Publications (9)39.32 Total impact
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Article: Late Results of Mitral Valve Repair With Glutaraldehyde-Treated Autologous Pericardium.
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ABSTRACT: BACKGROUND: Mitral valve repair is an established surgical procedure for treating severe organic mitral regurgitation. The mechanisms of mitral regurgitation due to infective endocarditis include rheumatic disease and congenital diseases such as a lack of leaflet tissue, and thus additional material is required to create a functional coaptation surface. We review our experience with 139 patients who underwent mitral valve repair with glutaraldehyde-treated autologous pericardium to treat organic mitral regurgitation between March 1992 and November 2011. METHODS: Mitral valve disease mainly consisted of infective endocarditis in 51 patients (active, n = 32; healed, n = 19) and rheumatic disease in 47. This procedure was also applied to 12 patients who required reoperation after mitral valve repair for degenerative, congenital, or rheumatic mitral regurgitation. The mean follow-up was 4.5 ± 4.3 years (maximum 19.1). RESULTS: Actuarial survival at 10 years was 84% ± 5%. Eleven reoperations proceeded at a mean of 68 months after surgery. The causes of reoperation were rheumatic disease progression (n = 4), infection (n = 3), patch dehiscence (n = 2), progressive fibrosis of the remaining mitral valve tissue after infective endocarditis (n = 1), and patch tear (n = 1). Mitral valves were replaced in 8 patients and re-repaired in 3 patients. The autologous pericardium was not calcified at the time of reoperation. The rate of freedom from reoperation was 82% ± 7% at 10 years. CONCLUSIONS: Mitral valves that might otherwise require replacement can be durably and predictably repaired using glutaraldehyde-treated autologous pericardium.The Annals of thoracic surgery 04/2013; · 3.74 Impact Factor -
Article: Pay Attention to Valvular Disease in the Presence of Atopic Dermatitis.
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ABSTRACT: Background: Atopic dermatitis (AD) is a common skin condition in which Staphylococcus (S.) aureus can cause native valve destruction in patients with infective endocarditis (IE). The aim of this study was to determine the early and late outcomes of IE and AD. Methods and Results: The medical records of patients with IE and AD who presented between January 1997 and September 2010 were analyzed retrospectively. IE and AD patients were compared with those with IE without AD. The mean follow-up period was 5.5±3.4 years. The incidence of AD among IE patients was 6.7% and they were significantly younger than those without AD (28.4 years vs. 53.7 years; P<0.0001). Methicillin-sensitive S. aureus and Streptococcus species were more prevalent in IE with AD (P<0.0001) and without AD (P=0.0259), respectively. One developed postoperative mediastinitis caused by methicillin-resistant S. aureus despite preoperative skin care. None of the patients died in hospital or had IE recurrence. Freedom from recurrent IE or prosthetic valve endocarditis at 5 years was 100±0.0%. Conclusions: Patients with IE must be checked for AD and history of AD because AD patients have a high incidence of staphylococcal colonization in their skin lesion.Circulation Journal 03/2013; · 3.77 Impact Factor -
Article: Reoperation for pseudoaneurysm of the thoracic aorta after cardiovascular surgery.
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ABSTRACT: PURPOSE: Pseudoaneurysms of the thoracic aorta after cardiovascular surgery are rare, but life-threatening complications. We herein describe the clinical outcomes of pseudoaneurysms of the thoracic aorta arising after cardiovascular surgery. METHODS: We retrospectively reviewed 14 patients (mean age 64 years) who underwent reoperation for a pseudoaneurysm of the thoracic aorta between January 1997 and December 2010. RESULTS: Pseudoaneurysms of the thoracic aorta were detected incidentally during routine follow-up in 11 asymptomatic patients, whereas symptoms or signs indicating an aortic pseudoaneurysm were present in three patients. The mean intervals between repeat and previous cardiovascular surgeries and the follow-up were 167 and 62 months, respectively. The aortic pseudoaneurysms were located in the proximal and distal suture lines in six patients, and at aortotomy sites in four. These locations accounted for about 70 % of all aortic pseudoaneurysms. None of the patients died in the hospital. Postoperative complications, such as a need for permanent pacemaker implantation or groin-related issues, occurred in five patients. However, no major postoperative complications, aorta-related events or a need for reoperation developed during the follow-up period. CONCLUSIONS: Regular follow-up, including imaging modalities and physical examinations, is mandatory to detect aortic pseudoaneurysms after cardiovascular surgery.Surgery Today 02/2013; · 1.22 Impact Factor -
Article: Clinical Outcomes of Redo Valvular Operations: A 20-Year Experience.
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ABSTRACT: BACKGROUND: A higher operative mortality rate has been reported after redo valvular procedures than after the primary operation. METHODS: Outcomes of 330 consecutive patients undergoing 433 redo valvular operations at our institute during a 20-year period (January 1990 to December 2010) were reviewed retrospectively. The mean follow-up was 6.4 years (range, 0.05 to 1.3 years). Logistic regression analysis was used to identify factors associated with hospital death. RESULTS: The overall hospital mortality rate was 6.7% (29 of 433 procedures). Logistic regression analysis identified only advanced New York Heart Association (NYHA) class as an independent predictor of hospital death. Overall survival at 5, 10, and 15 years was 83.6% ± 2.2%, 70.7% ± 3.4%, and 61.5% ± 4.5%, respectively. The 5-, 10-, and 15-year survivals for the first redo vs more than second redo groups were 86.5% ± 2.4% vs 74.7% ± 5.5%, 71.8% ± 3.9% vs 66.8% ± 6.6%, and 60.2% ± 5.7% vs 63.1% ± 7.2%, respectively (log-rank P = 0.505). The 5- and 10-year survivals for NYHA class I/II vs III/IV patients were 91.5% ± 2.1% vs 70.4% ± 4.5% and 77.8% ± 4.1% vs 58.5% ± 5.6%, respectively (log-rank p < 0.005). CONCLUSIONS: Redo valvular operation in NYHA class III/IV patients is associated with high hospital death and poor long-term survival. To achieve low hospital death and good long-term survival, redo operations, including more than third redo operations, should be performed in patients with lower NYHA class.The Annals of thoracic surgery 08/2012; · 3.74 Impact Factor -
Article: Tricuspid leaflet augmentation with an autologous pericardial patch for recurrent severe tricuspid regurgitation that occurred after suture annuloplasty.
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ABSTRACT: We, herein, report the use of tricuspid leaflet augmentation with an autologous pericardial patch to treat a patient with severe tricuspid regurgitation (TR) that occurred after suture annuloplasty. The patient underwent mitral valve replacement for rheumatic mitral disease and tricuspid suture annuloplasty for moderate TR 23 years ago. She developed right-sided heart failure associated with severe TR. Leaflet augmentation with an autologous pericardial patch and ring annuloplasty were applied at redo surgery. Postoperative echocardiography showed trivial TR with significant improvement of the patient's symptoms. We have now performed this technique on three cases of severe recurrent TR that occurred after suture annuloplasty, and excellent early results were obtained in each case.Surgery Today 07/2012; · 1.22 Impact Factor -
Article: Survival after simultaneous repair of bichamber cardiac and pulmonary vein rupture caused by blunt chest trauma.
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ABSTRACT: A 44-year-old woman was transferred to our institution because of blunt chest trauma. Transthoracic echocardiography revealed decompression of the right ventricle resulting from pericardial effusion. Her hemodynamic condition was worsening gradually, and the decision was made to take the patient to the operating room. After releasing a large amount of clotting blood within the pericardial cavity, catastrophic hemorrhage occurred. Under better visualization after the patient was placed on cardiopulmonary bypass, we identified a 5-cm longitudinal tear and a 2-cm tear in the right atrium (RA), a 2-mm tear in the right ventricle (RV), and a 5-mm tear in the right lower pulmonary vein (PV). Those tears were repaired successfully with 5-0 polypropylene sutures.The Annals of thoracic surgery 07/2012; 94(1):265-7. · 3.74 Impact Factor -
Article: Ortner syndrome associated with aortic pseudoaneurysm after repair of aortic coarctation 30 years previously.
Circulation 05/2012; 125(20):e937-8. · 14.74 Impact Factor -
Article: Aortic valve replacement after esophagectomy with substernal gastric tube and total laryngectomy with tracheostoma.
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ABSTRACT: A 77-year-old man successfully underwent aortic valve replacement with a bioprosthesis through a right thoracotomy. Right thoracotomy was utilized because the patient had previously undergone esophagectomy with reconstruction of a substernal gastric tube for esophageal cancer as well as total laryngectomy with tracheostoma formation for laryngeal cancer. Thus, even in a situation in which conventional median sternotomy was difficult, a good outcome for aortic valve replacement was achieved through an alternate approach. This case highlights the need to consider patient history when selecting a surgical approach.The Annals of thoracic surgery 05/2012; 94(1):271-3. · 3.74 Impact Factor -
Article: Outcomes of mitral valve repair for bileaflet prolapse.
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ABSTRACT: Repair of bileaflet prolapse has been considered to be technically demanding and challenging. To assess the reliability and durability of mitral valve repair for bileaflet prolapse, the present study compared the outcomes of mitral valve repair for bileaflet prolapse with those for posterior prolapse. From January 1991 to April 2010, 191 consecutive patients with bileaflet prolapse (group B) underwent mitral valve repair using a combination procedure of expanded polytetrafluoroethylene chordal reconstruction for anterior prolapse, resection suture technique with/without sliding technique for posterior prolapse, and ring annuloplasty. During the same period, 323 patients with posterior prolapse (group P) underwent standard mitral valve repair. Serial echocardiograms were obtained at discharge and 1, 3, 5, and 10 years postoperatively. The mean age in group B (54 ± 15 years) was significantly younger than that in group P (61 ± 12 years). Survival, including hospital death at 10 years, was superior in group B (group B, 90% ± 3%; group P, 83% ± 3%; P = .046). At 10 years, no significant differences were found between the groups in terms of freedom from recurrent mitral regurgitation of more than mild (group B, 89% ± 3%; group P, 90% ± 2%), freedom from reoperation (group B, 97% ± 2%; group P, 97% ± 1%), and event-free survival (group B, 79% ± 5%; group P, 83% ± 3%). The reproducibility and reliability of mitral valve repair for bileaflet prolapse compares favorably with that of posterior leaflet prolapse. Early surgery might be recommended for patients with severe mitral regurgitation owing to bileaflet prolapse.The Journal of thoracic and cardiovascular surgery 12/2011; 143(4 Suppl):S21-3. · 3.41 Impact Factor
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Institutions
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2011–2013
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Kobe City Medical Center General Hospital
Kōbe-shi, Hyogo-ken, Japan
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