Yoshiaki Saji

Osaka City University, Ōsaka-shi, Osaka-fu, Japan

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Publications (22)41.3 Total impact

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    ABSTRACT: We report the case of a 68-year-old man with progressive heart failure due to effusive-constrictive pericarditis. During approximately 1 month, echocardiography revealed rapid progression from pericarditis with effusion without tamponade to pericardial thickening and diastolic dysfunction. Cardiac catheterization revealed that the pressure in the right heart chambers remained high after pericardiocentesis. The patient was rescued by aggressive pericardiectomy and sharp dissection of the epicardium into small fragments. This on-pump beating-heart surgery is known as the waffle procedure.
    General Thoracic and Cardiovascular Surgery 05/2012; 60(5):297-301.
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    ABSTRACT: Surgical ventricular restoration (SVR) has been introduced to restore the dilated left ventricular (LV) chamber and improve LV systolic function; however, SVR has also been reported to detrimentally affect LV diastolic properties. We sought to investigate the impact of preoperative LV diastolic function on outcomes after SVR in patients with heart failure. Sixty-seven patients (60 +/- 14 years) with LV systolic dysfunction (LV ejection fraction, 0.27 +/- 0.10) underwent SVR. They were evaluated by echocardiography preoperatively, and early (<or=1 month) and late (mean, 3.4 years) after surgery. Patients were divided into three groups according to the preoperative diastolic filling patterns of transmitral flow (impaired relaxation, pseudonormal, and restrictive filling patterns). Patients in the restrictive group showed far greater cardiovascular mortality than the other two groups (p < 0.0001). The multivariate analysis showed that preoperative restrictive filling pattern was a predominant predictor for adjusted cardiovascular death (p = 0.023; hazard ratio = 3.0). Left ventricular ejection fraction, LV end-diastolic volume, and grade of mitral regurgitation improved in all groups early after surgery; however, these variables in the restrictive group significantly deteriorated late after surgery (from 29 +/- 8 to 25 +/- 6 for LV ejection fraction; from 183 +/- 59 to 226 +/- 53 for left ventricular end-diastolic volume; and from 0.7 +/- 0.6 to 1.7 +/- 0.9 for mitral regurgitation grade; p < 0.05 for all). In patients with LV systolic dysfunction undergoing SVR, preoperative restrictive LV diastolic filling pattern strongly related to higher mortality with aggravation of LV systolic function, mitral regurgitation grade, or LV remodeling. This might be attributable to deterioration of diastolic function induced by SVR.
    The Annals of thoracic surgery 05/2010; 89(5):1524-31. · 3.45 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 10/2009; 138(3):775-7. · 3.41 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 09/2009; 138(2):499-501. · 3.41 Impact Factor
  • Yoshiaki Saji, R Sakata
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    ABSTRACT: Intraaortic balloon pumping (IABP) is the most popular circulatory assist device in cardiac surgery. In the development of IABP several modifications have been made. First, reduction in the caliber to 6 Fr is the most important modification of the IABP catheter to relatively small Japanese patients. Second, direct pressure measurement through the tip of the catheter enabled more accurate and real-time assist. Third, a novel balloon pump automatically selects the trigger source, arranges the timing of the IABP inflation/deflation, and detects the arrhythmias. Further development of IABP will bring safer and more reliable hemodynamic management in cardiac surgery.
    Kyobu geka. The Japanese journal of thoracic surgery 07/2009; 62(8 Suppl):688-91.
  • The Journal of thoracic and cardiovascular surgery 05/2009; 138(5):1244-6. · 3.41 Impact Factor
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    ABSTRACT: Cardioplegic arrest has been the main mechanism of myocardial protection during open-heart surgery; however, it causes myocardial injury during ischemia-reperfusion. Free radical scavengers are widely known to attenuate ischemia-reperfusion injury in various settings. We investigated the effects of edaravone, a novel free radical scavenger that was originally used for cerebral protection, on myocardial function during ischemia-reperfusion after cardioplegic arrest. Rat hearts were excised and perfused using Langendorff apparatus. The hearts were cardioplegically arrested for 90 min using St. Thomas' Hospital cardioplegic solution (ST solution) at 4 degrees C every 45 min and then reperfused for 20 min. The hearts were divided into 4 groups (n = 13 in each group). In Group ST, the hearts were arrested using the ST solution alone. In Groups L, M, and H, the hearts were arrested using the ST solution supplemented with a low-dose (1 microM), moderate dose (10 microM), and high dose (100 microM) of edaravone, respectively. Left ventricular function (+dp/dt (max)) and the levels of the cardiac enzymes released were measured before and after cardioplegic arrest. At the end of the study, the water content and the tissue oxidative stress (8-hydroxy-2'-deoxyguanosine) of the heart were measured. During reperfusion, the edaravone-treated groups showed a greater functional recovery with regard to the +dp/dt (max) (P < 0.05). The lactate level was the lowest (P < 0.01) in Group M. The water content of the hearts in the edaravone-treated groups was significantly lower (P < 0.05) than that in Group ST. Oxidative stress was significantly lower (P < 0.01) in the edaravone-treated hearts than in Group ST, and it was the lowest in Group M. The addition of edaravone to the cardioplegic solution ameliorates the impairment in myocardial function by reducing the oxidative stress after cardioplegic arrest. In this study, the maximum improvement in the myocardial function was achieved by addition of a moderate dose (10 microM) of edaravone.
    Heart and Vessels 05/2009; 24(3):228-35. · 2.13 Impact Factor
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    ABSTRACT: Un anévrysme de l'aorte thoraco-abdominale (AATA) de type II de Crawford, secondaire à une dissection chronique, a été traité avec succès de manière hybride par une revascularisation viscérale chirurgicale et une double implantation d'endoprothèse d'Inoue. Une endoprothèse proximale monobranche a couvert la porte d'entrée proche de l'artère sous-clavière gauche et a simultanément exclu l'AATA, tandis qu'une endoprothèse tubulaire distale d'Inoue a couvert la réentrée. Ainsi, l'artère d'Adamkiewicz n'a pas été couverte et est restée intacte entre les deux endoprothèses d'Inoue. Les artères viscérales ont été reconstruites en utilisant un pontage rétrograde quadrifurqué tunnellisé en arrière de l'aorte et anastomosé en distalité de manière termino-terminale aux quatre vaisseaux, afin d'obtenir une configuration harmonieuse.
    Annales de Chirurgie Vasculaire 05/2009; 23(3).
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    ABSTRACT: We describe a novel suture consisting of a small piece of TachoSil (Nycomed, Copenhagen, Denmark) and a felt pledget-the TachoSil-pledget stitch-which was used to facilitate mechanical and biologic hemostasis in 5 patients undergoing aortic arch aneurysm repair. The TachoSil-pledget stitch achieved good or very good hemostasis at all 56 bleeding points to which it was applied, while 5 of 12 points to which a conventional felt-pledget stitch was applied required additional stitching or an additional hemostatic method.
    The Annals of thoracic surgery 01/2009; 86(6):2002-4. · 3.45 Impact Factor
  • World Pumps 01/2009; 23(3):451-451.
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    ABSTRACT: We report a successful surgical management of postinfarction ventricular septal perforation by infarction-exclusion technique with the on-pump beating heart approach and concomitant coronary artery bypass grafting. The identification of the suture line by direct inspection and finger palpation could be more accurate in determining contractile, thus viable myocardium supporting the patch, and concomitant coronary artery bypass grafting with on-pump beating heart could minimize the cardioplegia-induced myocardial damage.
    Interactive Cardiovascular and Thoracic Surgery 10/2008; 7(6):1207-9. · 1.11 Impact Factor
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    ABSTRACT: Hybrid therapy administered for thoracoabdominal aortic aneurysm involves stent grafts and surgical reconstruction. This therapy entails retrograde visceral artery bypass before stent-graft implantation, establishing an inflow from either the distal abdominal aorta or the iliac arteries. Kinking is of great concern since it may cause acute occlusion, especially in grafts to the celiac axis and superior mesenteric artery because these vessels are directed caudally toward the right. Here, we describe a novel technique to achieve good exposure of the visceral vessels and appropriate graft position.
    EJVES Extra 09/2008; 36(6):747-748.
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    ABSTRACT: Left atrial geometry and mechanical functions exert a profound effect on left ventricular filling and overall cardiovascular performance. We sought to investigate the perioperative factors that influence left atrial geometry and mechanical functions after the Maze procedure in patients with refractory atrial fibrillation and left atrial enlargement. Seventy-four patients with atrial fibrillation and left atrial enlargement (diameter > or = 60 mm) underwent the Maze procedure in association with mitral valve surgery. The maximum left atrial volume and left atrial mechanical functions (booster pump, reservoir, and conduit function [%]) were calculated from the left atrial volume-cardiac cycle curves obtained by magnetic resonance imaging. A stepwise multiple regression analysis was performed to determine the independent variables that influenced the postoperative left atrial geometry and function. The multivariate analysis showed that left atrial reduction surgery concomitant with the Maze procedure and the postoperative maintenance of sinus rhythm were predominant independent variables for postoperative left atrial geometry and mechanical functions. Among the 58 patients who recovered sinus rhythm, the postoperative left atrial geometry and function were compared between patients with (VR group) and without (control group) left atrial volume reduction. At a mean follow-up period of 13.8 months, sinus rhythm recovery rate was better (85% vs 68%, P < .05) in the VR group and maximum left atrial volume was less (116 +/- 25 mL vs 287 +/- 73 mL, P < .001) than in the control group. The maximum left atrial volume reduced with time only in the VR group (reverse remodeling). Postoperative booster pump and reservoir function in the VR group were better than in the control group (25% +/- 6% vs 11% +/- 4% and 34% +/- 7% vs 16% +/- 4%, respectively, P < .001), whereas the conduit function in the VR group was lower than in the control group, indicating that the improvement of the booster pump and reservoir function compensated for the conduit function to left ventricular filling. Left atrial reduction concomitant with the Maze procedure helped restore both contraction (booster pump) and compliance (reservoir) of the left atrium and facilitated left atrial reverse remolding. Left atrial volume reduction and postoperative maintenance of sinus rhythm may be desirable in patients with refractory AF and left atrial enlargement.
    The Journal of thoracic and cardiovascular surgery 06/2008; 135(6):1297-305. · 3.41 Impact Factor
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    ABSTRACT: Crawford type II thoracoabdominal aortic aneurysm (TAAA) secondary to chronic dissection was successfully treated with hybrid therapy comprising surgical visceral reconstruction and dual Inoue stent graft implantation. The proximal single-branched Inoue stent graft effectively sealed the entry located near the left subclavian artery and simultaneously excluded the TAAA, while the distal tubular Inoue stent graft sealed the reentry; thus, the artery of Adamkiewicz was left unexcluded and intact between the two Inoue stent grafts. The visceral arteries were reconstructed using a quadrifurcated retrograde bypass with posterior aortic tunneling and end-to-end distal anastomosis to all four vessels to achieve a curved and smooth configuration.
    Annals of Vascular Surgery 05/2008; 23(3):410.e7-11. · 0.99 Impact Factor
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    ABSTRACT: Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. The maze procedures in association with mitral valve surgery were performed to 57 AF patients with an enlarged LA (LA diameter >or=60mm). Among them, 32 patients had concomitant LA volume reduction surgery (VR group). Another 25 patients did not have the volume reduction (control group). Three months postoperatively LA end-diastolic volume (LAEDV, ml) assessed by magnetic resonance (MR) imaging was larger in the VR group than that in the control group (291+/-117 vs 223+/-81 ml, p<0.05). Postoperatively, sinus rhythm recovery rate was better (84 vs 68%, p<0.05) and LAEDV was drastically smaller (118+/-48 vs 203+/-76 ml, p<0.001) in the VR group than those in the control group. Among the patients with sinus rhythm recovery in both groups, LA contraction ejection fraction (%) improved in the VR group but not in the control group (22.3+/-7.8 vs 10.3+/-4.7%, p<0.001). The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.
    European Journal of Cardio-Thoracic Surgery 09/2007; 32(2):308-12. · 2.67 Impact Factor
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    ABSTRACT: Limb ischemia remains a challenge. To overcome shortcomings or limitations of gene therapy or cell transplantation, a sustained release system of basic fibroblast growth factor (bFGF) using biodegradable gelatin hydrogel has been developed. A phase I-IIa study was performed, in which 7 patients had critical limb ischemia. They were intramuscularly injected with 200 microg of bFGF-incorporated gelatin hydrogel microspheres into the gastrocnemius of the ischemic limb. End-points were safety and feasibility of treatment after 4 and 24 weeks. One patient was excluded from the study for social reasons, but only after symptomatic improvements. In the evaluation of the other 6 patients, significant improvements were observed in the distance walked in 6 min (295+/-42 m vs 491+/-85 m for pretreatment vs after 24 weeks, p=0.023) and in transcutaneous oxygen pressure (53.5+/-5.2 mmHg vs 65.5+/-4.0 mmHg, p=0.03). The rest pain scale also improved (3.5+/-0.2 vs 1.0+/-0.6, p=0.022). The ankle-brachial pressure index improved at 4 weeks but not at 24 weeks. Among 5 patients who had a non-healing foot ulcer, the ulcer was completely healed in 3 patients, reduced in 1, and there was no change in 1 patient at 24 weeks. The blood levels of bFGF were undetected or within the normal level in all patients. The sustained release of bFGF from gelatin hydrogel might be simple, safe, and effective to achieve therapeutic angiogenesis because it did not need genetic materials or collection of implanted cells, and because it did not have any general effects, which was supported by there being no elevation of the bFGF serum level.
    Circulation Journal 09/2007; 71(8):1181-6. · 3.58 Impact Factor
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    ABSTRACT: Cardiac manifestations of antiphospholipid antibody syndrome (APLS) comprise a major complication. Herein we report our surgical treatment of aortic regurgitation in a patient with APLS. A 61-year-old woman was referred to our hospital with symptoms of congestive heart failure. Systemic lupus erythematosus had been diagnosed at the age of 36, and immunosuppressive therapy has been continuously performed. APLS was also diagnosed at the age of 55, after which cardiomegaly was noted on chest radiographs and aortic regurgitation was evident on echocardiography. Although immunosuppressive therapy had been continued, cardiac symptoms began to develop. With a presumed diagnosis of valvular disease associated with autoimmune disease, the aortic valve was replaced with a bioprosthesis. Noninfective endocarditis was confirmed in the excised specimen and was likely involved in APLS. The patient was discharged on postoperative day 26 without complications.
    General Thoracic and Cardiovascular Surgery 08/2007; 55(7):293-6.
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    ABSTRACT: Aortic valve stenosis can be complicated by recurrent gastrointestinal bleeding, particularly that due to angiodysplasia, also called Heyde syndrome. Recently, acquired type 2A von Willebrand disease, which is characterized by the loss of the large multimer of von Willebrand factor by the shear stress of aortic valve stenosis, was reported to be associated with this hemorrhagic syndrome. A 78-year-old woman, with severe aortic stenosis, presented with advanced anemia due to recurrent gastrointestinal bleeding and was diagnosed Heyde syndrome. By perioperative supplementation of von Willebrand factor and factor VIII, aortic valve replacement was safely performed without gastrointestinal bleeding. After the operation, the multimer of von Willebrand factor was normalized and thereafter no gastrointestinal bleeding occurred. This case reports the successful aortic valve replacement for Heyde syndrome, with confirmed hematologic recovery.
    The Annals of thoracic surgery 02/2007; 83(1):287-8. · 3.45 Impact Factor
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    ABSTRACT: Large left atrial diameter is reported to be a predictor for recurrent atrial fibrillation after the Cox maze procedure, and left atrial diameter by itself influences the chance of sinus rhythm recovery, as well as maintenance of sinus rhythm. However, additional cut-and-sew procedures to decrease left atrial diameter extend operative time and can cause bleeding. Thus we developed a no-bleeding, faster, and therefore less invasive left atrial volume reduction technique to enhance the Cox maze procedure. The modified Cox maze III procedure with cryoablation or the left atrial maze procedure in association with mitral valve surgery was performed in 80 patients with atrial fibrillation and enlarged left atria (> or =60 mm). Among them, 44 patients had the concomitant volume reduction technique (VR group); continuous horizontal mattress sutures for left atrial plication were placed on the left atrial wall along the pulmonary vein isolation line. Cryoablation was applied to the suture line so that the plicated left atrium is anatomically and electrically isolated. Another 36 patients did not have the volume reduction technique (control group). The VR group had preoperative left atrial diameters similar to those of the control group (67.1 +/- 7.8 vs 64.5 +/- 6.7 mm) and a longer preoperative duration of atrial fibrillation (14.1 +/- 5.4 vs 9.5 +/- 5.1 years, P < .05) but had smaller postoperative left atrial diameters (47.6 +/- 6.3 vs 62.1 +/- 7.9 mm, P < .01). There were no differences in mean crossclamp/bypass time and chest tube drainage for 12 hours between the groups. Twelve months after surgical intervention, the sinus rhythm recovery rate of the VR group was better than that of the control group (90% vs 69%, P < .05). Even in patients with long-standing atrial fibrillation and an enlarged left atrium, maze procedures concomitant with the novel left atrial volume reduction technique improved the sinus rhythm recovery rate without increasing complications. Although further study with a larger number of patients and a longer follow-up period is needed, this safe and thus far potent technique that catheter-based ablation cannot copy might extend indication of the Cox maze procedure for patients with tough atrial fibrillation.
    The Journal of thoracic and cardiovascular surgery 11/2006; 132(5):1047-53. · 3.41 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the therapeutic efficacy of the combined growth factor therapy with an omental flap in a rabbit model of chronic myocardial ischemia. Chronic ischemia was created in rabbits by placing a constrictor on the left circumflex artery. Four weeks later the animals were divided into 3 groups: group FG, in which a gelatin hydrogel sheet incorporating 100 microg of basic fibroblast growth factor was placed over the left circumflex region followed by covering with the omental flap including the intact gastroepiploic artery; group F, in which only the basic fibroblast growth factor sheet was placed; and group N, in which no treatment was done. Cine magnetic resonance imaging analysis showed a greater percentage wall thickening in the left circumflex region in group FG than in other groups (group FG, 49.2% +/- 4.5%; group F, 41.2% +/- 3.8%; group N, 32.1% +/- 2.5%, P =.035, group FG vs group F). A colored microsphere assay showed higher perfusion in the left circumflex region in group FG than in group F. Perfusion in the left circumflex region was decreased after clamping the gastroepiploic artery pedicle in group FG (before clamping, 2.83 +/- 0.72 mL x min(-1) x g(-1); after clamping, 1.93 +/- 0.59 mL x min(-1) x g(-1); P < .01). In vivo angiography via gastroepiploic artery showed direct "to-and-fro" visible collaterals between the gastroepiploic and occluded left circumflex coronary arteries in group FG. The combined growth factor therapy with an omental flap induced arteriogenesis and provided additional perfusion via the gastroepiploic artery to ameliorate regional dysfunction in the chronically ischemic myocardium.
    The Journal of thoracic and cardiovascular surgery 11/2006; 132(4):891-99. · 3.41 Impact Factor

Publication Stats

119 Citations
41.30 Total Impact Points

Institutions

  • 2009
    • Osaka City University
      • Graduate School of Medicine
      Ōsaka-shi, Osaka-fu, Japan
  • 2007–2009
    • Kyoto University
      • Department of Cardiovascular Surgery
      Kyoto, Kyoto-fu, Japan
    • Kyōto Medical Center
      Kioto, Kyōto, Japan