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ABSTRACT: Objective: The treatment of thoracic aortic aneurysm accompanied by ischemic heart disease presents a surgical challenge and has up
to now shown a high hospital mortality rate. This report discusses the factors contributing to improved results in these cases.Methods: We conducted a retrospective analysis of the records of 24 consecutive patients who had undergone replacement of thoracic
aorta with combined coronary artery bypass grafting (CABG) between May 1991 and October 1998. Fifteen patients received total
arch replacement (Arch-with-CABG Group), and the other 9 patients received the Bentall operation (Bentall-with-CABG Group).
These results were compared with those patients who had undergone replacement of the thoracic aorta without CABG (Without-CABG
Group).Results: In the combined CABG groups, the overall operative mortality rate was 16.7%. In comparison with the Arch-without-CABG Group,
there was a significantly longer cardiopulmonary bypass time and longer selective cerebral perfusion time in the Arch-with-CABG
Group. However, no significant difference was observed in postoperative complications between the two groups. In addition,
there was no significant difference in either actuarial survival or the cardiac-event-free rate at 5 years between the replacement
of thoracic aorta with-and without-CABG Groups (83.1% vs. 90.4%, and 78.5% vs. 77.7%, respectively). No reoperation and no
late death were observed during the follow-up period (mean 21.3 months).Conclusions: We concluded that replacement of the thoracic aorta combined with CABG can be carried out safely, and that revascularization
for coronary artery disease is useful for preventing any occurrence of cardiac event.
The Japanese Journal of Thoracic and Cardiovascular Surgery 04/2012; 49(4):236-243.
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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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ABSTRACT: Although intravenous administration of prostaglandin E(1) (PGE(1)) is commonly used in the treatment of peripheral arterial disease, it rapidly becomes inactivated in the lung. Whether local administration of sustained-release (SR) PGE(1) enhances neovascularization in murine hindlimb ischemia was investigated.
Poly lactide-co-glycolide (PLGA) microspheres were the 4-week SR carrier of PGE(1). C57BL/6 mice with unilateral hindlimb ischemia were randomly treated as follows: no treatment (Group N); single administration of 100 microg/kg PGE(1) solution (Group L) into the ischemic muscles; daily systemic administration of PGE(1) for 2 weeks at a total dose 100 microg/kg (Group S); and single administration of PGE(1)-100 microg/kg-loaded PLGA (Group P100) into the ischemic muscles. The blood perfusion in Group P100 was higher than in Groups N, L and S (ischemic/nonischemic blood perfusion ratio 88 +/-11% vs 73 +/-11% (P<0.01), 77 +/-9% (P<0.05), 79 +/-11% (P<0.05), respectively). Vascular density and alphaSMA-positive-vessel density in Group P100 were higher than in Groups N, L and S (vascular density (vessels/m(2)): 241 +/-39 vs 169 +/-49 (P<0.01), 169 +/-54 (P<0.01), 201 +/-42 (P<0.05), respectively; alphaSMA-positive-vessel density (vessels/m(2)): 34 +/-10 vs 18 +/-6 (P<0.01), 21 +/-11 (P<0.01), 22 +/-10 (P<0.01), respectively)
Local administration of a single dose of SR PGE(1) enhances neovascularization in mice hindlimb ischemia more efficiently than daily systemic administration.
Circulation Journal 05/2009; 73(7):1330-6. · 3.77 Impact Factor
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The Journal of thoracic and cardiovascular surgery 04/2009; 137(3):783-4. · 3.41 Impact Factor
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Keiichi Hirose,
Akira Marui, Yoshio Arai,
Toshihiro Kushibiki,
Yu Kimura,
Hisashi Sakaguchi,
Huang Yuang,
B I R Shyamal Chandra,
Tadashi Ikeda,
Shigeru Amano,
Yasuhiko Tabata,
Masashi Komeda
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ABSTRACT: Pulmonary hypertension is a life-threatening disease, and alternative strategies are essential for patients with critical pulmonary hypertension. We developed a new procedure using microgelatin hydrogel microspheres incorporating basic fibroblast growth factor (mGHMs/bFGF) for intratracheal administration and evaluated the effect of a single intratracheal administration of mGHMs/bFGF on rats with monocrotaline-induced pulmonary hypertension.
Monocrotaline was injected into 54 rats simultaneously with intratracheal administration of plain mGHMs (vehicle group), bFGF in solution form (free-bFGF group), mGHMs/bFGF (mGHMs/bFGF group), and plain saline with subcutaneous injection of saline instead of monocrotaline (control group, n = 18). Three weeks after the administration, 48 rats (n = 12 from each group) were subjected to hemodynamic and histologic evaluations. Survival was assessed in 6 rats of each group 10 weeks after the intratracheal administration.
The mGHMs/bFGF group showed significantly lower right ventricular/left ventricular pressure ratios at 3 weeks than the vehicle and free-bFGF groups (0.35 +/- 0.04, 0.54 +/- 0.11, 0.58 +/- 0.21, and 0.36 +/- 0.05 for the control, vehicle, free-bFGF, and mGHMs/bFGF groups, respectively; P < .01). Histologically, the mGHMs/bFGF group had a significantly higher number of vessels (diameter > or = 50 microm) than the other groups (5.3 +/- 2.6, 4.6 +/- 2.8, 7.3 +/- 2.5, and 18.9 +/- 7.0 vessels/mm(2), respectively; P < .01). Ten weeks after the intratracheal administration, 6 (100.0%) rats had survived in the control group, and 1 (16.7%) survived in the vehicle, 0 (0%) in the free-bFGF, and 5 (83.3%) in the mGHMs/bFGF groups (n = 6 each).
A single intratracheal administration of mGHMs/bFGF increased the number of vessels in the lung and ameliorated survival and hemodynamics in rats with monocrotaline-induced pulmonary hypertension.
The Journal of thoracic and cardiovascular surgery 11/2008; 136(5):1250-6. · 3.41 Impact Factor
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Yuhong Huang,
Akira Marui,
Hisashi Sakaguchi,
Jiro Esaki, Yoshio Arai,
Keiichi Hirose,
Shyamal Chandra Bir,
Hisanori Horiuchi,
Takayuki Maruyama,
Tadashi Ikeda,
Yasuhiko Tabata,
Masashi Komeda
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ABSTRACT: Basic fibroblast growth factor (bFGF) is a potent mitogen; however, diabetes mellitus might impair its angiogenic property. Prostaglandin E1 (PGE1) is a potent vasodilator and improves endothelial function. Thus, PGE1 could potentiate the angiogenic properties of bFGF in patients with diabetes mellitus.
Streptozotocin-induced diabetic mice with unilateral hindlimb ischemia were randomly treated as follows: no treatment, 0.2 microg of PGE1, 10 microg of bFGF, and combined administration of PGE1 and bFGF. Blood perfusion was evaluated by the ratio of ischemic-to normal-limb blood perfusion. Four weeks after the treatment, the combined administration of bFGF and PGE1 increased the blood perfusion ratio as compared with single bFGF or PGE1 (77+/-10% vs 56+/-10% and 58+/-10%; p < 0.05, respectively). A histological evaluation showed that vascular density in the combined therapy was higher than single bFGF or PGE1 (418+/-59 vs 306+/-69 and 283+/-71 vessels/mm2; p < 0.01, respectively); the maturity in combined therapy was also higher than single bFGF or PGE1 (46+/-14 vs 30+/-14 and 28+/-6 vessels/mm2; p < 0.01, respectively).
PGE1 potentiated the impaired angiogenic properties of bFGF in diabetic murine hindlimb ischemia. This new strategy might contribute to more effective therapeutic angiogenesis for ischemic limb in patients with diabetes.
Circulation Journal 10/2008; 72(10):1693-9. · 3.77 Impact Factor
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Shyamal Chandra Bir,
Masatoshi Fujita,
Akira Marui,
Keiichi Hirose, Yoshio Arai,
Hisashi Sakaguchi,
Yuhong Huang,
Jiro Esaki,
Tadashi Ikeda,
Yasuhiko Tabata,
Masashi Komeda
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ABSTRACT: BACKGROUND: The combined treatment of sustained-release basic fibroblast growth factor (Sr-bFGF) and a 5-hydroxytryptamine(2A) blocker, sarpogrelate, was evaluated to see whether it reversed the impaired collateral circulation in diabetic (DM) mouse hindlimb ischemia. METHOD AND RESULTS: Diabetic and normal mice with ischemic hindlimb were randomly assigned to 1 of 5 experimental groups (no treatment, sarpogrelate 50 mg . kg(-1) . day(-1), 20 microg or 50 microg Sr-bFGF and a combined treatment of 20 microg Sr-bFGF and sarpogrelate), and treated for 4 weeks. Tissue blood perfusion (TBP), vascular density (angiogenesis) and the number of mature vessels (arteriogenesis) were checked by the use of standard methods. Although angiogenesis was comparable (161+/-14 vs 154+/-12 vessels/mm(2)), the laser Doppler perfusion image index (LDPII) (0.43+/-0.11 (SD) vs 0.63+/-0.08, p<0.05) and arteriogenesis (8+/-3 vs 12+/-4 vessels/mm(2), p<0.05) were significantly lower in DM mice than those in normal mice. The dose of Sr-bFGF for the sufficient number of mature vessels (>or=45 vessels/mm(2)) and LDPII (>or=0.9) was 20 microg for the normal mice, and 50 microg for the DM mice, which was reduced with the aid of sarpogrelate. Conclusions A combined therapy of Sr-bFGF and sarpogrelate is effective for neovascularization to reverse the impaired arteriogenesis and TBP in DM mice.
Circulation Journal 05/2008; 72(4):633-40. · 3.77 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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Hisashi Sakaguchi,
Akira Marui,
Keiichi Hirose,
Takamasa Nomura, Yoshio Arai,
Shyamal Chandra Bir,
Yuhong Huang,
Jiro Esaki,
Yasuhiko Tabata,
Tadashi Ikeda,
Masashi Komeda
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ABSTRACT: Methicillin-resistant Staphylococcus aureus graft infection is one of the most serious complications of vascular surgery. Vancomycin is a potent antibiotic against methicillin-resistant S. aureus; however, systemic administration of vancomycin is not very effective against methicillin-resistant S. aureus graft infection. Therefore, we investigated whether a local sustained release of vancomycin prevents methicillin-resistant S. aureus graft infection.
We have developed a poly-L-lactide-co-caprolactone sheet that enabled sustained release of vancomycin for 2 weeks. An expanded polytetrafluoroethylene vascular graft patch (1.5 mm2) was sutured at the anterior wall of the incised murine abdominal aorta. Methicillin-resistant S. aureus (1.0 x 10(3) colony-forming units) was inoculated onto the graft surface. Thereafter, the graft was treated as follows (n = 6 each): no treatment (control group), local injection of an aqueous solution of vancomycin (vancomycin solution group) and local implantation of poly-L-lactide-co-caprolactone containing vancomycin (vancomycin-PLCA group). After 7 days, the graft and blood were sampled and cultured.
The methicillin-resistant S. aureus counts in the grafts of the vancomycin-PLCA group were significantly lower than those of the other groups. Blood cultures of the vancomycin-PLCA group were all negative, whereas those of the other groups were all positive for infection. The survival rate in the vancomycin-PLCA group at 28 days was considerably higher than that in the control group (83.3% vs 16.7%).
A local sustained-release sheet containing vancomycin reduced methicillin-resistant S. aureus counts in the infected vascular grafts, prevented sepsis, and drastically improved survival rates. This can be used as a highly effective and less-invasive adjunctive treatment method for preventing prosthetic methicillin-resistant S. aureus graft infection.
The Journal of thoracic and cardiovascular surgery 02/2008; 135(1):25-31. · 3.41 Impact Factor
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Keiichi Hirose,
Akira Marui, Yoshio Arai,
Takamasa Nomura,
Kozo Kaneda,
Yu Kimura,
Tadashi Ikeda,
Masatoshi Fujita,
Masao Mitsuyama,
Yasuhiko Tabata,
Masashi Komeda
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ABSTRACT: Catheter-related infection is one of the most serious complications. Microbes migrate along the catheter (the foreign material) from the wound at the insertion-site, leading to catheter-related infection. Basic fibroblast growth factor (bFGF) is a potent mitogen that promotes the growth and regeneration of organs and tissues in vivo. Catheter-related bacterial invasion was simulated by the invasion of inoculated bacteria into a transplanted foreign material. Sterile Dacron sheets (foreign materials) were implanted on the subcutis of 96 male mice (C57BL/6) randomized into four groups (n = 24 per group). Group A: Dacron sheets only; Group B: Dacron sheets treated with a plain gelatin hydrogel sheet; Group C: Dacron sheets treated with free bFGF (50 microg); Group D: Dacron sheets treated with sustained-release bFGF (50 microg). On day 7, "detachment test" (to measure the force needed to pull out the Dacron sheet) and microscopic evaluations were performed, and the tissue immediately above the Dacron sheet was inoculated with methicillin-resistant Staphylococcus aureus (MRSA) 1 x 10(6) colony-forming units. The total energy needed for pulling out the implanted Dacron sheet in Group D was significantly higher than other three groups (P < 0.01). Group D had a large granulation tissue area containing a large amount of collagen tissue and vessels microscopically. Two days after the MRSA inoculation, the number of MRSA in the Dacron sheet of Group D was smallest. Pretreatment with sustained-release form of bFGF promoted tissue regeneration and reduced catheter-related bacterial invasion, indicating a useful adjuvant for reducing catheter-related infection.
Heart and Vessels 07/2007; 22(4):261-7. · 2.05 Impact Factor
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ABSTRACT: Whether the combined treatment with sustained-release basic fibroblast growth factor (bFGF) and heparin enhances neovascularization in hypercholesterolemic mouse hindlimb ischemia was investigated.
Wild-type C57BL/6 and low density lipoprotein receptor-deficient mice were assigned to 1 of the following 4 experimental groups and treated for 2 weeks after femoral artery extraction: group N, no treatment; group H, daily subcutaneous injection of heparin calcium; group F, single intramuscular injection of the sustained-release bFGF microspheres; and group FH, combined treatment with sustained-release bFGF and heparin. Among the wild-type mice at 4 weeks after femoral artery extraction, the laser Doppler perfusion image index (LDPII) in groups H, F, and FH was significantly higher than that in group N. The vascular density in group FH was the highest among the 4 groups. The maturation index in the 3 treated groups was significantly higher than that in group N. Among the hypercholesterolemic mice, the LDPII in group FH was significantly higher than that in the other 3 groups. The vascular density and maturation index in group FH were the highest among the 4 groups.
Combined treatment with sustained-release bFGF and heparin enhanced neovascularization in the hypercholesterolemic hindlimb ischemia model.
Circulation Journal 04/2007; 71(3):412-7. · 3.77 Impact Factor
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Kazuhiko Doi,
Tadashi Ikeda,
Akira Marui,
Toshihiro Kushibiki, Yoshio Arai,
Keiichi Hirose,
Yoshiharu Soga,
Atsushi Iwakura,
Koji Ueyama,
Kenichi Yamahara,
Hiroshi Itoh,
Kazunobu Nishimura,
Yasuhiko Tabata,
Masashi Komeda
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ABSTRACT: Recently we have developed new sustained release system of basic fibroblast growth factor (bFGF) using gelatin hydrogel as a carrier. Using this system, we examined the effect of topical sustained release of bFGF on angiogenesis and tissue blood perfusion in a rabbit model of hind limb ischemia. Thirty-two rabbits underwent excision of right femoral artery under general anesthesia. Two weeks later the rabbits were randomized into four groups (n = 8 each): no treatment, intramuscular injection of gelatin hydrogel alone, and intramuscular injection of gelatin hydrogel incorporating 30 microg and 100 microg of bFGF. Four weeks after each treatment, selective angiography, tissue blood flowmetry using laser Doppler perfusion imaging, and histological examination of thigh muscle were performed. In groups treated with bFGF incorporating gelatin hydrogel, tissue blood flow, number of arterioles, and vascular density were significantly increased in a dose-dependent manner 4 weeks after the treatment. Serum concentrations of bFGF and vascular endothelial growth factor were not elevated 4 weeks after the treatment. In conclusion, sustained release of bFGF using gelatin hydrogel augmented angiogenesis and improved tissue blood flow after excision of the femoral artery.
Heart and Vessels 03/2007; 22(2):104-8. · 2.05 Impact Factor
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ABSTRACT: Recently we have developed new sustained release system of basic fibroblast growth factor (bFGF) using gelatin hydrogel as a carrier biomaterial. We examined the effect of topical sustained release of bFGF on blood flow recovery and tissue regeneration in various animal models of cardiovascular area. These results revealed effectiveness and safety of this therapy. We evaluated the effect of sustained release of bFGF for not only normal but also diabetes model. Slow release system of bFGF from biodegradable gelatin hydrogel prevents bFGF glycation and its combination with 5-hydroxytryptamine blocker has shown sufficient neovascularization in diabetic limb ischemia. The method may provide a more effective therapeutic angiogenesis in patients with diabetes. Clinical trial of therapeutic angiogenesis for severe hindlimb ischemia has already started.
Nippon rinsho. Japanese journal of clinical medicine 12/2006; 64(11):2142-7.
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ABSTRACT: The effectiveness of sustained-release basic fibroblast growth factor (bFGF) in potentiating arteriogenesis and angiogenesis was evaluated, as well as determining whether chronic oral administration of sarpogrelate, a serotonin blocker, would further increase collateral blood flow in the rabbit hindlimb following surgical induction of ischemia by femoral artery extraction.
Two weeks after femoral artery removal, the rabbits were assigned to 1 of 4 experimental groups and treated for 4 weeks: group A, no treatment; group B, supplemented with diet containing sarpogrelate; group C, single intramuscular injection of sustained-release form of bFGF microspheres; group D: combined treatment with sustained-release bFGF and sarpogrelate. Endpoint measurements performed at 6 weeks found that the ischemic hindlimb blood flow was significantly improved in the rabbits that received sustained-release bFGF, with a further significant improvement in those with the additional administration of sarpogrelate. Angiographic assessment revealed augmented density of collateral vessels in the medial thigh region in the rabbits given the combined treatment.
The findings demonstrate that sustained-release bFGF stimulated the development of collateral vessels, and additional administration of sarpogrelate produced a further improvement in hindlimb blood flow in the rabbit hindlimb ischemia model.
Circulation Journal 10/2006; 70(9):1190-4. · 3.77 Impact Factor
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Keiichi Hirose,
Akira Marui, Yoshio Arai,
Takamasa Nomura,
Sachiko Inoue,
Kozo Kaneda,
Tetsuya Kamitani,
Masatoshi Fujita,
Masao Mitsuyama,
Yasuhiko Tabata,
Masashi Komeda
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ABSTRACT: The purpose of this study was to evaluate the effectiveness of a sustained-release sheet with vancomycin (VCM) to prevent prosthetic graft infection.
VCM was incorporated into a poly-L-lactide-co-caprolactone (PLCA) sheet (VCM-PLCA). The release profile of VCM from the VCM-PLCA sheet and the tissue concentration of VCM released in vivo were examined. To assess the antibacterial effect of the VCM-PLCA sheet, a sterile Dacron sheet was implanted into 96 male mice (C57BL/6), who were randomly divided into four groups of 24 each and treated as follows: no treatment (group A, control group), a local bolus injection of an aqueous solution of VCM (group B), a plain PLCA sheet (group C), and a VCM-PLCA sheet (group D). After the treatment, methicillin-resistant Staphylococcus aureus (MRSA) (1 x 10(6) colony forming units) was inoculated onto the Dacron graft surface. The Dacron grafts were retrieved on days 3, 7, 10, and 14 after the implantation, and the number of MRSA in the Dacron grafts was counted.
VCM was slowly released from the VCM-PLCA sheet over 2 weeks in vivo, and the mean in vivo concentrations of VCM in the tissue around a VCM-PLCA sheet were 7.95, 26.39, 13.87, 12.51, 8.36, and 10.33 mug/mL (the minimum inhibitory concentration of VCM against MRSA is 2.0 mug/ml), at 1, 2, 5, 7, 10, and 14 days after the implantation, respectively. MRSA colonization on the cultivated agar plates was detected in all samples from groups A, B, and C at any postoperative time points. In contrast, some samples were negative for bacterial cultures in group D (2, 3, 1, and 2 samples out of 6 samples each on days 3, 7, 10, and 14 after the implantation, respectively). At all time points, the number of MRSA bacteria in the implanted Dacron graft in group D was by far the lowest (P < .01 at each time point).
The sustained-release sheet with VCM appears to be effective for the reduction of subcutaneous prosthetic graft infection.
Journal of Vascular Surgery 09/2006; 44(2):377-82. · 3.21 Impact Factor
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ABSTRACT: Sternal wound complications are devastating events occurring in coronary artery bypass surgery, particularly in patients with diabetes. Prostaglandin E2 receptors have 4 subtypes, and the activation of the EP4 receptor induces bone regeneration. The present study investigated the utility of a prostaglandin E2 EP4 receptor-selective agonist in sternal healing after median sternotomy with the removal of the bilateral internal thoracic arteries in diabetic rats.
Diabetic Wistar rats with blood glucose levels of greater than 400 mg/dL were established by means of a single intraperitoneal injection of streptozotocin. After median sternotomy and bilateral internal thoracic artery removal in 16 diabetic rats, 8 rats were administered the EP4 agonist (300 microg) on the posterior table of the sternum (EP4 group), whereas 8 did not receive any treatment (control group). Sternal healing and incidence of sternal wound complications were evaluated 4 weeks after the operation.
Sternal wound complications developed in 5 rats in the control group but in only 1 rat in the EP4 group (P < .01). Histologic examination revealed an almost completely healed sternum filled with regenerated bone tissue only in the EP4 group. Both bone mineral content and bone mineral density, as assessed with dual-energy x-ray absorptiometry, were higher in the EP4 group than in the control group (71.7 +/- 12.1 vs 48.9 +/- 11.7 mg for bone mineral content [P < .01] and 66.8 +/- 14.6 vs 47.9 +/- 6.3 mg/mm2 for bone mineral density [P < .05]).
The prostaglandin E2 EP4 agonist accelerated the sternal healing and decreased the incidence of sternal wound complications in the diabetic ischemic sternum. This method might help in decreasing sternal necrosis in high-risk patients or permit wider application of bilateral internal thoracic arteries in coronary artery bypass surgery, even in patients with diabetes.
The Journal of thoracic and cardiovascular surgery 03/2006; 131(3):587-93. · 3.41 Impact Factor
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ABSTRACT: Catheter-related infection is a frequent and serious complication. One factor responsible for catheter-related infection is bacterial invasion at the catheter-insertion site. We have shown that the sustained-release form of basic fibroblast growth factor (bFGF) enhances tissue regeneration and angiogenesis in various pathological conditions. The purpose of this study was to determine whether topical use of sustained-release form of bFGF promotes tissue regeneration around the wound and prevents catheter-related bacterial invasion. Fifty-four male mice (C57BL/6) were divided into three groups according to what was implanted subcutaneously on the back (each group, n=18): a Dacron sheet alone (group A), a Dacron sheet and a plain gelatin sheet (group B), and a Dacron sheet and sustained-release of bFGF (50 microg) (group C). Seven days after the implantation, the tissue immediately above the Dacron sheet was inoculated with methicillin-resistant Staphylococcus aureus (MRSA). In histological examinations, group C had a larger granulation tissue area containing a larger amount of collagen tissue and vessels than the other groups. Two days after the MRSA inoculation, the number of MRSA in the Dacron sheet of group C was significantly smaller than the other groups (P<0.01). Pretreatment with sustained-release form of bFGF may prevent catheter-related bacterial invasion.
Interactive cardiovascular and thoracic surgery 12/2005; 4(6):526-30.
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ABSTRACT: We evaluated coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) within 14 days of onset.
Of 1,450 patients undergoing isolated CABG in the last 12 years we retrospectively analyzed operative risk factors and studied the use of CABG in treating AMI in 66 undergoing surgery during the AMI phase. We divided them into 2 groups: Group D (deceased: n = 8) and Group S (survivors: n = 58).
Total operative mortality was 12.1% (8/66). Univariate analysis showed the following preoperative parameters to be significant in Group D: diabetes mellitus, cardiogenic shock, shortness of the interval between AMI onset and surgery, mean peak creatine phosphokinase-MB, AMI of the left main trunk, and failed recanalization of the infarcted artery. Multivariate analysis showed diabetes mellitus, cardiogenic shock, and AMI of the left main trunk as independent risk factors for hospital mortality. Intra-operative parameters between groups showed no statistical difference. Mortality in patients who did not suffer cardiogenic shock was zero.
Maintenance of hemodynamics in the early phase is vital in treating AMI. The most important element in surgical intervention is revascularization of main branches. We concluded that CABG in AMI involves relatively low risk.
The Japanese Journal of Thoracic and Cardiovascular Surgery 09/2002; 50(8):325-9.
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ABSTRACT: Pedicled bilateral internal thoracic artery grafting (BITA) has been discouraged in historical high-risk groups such as diabetes mellitus (DM), renal failure, old age, and obesity because of reported high incidence of mediastinitis. However, considering the fact that there are abundant short and long-term results including angiography study about the conventional pedicled grafts, it might be worthwhile reassessing the results of pedicled BITA grafting with modern techniques by a disciplined surgical team before abandoning the method.
Between September 1989 and September 1999, 1371 patients underwent isolated coronary artery bypass grafting (CABG) in Kumamoto central hospital. Of these patients, 558 patients who had bilateral ITA strategy (mean age 63.0+/-9.2 years, 13-79) were studied. The method of harvest of ITAs is consistently the use of conventional pedicled grafts. The use of bone wax and unnecessary electrocautery injury to the periostium or cartilage were avoided as much as possible. The only change in the surgical technique in the study period is the application of the pinpoint hemostasis for the presternal tissues from August 1997 (late period). Results: In late period, there were significantly more patients with sternal sepsis risk factors such as diabetes mellitus (early: late; 19.3% vs. 34.8%, P<0.00003), and renal failure (0.3 vs. 9.7%, P<0.0001) as well as patients who had gastroepiploic artery grafting (16.9 vs 48.5%, P<0.0001) and those who required aortic non-touch technique (2.1 vs. 7.9%, P<0.001). The percentage of the patients receiving BITA grafting among the isolated CABG patients increased in the late period from 31.7% (331/1043) to 69.2% (227/328) (P<0.001), reflecting that a more aggressive approach towards bilateral ITA and arterial grafting has been taken in the late period. Overall operative mortality was 1.1% (n=6). Mediastinitis occurred in seven patients (1.3%). Of these, only one mediastinitis occurred in late period (0.4%). No mediastinitis occurred in 23 chronic renal dialysis patients. Among the 143 DM patients, there were three mediastinitis (2.1%). Of three, only one occurred in late period, yielding 1.3% mediastinitis rate. There was one mediastinitis (0.7%) among 134 elderly patients more than 70 years of age. Univariate analysis identified obesity as a risk factor for mediastinitis. And there was a trend of decreasing mediastinits in late period but did not reached a statistical significance (P<0.2). Multivariate analysis identified obesity and arteriosclerosis obliterates as independent risk factors. Neither diabetes mellitus, dialysis, female gender, nor old age were significant independent predictors of mediastinitis. Despite the significantly high percentage of high-risk patients in late group, there were no significant difference in mortality and morbidity between the two groups.
Pedicled BITA grafting is feasible with acceptable morbidity and shouldn't be abandoned even in high-risk patients such as DM, old age, and dialysis, especially combined with pinpoint-hemostasis, avoiding excessive use of bone wax, and strict aseptic technique. These point require a surgical team familiar with these techniques to maintain adequate skills in conduit procurement.
European Journal of Cardio-Thoracic Surgery 06/2002; 21(6):1015-9. · 2.55 Impact Factor
