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ABSTRACT: To determine the safety and usefulness of antegrade hypothermic cerebral perfusion in conjunction with mild hypothermic (tepid) visceral perfusion (so-called cool head-warm body perfusion; CHWB) in aortic surgery; the clinical outcomes and perioperative data on this new technique were retrospectively analyzed.
From January 1990 to March 1999, 59 patients underwent ascending aorta or aortic arch surgery using antegrade selective cerebral perfusion (SCP). Three perfusion techniques, differentiated by perfusion temperature, were used, those being deep hypothermia (DH; nasopharyngeal temperature of 20 degrees C, n=14), moderate hypothermia (MH; nasopharyngeal temperature of 28 degrees C, n=17) and CHWB (nasopharyngeal temperature of 25 degrees C and bladder temperature of 32 degrees C, n=28). Selection of the technique largely followed a chronological pattern, in this order: DH, MH and, more recently, CHWB. The three groups were retrospectively compared in terms of operative outcome, duration of cardiopulmonary bypass (CPB) and operation, and intraoperative blood loss.
The early (within 30 days after surgery) mortality/hospital mortality (including operative mortality) was 7.1/21.4, 5.9/11.8 and 3.6/7.1% in the DH, MH and CHWB groups, respectively. The rate of stroke was 7.1, 6.3 and 3.6% in the DH, MH and CHWB groups, respectively. No statistical difference was found in early or hospital mortality, or in the rate of stroke among the three groups. The CPB time, especially the time for rewarming, was significantly shorter in the CHWB than in the DH group. Likewise, the operation time, especially the time after CPB, was significantly shorter in the CHWB than in the DH and MH groups. Blood loss was significantly less in the CHWB than in the DH group.
Our data suggest that CHWB perfusion in aortic surgery is a safe and useful technique in shortening the operation time and reducing blood loss, but further prospective study is necessary.
European Journal of Cardio-Thoracic Surgery 10/2000; 18(3):262-9. · 2.55 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 10/1998; 116(3):522-4. · 3.41 Impact Factor
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ABSTRACT: Supplementation of angiographic information during bypass procedures is an attractive goal for the echocardiographic researcher. Compared with color flow mapping, power Doppler imaging is superior in terms of identifying small vessels and noise suppression because of the use of Doppler signal strength for imaging. Although power Doppler imaging does not provide information about flow velocity or its direction, it does show detailed vessel flow in a static organ. Our study was designed to obtain angiographic images of the coronary artery by the use of power Doppler imaging in 31 patients during open heart surgery. During cold cardioplegic infusion, the epicardial coronary artery and the coronary artery within myocardium, such as the septal perforator, could be well visualized by power Doppler imaging. There was good correlation between the diameters of coronary arteries measured from power Doppler imaging and those from quantitative coronary angiography (r = 0.964, p < 0.0001). We obtained clear and accurate images of the coronary artery by using power Doppler imaging during cardiac standstill. These images might provide meaningful supplemental information to the operator, such as confirming the target coronary artery during the cardioplegia and choosing the appropriate arterial portion for a bypass operation.
Journal of the American Society of Echocardiography 04/1998; 11(3):219-27. · 3.71 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 04/1997; 113(3):605-6. · 3.41 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 01/1997; 112(6):1666-7. · 3.41 Impact Factor
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ABSTRACT: A total of 20 patients who developed cardiac arrest or severe cardiogenic shock were resuscitated with percutaneous cardiopulmonary support system (PCPS). The etiology of shock was acute myocardial infarction (n = 8), post-infarction left ventricular (LV) free wall rupture (n = 9) and others (n = 3). After successful resuscitation with PCPS, 17 patients underwent therapeutic interventions: either closure of an LV rupture (n = 9), coronary artery bypass grafting (n = 4), percutaneous transluminal angioplasty (n = 1) and percutaneous transluminal coronary recanalization (n = 1). Of the 20 patients, 17 were weaned from PCPS or standard cardiopulmonary bypass. Nine patients survived longer than 30 days and 6 patients were discharged from the hospital. In nine patients with LV free wall rupture, one could be discharged from the hospital. Even though our experience is still small in number, it can be concluded that cardiopulmonary resuscitation using PCPS improves survival in fatally ill patients.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 12/1996; 44(11):2006-10.
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ABSTRACT: A total of 16 patients who developed severe cardiogenic shock were resuscitated with a percutaneous cardiopulmonary support system (PCPS). The etiology of shock was acute myocardial infarction (n = 7), or post-infarction left-ventricular (LV) free wall rupture (n = 9). After successful resuscitation with the PCPS, 15 patients underwent therapeutic interventions: closure of an LV rupture (n = 9), coronary artery bypass grafting (n = 4), percutaneous transluminal angioplasty (n = 1), and percutaneous transluminal coronary recanalization (n = 1). Of the 16 patients, 14 were weaned from PCPS or standard cardiopulmonary bypass. Six patients survived longer than 30 days, 3 (19 percent) of whom were discharged from the hospital. The long-term survival rate in the 6 patients who underwent coronary revascularization was 33 percent (2/6). Of the 9 patients with LV free wall rupture, 1 was discharged from the hospital. Even though it cannot be concluded, from this small number of patients, that cardiopulmonary resuscitation using PCPS improves survival, it appears that PCPS is a powerful resuscitative modality for seriously ill patients with acute myocardial infarction or LV rupture.
Heart and Vessels 02/1996; 11(1):27-9. · 2.05 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 02/1996; 111(1):276. · 3.41 Impact Factor
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ABSTRACT: An 18-year-old boy with dilated cardiomyopathy developed a relatively rapid deterioration and went into severe congestive heart failure. After short-while use of percutaneous cardiopulmonary support system (PCPS) and IABP, LVAS was indicated because of persisting low cardiac output syndrome and deterioration of organ functions. An LVAS (TOYOBO) was implanted on June 26, 1992 in a fashion of left atrium to ascending aorta bypass. Satisfactory circulatory support (flow rates of 4-5 L/min) was achieved resulting in complete recovery of the organ functions. After two months of LVAS support, the patient was transported to U.S.A.. The LVAS system was working well without any problems during 17 hrs flight under low atmospheric pressure (0.8 atm) in the plane. The patient successfully underwent heart transplantation (HTx) at Texas Heart Institute after 119 days support of LVAS. The patient is doing well enjoying active life after HTx. This is the first case of successful bridge use of extracorporeal LVAS to HTx in Japan.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 11/1994; 42(10):1984-9.
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ABSTRACT: Open heart surgery with non-blood transfusion was performed in 2 cases of severe mitral valve disease with cardiac cachexia by administering recombinant human erythropoietin (EPO). Case 1 was a 72-year-old and case 2 was a 66-year-old woman whose % usual body weight was 71-79% and Ht value on admission was 28.5-30%. Both patients were administered 9000-18000 U/week of EPO and ferrous sulfate pre- and postoperatively. In each case 800-1200 ml of autologous blood was drawn within 3 weeks preoperatively without hemodynamic change or decrease of Ht value. Both patients were received mitral valve replacement with non-blood transfusion. Preoperative administration of EPO and autologous blood preservation allowed open heart surgery with non-blood transfusion even in such a serious case as cardiac cachexia.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 02/1993; 41(1):105-10.
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ABSTRACT: From January 1988 through December 1990, 7 patients older than 75 years underwent emergent cardiovascular operation. We evaluated those operative results. The mean age was 80.1 years (range 77 to 85 years) and there were 5 men and 2 women. Coronary artery bypass grafting for 2 cases, closure of ventricular septal perforation for 1 case, graft replacement of ascending aorta and suspension of aortic valve in 2 cases, closure of left ventricular free wall rupture (LVFWR) in 1 case and closure of arch aneurysm rupture for 1 case were performed. Operative mortality was 14.3% (1/7). There was one hospital death. Five survivors had uneventful course in early postoperative term, but they needed long elaborate hospital care because of complications in noncardiac general organs in late postoperative term. They need nutritional support, rehabilitation for muscle weakness and so on. Their mean postoperative hospital period was 53 days. All of them were improved in New York Heart Association I or II. We concluded that we attained a good operative result in emergent cardiovascular operation in patients older than 75 years by effective operation as a result of long elaborate postoperative hospital care.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 05/1992; 40(4):578-82.
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ABSTRACT: Eight patients with infarct-related ventricular septal perforation underwent surgical repair using Teflon felt patch. The overall early operative mortality rate was 12% (1/8). One of three patients (33%) with cardiogenic shock preoperatively, one of five patients (20%) operated within 7 days after the onset of infarction died within 30 days after operation. A patient with inferior infarction died early after operation. In 5 of 8 patients (63%), IABP was removed within 24 hours after operation. A patient died due to the recurrence of gastric cancer in late postoperative phase. None of patients was found to have a recurrence of the ventricular septal perforation after the operation. Five of 6 patients (83%) surviving the operation are in NYHA class I or II.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 05/1992; 40(4):543-8.
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ABSTRACT: Percutaneous cardiopulmonary support system (PCPS) was applied for a 85 years old man with circulatory collapse caused by left ventricular free wall blow out rupture following acute anterior myocardial infarction. PCPS was started after the cardiac massage for 7 minutes without thoracotomy or release of cardiac tamponade and flow of ranging from 2.3 to 2.7 L/min/m2 was achieved. The patient was transferred to operating room and closure of the ventricular rupture was performed under the usual cardiopulmonary bypass. Postoperative recovery of cardiac function and consciousness was satisfactory but he was died of multiple organ failure caused by sepsis at 36 postoperative day. PCPS and consecutive surgical therapy seemed useful method for the treatment of left ventricular free wall blow out rupture.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 02/1992; 40(1):86-90.
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ABSTRACT: During the last 3 years, left or bi-ventricular support using a centrifugal pump as a ventricular assistance device was performed in 10 patients after open heart surgery. The basic lesions were coronary heart disease in 8 and valvular disease in 2 patients. Bypass support ranged in time from 33 to 240 h (average 114 h), and 3 patients received biventricular support. Six patients have survived in this group. Other supportive methods, in the form of emergency or elective use of portable cardiopulmonary bypass support, were used in 8 patients; 4 with cardiogenic shock and 4 for supported percutaneous coronary angioplasty. These assisted circulations appear to be useful and promising in the management of the critical cardiac patient.
Japanese Circulation Journal 02/1992; 56(1):111-6.
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Japanese Circulation Journal 02/1992; 56 Suppl 5:1446-9.
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ABSTRACT: A closed system of percutaneous cardiopulmonary bypass (PCPB) with centrifugal pump and membrane oxygenator was applied for 2 patients with circulatory collapse caused by acute reclosure of left anterior descending coronary artery after PTCA in case 1 and acute myocardial infarction due to left main coronary artery lesion in case 2. Both patients were brought to operating room under the circulatory support of PCPB and successful coronary artery bypass was performed. Case 1 survived and case 2 died from sepsis due to mediastinitis inspite of satisfactory recovery of cardiac function. PCPB was confirmed as a useful method for emergency circulatory support and a bridge to cardiac surgery in patients with cardiogenic circulatory collapse.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 08/1991; 39(7):1081-6.
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ABSTRACT: To evaluate the effect of aortic valve replacement on left ventricular function in aortic regurgitation, the ratio of end-systolic wall stress to end-systolic volume index (ESS/ESVI) and standard ejection phase indexes of left ventricular function were measured angiographically in 29 patients with isolated, chronic aortic regurgitation before and an average of 26 months after aortic valve replacement. The patients were divided into three groups based on preoperative left ventricular volume at end-systole (ESVI); 12 patients had an ESVI smaller than 100 ml/m2 (group I), 11 had an ESVI of 100 to 200 ml/m2 (group II) and 6 had an ESVI greater than 200 ml/m2 (group III). Postoperatively, end-diastolic volume index and ESVI decreased markedly in all 3 groups and end-systolic stress also decreased. Systolic pump performance assessed as ejection phase indexes improved in all groups with group I and group II showing normal or near-normal ejection fraction, while group III still had a depressed ejection fraction. Left ventricular contractile function as assessed by ESS/ESVI improved significantly in each group postoperatively. After operation, group I patients had normal values. However, both group II and group III still had a subnormal ratio, suggesting a depressed contractility despite normal or near normal systolic pump performance. Surgical correction for aortic regurgitation should be considered before a preoperative ESVI exceeds 100 ml/m2, to preserve postoperative left ventricular contractility.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 07/1991; 39(6):867-75.
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ABSTRACT: We evaluated the late results of coronary bypass grafting (CABG) in 85 patients. The patients were divided into two groups according to preoperative MI size estimated by the Selvester QRS score; 24 with MI size of larger than 20% of LV muscle (group A; average 28 +/- 11%), and 61 with MI size smaller than 20% (group B; average 10 +/- 9%). New York Heart Association classes of both groups following CABG improved significantly (from 2.8 +/- 0.7 to 1.3 +/- 0.4 in group A; p less than 0.01, from 2.5 +/- 0.6 to 1.2 +/- 0.5 in group B; p less than 0.01). There was higher incidence of serious ventricular arrhythmias in group A than in group B (83% vs. 21%, p less than 0.01). In Group A, LVEF and LVESVI did not improve following CABG (from 17 +/- 9 to 16 +/- 8 mmHg, from 39 +/- 15 to 40 +/- 15%, from 66 +/- 28 to 69 +/- 40 ml/M2), while in Group B, those improved significantly (from 13 +/- 6 to 11 +/- 5 mmHg; p less than 0.01, from 53 +/- 14 to 58 +/- 10%; p less than 0.01, from 39 +/- 23 to 32 +/- 14 ml/M2; p less than 0.05). The exercise-to-rest LVSWI ratios increased significantly following CABG in both groups (from 86 +/- 25 to 160 +/- 56% in group A; p less than 0.05, from 92 +/- 31 to 140 +/- 37% in group B; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 12/1990; 38(11):2208-14.
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ABSTRACT: A left ventricular assist device (LVAD) was applied to a patient who had profound left ventricular failure following extended myocardial infarction caused by the left main trunk obstruction. The patient was a 61-year-old man, who had severe chest distress and was admitted 11 hours after the onset of the symptom. At the time of admission, he was already in cardiogenic shock. The emergent coronary angiography showed complete obstruction of the left main trunk and the intact right coronary artery which had no collateral flow to the left coronary artery. The intraaortic balloon pumping (IABP) was started bu could not maintain the satisfied circulation. Then a LVAD was applied to the patient 5 days after the onset. The LVAD maintained the normal circulation and prohibited exaspiration of organ failure. 19 days after the onset, scartectomy and A-C bypass to LAD was performed. The patient could not be weaned from LVAD and died of right ventricular failure following ventricular arrhythmia 20 days after the installation of LVAD. The use of LVAD for nonoperative cardiogenic shock is rare. Circulatory support with a LVAD in the treatment of a patient in cardiogenic shock following a acute myocardial infarction was considered useful.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 11/1990; 38(10):2122-7.
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ABSTRACT: We evaluated relations with operative results of emergency aortocoronary bypass grafting to severity of residual stenotic lesion after surgery in patients with impending myocardial infarction or acute myocardial infarction. Mortality in patients with residual stenotic lesion whose score more than 15 is 66%. Mortality in patients with residual stenotic lesion whose score less than 15 is 5%, excluding patients died with noncardiac cause. Four of 6 patients (66%) with residual stenotic lesion whose score more than 5 have residual angina after the operation. None of fourteen patients with residual stenotic lesion whose score less than 5 has residual angina after the operation. In theory, we could save their lives with only one graft in 76% patients and cure their angina with less than 2 grafts in 72% patients. These grafts are key grafts.
[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai 07/1990; 38(6):1006-10.
