IV in 1 patient. According to our original therapeutic strategies, 4 patients underwent simultaneous procedures and 10 received staged procedures. Overall survival rates. There was 1 hospital death caused by multiple organ failure. No prosthetic graft infection was noted. Thirteen patients were discharged, and 3 died of cancer recurrence during an average follow-up period of 26.3 months. The cumulative survival rate was 76.6% at 1 year and 68.1% at 3 years. One-year survival rates were 90.0% in stages I and II gastric cancer and 50.0% in stages III and IV gastric cancer. Prognosis of patients who underwent surgical intervention for both gastric cancer and cardiac or aortic diseases was mainly limited by the clinical stage of gastric cancer.
  Archives of Surgery 12/2005; 140(11):1109-14. · 4.24 Impact Factor
• Article: A case with four-channel aortic dissection.

  Yutaka Okita, Kenji Okada, Takuro Tsukube, Yosuke Tanaka
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  ABSTRACT: A 65-year-old male with four-channel aortic dissection successfully underwent replacement of the thoracoabdominal aorta, reconstruction of the celiac, superior mesenteric artery, renal arteries, and 5 pairs of intercostals or lumbar arteries using deep hypothermic technique.
  European Journal of Cardio-Thoracic Surgery 03/2005; 27(2):348-50. · 2.55 Impact Factor
• Article: Transcranial myogenic motor-evoked potentials after transient spinal cord ischemia predicts neurologic outcome in rabbits.

  Hirohisa Murakami, Takuro Tsukube, Yujiro Kawanishi, Yutaka Okita
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  ABSTRACT: Myogenic transcranial motor-evoked potentials (tc-MEPs) were applied to monitor spinal cord ischemia in the repairs of thoracoabdominal aortic aneurysms. We investigated whether tc-MEPs after spinal cord ischemia/reperfusion could be used to predict neurologic outcome in leporine model. Tc-MEPs were measured at 30-second intervals before, during, and after spinal cord ischemia (SCI) induced by balloon occlusion of the infrarenal aorta. Twenty rabbits were divided into five groups. Four groups (n = 4 animals in each group) had transient ischemia induced for 10, 15, 20, or 30 minutes. In fifth group, the terminal aorta at the aortic bifurcation was occluded for 30 minutes. All animals were evaluated neurologically 48 hours later, and their spinal cords were removed for histologic examination. The tc-MEPs in each SCI group rapidly disappeared after SCI. After reperfusion, the recovery of tc-MEPs amplitude was inversely correlated to duration of SCI. Tc-MEPs amplitude at one hour after reperfusion was correlated with both neurologic score and number of neuron cells in the spinal cord 48 hours later. Logistic regression analysis demonstrated that the neurologic deficits differed significantly between animals with tc-MEPs amplitude of less than 75% of the baseline and those with an amplitude of more than 75%. The amplitude of tc-MEPs after ischemia /reperfusion of the spinal cord showed a high correlation with durations of SCI, with neurologic deficits, and with pathologic findings of the spinal cord. Tc-MEPs, therefore, could be used to predict neurologic outcome. In particular, tc-MEPs whose amplitude recovered by less than 75% indicated a risk of paraplegia.
  Journal of Vascular Surgery 02/2004; 39(1):207-13. · 3.21 Impact Factor
• Article: Complications of cerebrospinal fluid drainage in thoracoabdominal aortic aneurysm repair.

  Hirohisa Murakami, Kazunori Yoshida, Yutaka Hino, Hitoshi Matsuda, Takuro Tsukube, Yutaka Okita
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  ABSTRACT: Spinal cord ischemia resulting in postoperative paraplegia is a devastating complication of thoracoabdominal aortic aneurysm repair, and has been attributed to many causes. To prevent spinal cord compartment syndrome, cerebrospinal fluid drainage has been used as an adjunct to thoracoabdominal aortic aneurysm repair, with procedure-related complications generally occurring infrequently. We present two case reports of serious complications from CSF drainage.
  Journal of Vascular Surgery 02/2004; 39(1):243-5. · 3.21 Impact Factor
• Article: Transbrachial arterial insertion of aortic occlusion balloon catheter in patients with shock from ruptured abdominal aortic aneurysm.

  Hitoshi Matsuda, Yosuke Tanaka, Yutaka Hino, Ritsu Matsukawa, Nobuchika Ozaki, Kenji Okada, Takuro Tsukube, Yoshihiko Tsuji, Yutaka Okita
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  ABSTRACT: Of 125 surgical patients with abdominal aortic aneurysm (AAA) treated from 1999, 11 patients with deep shock from ruptured AAAs who underwent aortic occlusion balloon catheter (AOBC) insertion before laparotomy were studied. With the patients under local anesthesia, the brachial artery was exposed and the balloon catheter was inserted into the thoracic aorta. The balloon was inflated halfway and pulled back gently to the orifice of the left subclavian artery, and was advanced with the aid of blood flow down to the abdominal aorta. After full inflation of the balloon, the catheter was pulled until the balloon was fixed at the proximal shoulder of the AAA. AOBC insertion was completed within 16.1 +/- 5.1 minutes. Systolic blood pressure at presentation was 84.1 +/- 31.7 mm Hg, deteriorated to 60.9 +/- 15.4 mm Hg on arrival in the operating room, and increased significantly (P <.0001) to 123.4 +/- 25.3 mm Hg after AOBC insertion. The balloon burst in three patients. Embolic complications were observed in two patients. There were three deaths, two associated with the balloon bursting. In nine patients whose shock was successfully controlled by AOBC, operative mortality was 11%. Transbrachial arterial insertion of an AOBC may be useful to ameliorate hemorrhagic shock in patients with ruptured AAAs.
  Journal of Vascular Surgery 12/2003; 38(6):1293-6. · 3.21 Impact Factor
• Article: Oxidative stress in the pathogenesis of thoracic aortic aneurysm: protective role of statin and angiotensin II type 1 receptor blocker.

  Junya Ejiri, Nobutaka Inoue, Takuro Tsukube, Takashi Munezane, Yutaka Hino, Seiichi Kobayashi, Ken-ichi Hirata, Seinosuke Kawashima, Shinobu Imajoh-Ohmi, Yoshitake Hayashi, Hiroshi Yokozaki, Yutaka Okita, Mitsuhiro Yokoyama
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  ABSTRACT: The pathogenesis of thoracic aortic aneurysms (TAA) is still unclear. A recent investigation indicated that angiotensin II, a potent activator of NADH/NADPH oxidase, plays an important role in aneurysmal formation. We investigated the potential role of p22phox-based NADH/NADPH oxidase in the pathogenesis of TAA. Human thoracic aneurysmal (n=40) and non-aneurysmal (control, n=39) aortic sections were examined, and the localization of p22phox, an essential component of the oxidase, and its expressional differences were investigated by immunohistochemistry and Western blot. In situ reactive oxygen species (ROS) generation was examined by the dihydroethidium method, and the impact of medical treatment on p22phox expression was investigated by multiple regression analysis. In situ production of ROS and the expression of p22phox increased markedly in TAA throughout the wall, and Western blot confirmed the enhanced expression of p22phox. The expression was more intense in the regions where monocytes/macrophages accumulated. In these inflammatory regions, numerous chymase-positive mast cells and angiotensin converting enzyme-positive macrophages were present. Their localization closely overlapped the in situ activity of matrix metalloproteinase and the expression of p22phox. Multiple regression analysis revealed that medical treatment with statin and angiotensin II type 1 receptor blocker (ARB) suppressed p22phox expression in TAA. Our findings indicate the role of p22phox-based NADH/NADPH oxidase and the local renin-angiotensin system in the pathogenesis of TAA. Statin and ARB might have inhibitory effects on the formation of aneurysms via the suppression of NADH/NADPH oxidase.
  Cardiovascular Research 11/2003; 59(4):988-96. · 6.06 Impact Factor
• Article: Successful replacement of aortic root with valve-sparing technique and proximal arch in a patient with myelodysplastic syndrome.

  Tomomi Hasegawa, Takuro Tsukube, Tomonori Higuma, Yutaka Okita
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  ABSTRACT: Cardiac surgery in a patient with myelodysplastic syndrome (MDS) increases the risk of bleeding and infection. Here we report a case of a 70-year-old man with MDS who underwent successful replacement of the aortic root with the valve-sparing technique and proximal arch for aneurysmal dilatation from the aortic root to ascending aorta with moderate aortic valve regurgitation. Perioperatively, a transfusion of red blood cells and an infusion of a grannulocyte colony-stimulating factor were required for his serious erythrocytopenia and leukocytopenia. Bleeding tendency was so severe that re-exploration to control postoperative surgical bleeding was performed and a large amount of blood cells were transfused. There was no infection on the postoperative course. Perioperative management for cardiac surgery in patients with MDS must be carefully programmed by a co-operative team consisting of cardiovascular surgeons and hematologists.
  The Japanese Journal of Thoracic and Cardiovascular Surgery 08/2003; 51(7):322-5.
• Article: Rib-cross thoracotomy for replacement of the thoracoabdominal or total descending aorta.

  Takuro Tsukube, Masahiro Yoshimura, Hitoshi Matsuda, Kenji Okada, Ritsu Matsukawa, Yutaka Hino, Hirohisa Murakami, Yujiro Kawanishi, Yutaka Okita
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  ABSTRACT: We describe the use of rib-cross thoracotomy and costal coaptation pins made with bioabsorbable poly-L-lactide for rib approximation. This thoracotomy provided an excellent intraoperative exposure of the entire descending aorta and thoracoabdominal aorta in patients with extended thoracoabdominal aortic aneurysm without increase in postoperative morbidity.
  Journal of Vascular Surgery 02/2003; 37(1):219-21. · 3.21 Impact Factor
• Article: Reconstruction of right ventricular outflow tract with stentless xenografts in Ross procedure.

  Takuro Tsukube, Yujiro Kawanishi, Hirohisa Murakami, Yutaka Hino, Ritsu Matsukawa, Nobuchika Ozaki, Kenji Okada, Hitoshi Matsuda, Noboru Wakita, Masami Nishiwaki, Yutaka Okita
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  ABSTRACT: To investigate whether the use of a stentless porcine aortic xenograft can be an alternative for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure, 9 patients underwent the Ross procedure and RVOT reconstruction with a stentless xenograft since January 2000. After the aortic valve was replaced with a pulmonary autograft, a stentless xenograft with a xeno- pericardial roll was implanted in the RVOT. One patient required subsequent aortic valve replacement because of severe regurgitation of the pulmonary autograft. All patients recovered well from the operation. The right ventricle-pulmonary arterial pressure gradient was 18 +/- 7 mm Hg at discharge and was not significantly increased during the 2-year follow-up period. Although 1 patient died of ventricular arrhythmia 5 months after, his cardiac function was normal, and transpulmonary valve pressure was 19 mm Hg in the follow-up. The other 7 patients are currently in New York Heart Association functional Class I. Although long-term follow-up is required to explain the durability, the stentless xenograft with a pericardial roll is considered to be an alternative for reconstruction of the RVOT within 2 years after the Ross procedure.
  Artificial Organs 01/2003; 26(12):1055-9. · 2.00 Impact Factor
• Article: Girdling effect of adynamic cardiomyoplasty in a model of dilated cardiomyopathy.

  Yoshio Ootaki, Takuro Tsukube, Yutaka Okita
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  ABSTRACT: The potential benefits of adynamic cardiomyoplasty remain unclear. We determined whether unstimulated skeletal muscle wrap alone prevents or attenuates progressive left ventricular dilation in a canine model of congestive heart failure produced by repeated intracoronary infusions of doxorubicin. 14 dogs were randomized in to 2 groups, 1 undergoing cardiomyoplasty (CMP group) and 1 that did not (CONT group). Intracoronary doxorubicin was administered weekly for 5 weeks to induce heart failure. Hemodynamic data was obtained before infusion and 5 weeks afterward. Echocardiography was done weekly. Significant left ventricular dilation was observed in the CONT group--left ventricular end-diastolic diameter increased from 28.9 +/- 2.7 to 38.5 +/- 3.3 mm (p < 0.05). Significant left ventricular dilation was also observed in the CMP group--left ventricular end-diastolic diameter increased from 28.9 +/- 3.3 to 38.0 +/- 4.2 mm (p < 0.05). Dilation was slower in the CMP group than in the CONT group, however. Ejection fraction decreased from 58.0 +/- 13.8 to 29.9 +/- 13.7% in the CONT group, but was preserved from 56.0 +/- 8.8 to 51.9 +/- 10.3% in the CMP group. Adynamic cardiomyoplasty reduces ventricular dilation associated with heart failure without exacerbating left ventricular dysfunction.
  The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2002; 50(3):104-8.
• Article: Huge left atrial thrombus with mitral stenosis in congenital factor XII deficiency.

  Tomomi Hasegawa, Masahisa Uematsu, Takuro Tsukube, Yukihiro Takemura, Yutaka Okita
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  ABSTRACT: Factor XII deficiency has been reported to be a risk factor for thromboembolism as a result of inactivation of fibrinolysis. We describe a case of a huge left atrial thrombus with mitral stenosis, which was successfully removed surgically in a Factor XII deficient patient.
  The Annals of Thoracic Surgery 02/2002; 73(1):286-8. · 3.74 Impact Factor
• Article: Allograft replacement of common iliac artery mycotic aneurysm caused by Bacteroides fragilis vertebral spondylitis--a case report.

  Yoshihiko Tsuji, Yutaka Okita, Kazuo Niwaya, Takuro Tsukube, Minoru Doita, Takashi Marui, Masahisa Uematsu, Hirohisa Murakami
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  ABSTRACT: Mycotic aneurysm secondary to vertebral spondylitis is a rare but life-threatening pathology with high mortality and morbidity. The authors describe a successfully treated case of mycotic aneurysm of the common iliac artery complicated with vertebral spondylitis in a 74-year-old man. Under midline laparotomy, complete debridement of the infected tissues, in-situ replacement of the common iliac artery with cryopreserved aortic allograft, and iliac bone autotransplantation and omentopexy to fill the debrided cavity were performed. The postoperative course was uneventful, and he remains well 3 years after his operation without persistent infection or allograft rejection.
  Vascular and Endovascular Surgery 37(6):441-4. · 0.99 Impact Factor
• Article: Transaortic video-assisted removal of a left ventricular thrombus

  Takuro Tsukube, Masayoshi Okada, Yoshio Ootaki, Yoshihiko Tsuji, Chojiro Yamashita
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  ABSTRACT: A mobile and pedunculated left ventricular thrombus was developed after acute myocardial infarction in a 59-year-old man, and was successfully removed surgically through the aortic valve using a video-assisted thoracoscope. Transaortic video-assisted thoracoscopy greatly facilitated exposure of the interior of the left ventricle and preserved left ventricular function by avoiding ventriculotomy.
  The Annals of Thoracic Surgery.