[Show abstract][Hide abstract] ABSTRACT: The Symposium of Regenerative Medicine for Patients, organized by the Japanese Society for Regenerative Medicine, was held on 28 September 2014 in Tokyo, Japan. The event provided an overview of the important areas of cell-based medicine, and highlighted the first-in-human clinical trial of induced pluripotent stem cell (iPSC)-derived products. Recent advances in regenerative medicine were also discussed, especially regarding the use of somatic cells such as chondrocytes, skeletal myocytes and cardiomyocytes under both the Act on the Safety of Regenerative Medicine, and the Pharmaceuticals, Medical Devices and Other Therapeutic Products Act.
[Show abstract][Hide abstract] ABSTRACT: A 60-year old female was referred to our institution for surgical intervention to treat bilateral coronary artery fistulas to the pulmonary artery (PA). Multidetector computed tomography (MDCT) imaging showed two tortuous vessels with multiple aneurysmal dilatations originating from the right coronary artery and left anterior descending artery. Furthermore, oximetry revealed an oxygen step-up of 10% between the PA and the right ventricle, consistent with an estimated left-to-right shunt of 47.1%, indicating that the patient was a candidate for surgery. Under heart arrest, the main PA was longitudinally opened and a single efferent hole sized 10 mm in diameter located in the anterior sinus of the pulmonary trunk was closed. Thereafter, the two afferent vessels were individually ligated at their proximal origins. Postoperative MDCT demonstrated no evidence of abnormal vessel communication between the coronary arteries and the PA, as well as relatively dilated native coronary arteries when compared with the preoperative state. At the 6-month follow-up examination, the patient was asymptomatic and showed no complications.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2015; DOI:10.1093/ejcts/ezv373 · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Although transcatheter aortic valve implantation (TAVI) is a new alternative treatment with acceptable midterm results for high surgical risk patients, at present performing the procedure in dialysis patients is not reimbursed in Japan.Methods and Results:The study group of 17 dialysis patients (mean age, 76.7±5.0 years) underwent TAVI with the SAPIEN/SAPIEN XT. EuroSCORE and STS score were 25.0±19.0% and 15.4±12.3%, respectively. Transiliofemoral and transapical approaches were performed in 7 (41.2%) and 10 patients (58.8%), respectively. ICU and hospital stays after TAVI were 1.8±1.6 and 12.9±12.7 days, respectively. Mean transvalvular gradients at discharge significantly decreased from 45.9±13.3 mmHg to 10.7±4.3 mmHg (P<0.0001) and effective orifice area significantly increased from 0.78±0.17 to 1.69±0.37 cm(2)(P<0.0001). Device success was 87.5%. One patient required a valve-in-valve procedure on 187-postoperative-day for an acute increase in paravalvular leakage caused by initial lower implantation of the device. The overall mortality at 1 year was 0% and clinical efficacies at 30 days, 6 months, and 1 year were 93.8%, 83.3%, and 69.2%, respectively.
Satisfactory early results were achieved with TAVI in Japanese dialysis patients with a high surgical risk, indicating it is a safe and effective alternative for the treatment of aortic valve stenosis in such patients.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
The purpose of this study was to assess the efficacy of tolvaptan, a vasopressin V2 receptor agonist, for the management of postoperative surgical fluid retention after heart valve surgery.
This was a prospective observational study of 64 patients with heart valve disease who underwent valve surgery between 2013 and 2014. Those in the tolvaptan group received tolvaptan in addition to conventional diuretic therapy. The results were compared to the results of 55 patients who underwent heart valve surgery between 2007 and 2010 and received conventional postoperative diuretics alone.
The time to return to the preoperative BW was significantly shorter in the patients who received tolvaptan (6.1 ± 3.8 vs. 8.7 ± 6.7 days, p < 0.05), while the level of sodium was significantly decreased in the patients who received conventional diuretics. The degree of increase in the creatinine level tended to be smaller in the tolvaptan group. The response to tolvaptan was related to the postoperative degree of BW increase and the preoperative creatinine level.
Tolvaptan was effective in treating fluid retention during the early postoperative stage in cardiac surgery patients, without increased renal failure or abnormal electrolyte levels. This new type of diuretic therapy may be a suitable option for postoperative fluid management in patients undergoing cardiac surgery.
Surgery Today 09/2015; DOI:10.1007/s00595-015-1251-y · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Open stent grafting for extended aortic repair has been widely carried out around their world. We reported the effectiveness of a new device as an open stent graft for extended aortic repair.
A new device was used as an open stent graft in this study. The graft part of the device has a woven structure made of Nitinol wire, a superelastic/shape-memory alloy. The subjects of this study were patients aged 20-84 with aneurysms (n = 38) or aortic dissection (n = 22) in the thoracic aorta, including the distal aortic arch and the proximal descending aorta. This study was a multicentre, non-blinded study. The follow-up period was 36 months.
Three subjects (5.0%) died during hospitalization due to multiorgan failure. Spinal cord injury (SCI) was observed in 4 subjects (6.7%): paraplegia in 1 and paraparesis in 3 subjects. The 3-year survival rate was 76.7% overall: 68.4% for the subjects diagnosed as having aortic aneurysms (the aortic aneurysm group) and 90.9% for those having aortic dissection (the aortic dissection group). For the aortic aneurysm group, thrombus formation in the aortic aneurysm was observed in 97% of the patients 6 months after operation, and in 100% 12 months after operation. Meanwhile, for the aortic dissection group, with regard to the false lumen of aortic dissection, thrombus formation was observed in 94% of the patients 6 months after operation, in 94% 12 months after operation and in 100% 24 months after operation. Expansion of the aortic aneurysm sac was observed in 2 subjects (6.1%). Among these 2 subjects, endoleak was observed in 1 subject, which was improved by additional thoracic endovascular aortic repair.
The safety and effectiveness of this investigational device was verified over a period up to 36 months after operation. A long-term follow-up would be necessary to further verify the effectiveness of the device in the future.
European Journal of Cardio-Thoracic Surgery 09/2015; DOI:10.1093/ejcts/ezv310 · 3.30 Impact Factor