Yoshiki Sawa

Osaka City University, Ōsaka, Ōsaka, Japan

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Publications (748)2343.9 Total impact

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    ABSTRACT: Whereas surgical outcomes of congenital heart surgery have improved during the past two decades, there are still measurable postoperative mortalities in this field. This study is aimed at evaluating the current situation of mortality following congenital heart surgery. Data on all registered 28 810 patients in The Japan Congenital Cardiovascular Surgery Database (JCCVSD) between 2008 and 2012 were analysed, except for patients with degenerative cardiomyopathy including dilated, restrictive and hypertrophic cardiomyopathy, and pathologically or histologically malignant cardiac tumours. The number of registered cases increased every year, and reached ∼9000 cases in 2012. The median age at surgery was 0.8 years (range, 0-82). More than half of the patients (54%) who underwent surgery were <1 year old, and 6.0% of all patients were over 18 years old (adults). In this study, all mortalities within 90 days after the operation and mortality at discharge beyond 90 days of hospitalization were defined as '90-day and in-hospital mortality'. The 30-, 90-day and in-hospital mortality rates were 2.3, 3.5 and 4.5%, respectively. The mean and median durations from surgery to death were 61 ± 89 and 28 days (range, 0-717), respectively. Whereas 658 mortalities (51%) occurred within 30 days of surgery, 265 (21%) occurred later than 90 days after surgery. A total of 3630 patients (13%) were hospitalized for more than 90 days after the operation; of those, 3365 patients survived at discharge (93%). Cardiac problems were the most frequent causes of death after the surgery at any point in time, and 7.1 per 1000 patients died at over 30 days after the operation due to solely cardiac. The investigation of JCCVSD revealed that about a half of mortalities occurred later than 30 days; hence 90-day and in-hospital mortality would be a good discriminator that accurately represented the current situation of mortality after congenital heart surgery. Mortalities long after the operation due to post-cardiotomy heart failure without any other lethal complications were still not rare. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Interactive Cardiovascular and Thoracic Surgery 04/2015; DOI:10.1093/icvts/ivv109 · 1.11 Impact Factor
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    ABSTRACT: Heart failure mainly caused by ischemic or dilated cardiomyopathy is a life-threatening disorder worldwide. The previous work in cardiac surgery has led to many excellent surgical techniques for treating cardiac diseases, and these procedures are now able to prolong the human lifespan. However, surgical treatment for end-stage heart failure has been under-explored, although left ventricular assist device (LVAD) implantation and heart transplantation are options to treat the condition. LVAD can provide powerful circulatory support for end-stage heart failure patients and improve the survival and quality of life after implantation compared with the existing medical counterparts. Moreover, LVADs play a crucial role in the "bridge to transplantation", "bridge to recovery" and recently have served as "destination therapy". The structural and molecular changes that improve the cardiac function after LVAD implantation are called "reverse remodeling", which means that patients who have received a LVAD can be weaned from the LVAD with restoration of their cardiac function. This strategy is a desirable alternative to heart transplantation in terms of both the patient quality of life and due to the organ shortage. The mechanism of this bridge to recovery is interesting, and is different from other treatments for heart failure. Bridge to recovery therapy is one of the options in regenerative therapy which only a surgeon can provide. In this review, we pathophysiologically analyze the reverse remodeling phenomenon induced by LVAD and comment about the clinical evidence with regard to its impact on the bridge to recovery.
    Surgery Today 04/2015; DOI:10.1007/s00595-015-1149-8 · 1.21 Impact Factor
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    ABSTRACT: Restrictive mitral annuloplasty (RMA) can reverse left ventricular (LV) remodeling and reduce plasma B-type natriuretic peptide (BNP), a surrogate biomarker of heart failure. However, the relationship between reverse LV remodeling and plasma BNP changes after RMA is poorly defined. We explored the main hemodynamic factors contributing to change in plasma BNP after RMA in patients with functional mitral regurgitation (MR). Twenty-four patients with moderate to severe functional MR secondary to LV systolic dysfunction [ejection fraction (EF) <40%] underwent 64-row multidetector computed tomography (MDCT) before and 1.4 months after RMA. LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), LVEF, and regional and global end-systolic wall stress (ESS) were calculated from 3-dimensional MDCT images, with blood samples for plasma BNP measurement collected the same day. After RMA, LV volumes and global ESS were decreased, while LVEF improved (all p<0.01). There were significant correlations between changes in LVEDVI and LVESVI (r=0.90, p<0.0001), LVESVI and global ESS (r=0.54, p=0.006), and global ESS and LVEF (r=-0.60, p=0.002). The median value for the plasma BNP also decreased from 597pg/ml [interquartile range (IQR), 360-934pg/ml] to 207pg/ml (IQR, 124-271pg/ml), in association with changes in LVEDVI (r=0.47, p=0.019), LVESVI (r=0.56, p=0.004), LVEF (r=-0.60, p=0.002), and global ESS (r=0.74, p<0.0001). Multivariate regression analysis showed that global ESS change was the strongest contributor to change in natural-log-transformed plasma BNP (standardized partial regression coefficient=0.59, p=0.004), indicating a strong association between decrease in LV afterload and reduction in plasma BNP level after RMA. There may be a significant association between LV reverse remodeling and plasma BNP change after RMA. Furthermore, LV end-systolic myocardial stress may be the key mechanical stimulus influencing plasma BNP after surgical correction for functional MR. Whether these favorable BNP responses and reverse remodeling can predict improved survival requires further study. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
    Journal of Cardiology 04/2015; DOI:10.1016/j.jjcc.2015.02.015 · 2.57 Impact Factor
  • Nature Reviews Clinical Oncology 03/2015; DOI:10.1038/nrclinonc.2014.159-c1 · 15.70 Impact Factor
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    ABSTRACT: We conducted in vivo examinations of a newly designed stentless mitral valve (SMV), formed by suturing 2 leaflets with the "legs" serving as chorda tendinea, made from bovine pericardium, to a flexible ring.Methods and Results:Seven pigs underwent implantation of the SMV constructed with a 23-mm (n=5) or 25-mm (n=2) Duran ring. Baseline echocardiography examinations were used to evaluate the annular anteroposterior diameter, and distance between the mitral annulus (MA) and papillary muscles (PMs) to determine SMV-leg length. After removing the native valve, the SMV-legs were fixed to the anterior and posterior PMs, followed by fixation of the ring to the native MA. Immediately after surgery, all animals presented none or trivial mitral regurgitation, with mean and peak trans-SMV pressure gradient values of 1.9±0.8 and 6.0±3.1 mmHg, respectively. The mean length of the SMV-leg was 19.4±3.9 mm, which correlated with the distance between anterior and posterior MA-PM (r=0.96 and 0.94, respectively, P<0.01 for both). The discrepancy between the anteroposterior diameter of the ring (outside diameter) and that of the native valve was 1.0±2.9 mm, which correlated with the trans-SMV pressure gradient (r=0.81, P=0.025). In our preliminary study, the SMV demonstrated excellent diastolic inflow dynamics and closing function in vivo. Preoperative precise assessment of MV configuration may serve as a basis for selection of appropriate ring size and SMV-leg length. (Circ J 2015; 79: 553-559).
    Circulation Journal 02/2015; 79(3). DOI:10.1253/circj.CJ-14-1113 · 3.69 Impact Factor
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    ABSTRACT: Cardiac failure is a major cause of mortality and morbidity worldwide, since the standard treatment for cardiac failure in the clinical practice is chiefly to focus on removal of insults against the heart or minimisation of additional factors to exacerbate cardiac failure, but not on regeneration of the damaged cardiac tissue. A synthetic prostacyclin agonist, ONO-1301, has been developed as a long-acting drug for acute and chronic pathologies related to regional ischaemia, inflammation and/or interstitial fibrosis by pre-clinical studies. In addition, poly-lactic co-glycolic acid-polymerised form of ONO-1301, ONO-1301SR, was generated to achieve a further sustained release of this drug into the targeted region. This unique reagent has been shown to act on fibroblasts, vascular smooth muscle cells and endothelial cells in the tissue via the prostaglandin IP receptor to exert paracrinal release of multiple protective factors, such as hepatocyte growth factor, vascular endothelial growth factor or stromal cell-derived factor-1, into the adjacent damaged tissue, which is salvaged and/or regenerated as a result. Our laboratory developed a new surgical approach to treat acute and chronic cardiac failure using a variety of animal models, in which ONO-1301SR is directly placed over the cardiac surface to maximise the therapeutic effects and minimise the systemic complications. This review summarises basic and pre-clinical information of ONO-1301 and ONO-1301SR as a new reagent to enhance tissue salvage and/or regeneration, with a particular focus on the therapeutic effects on acute and chronic cardiac failure and underlying mechanisms, to explore a potential in launching the clinical study.
    Heart Failure Reviews 02/2015; DOI:10.1007/s10741-015-9477-8 · 3.99 Impact Factor
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    ABSTRACT: To identify the risk factors of prolonged hemodynamic compromise caused by rapid pacing for valve deployment during transcatheter aortic valve implantation.
    Journal of Cardiothoracic and Vascular Anesthesia 02/2015; DOI:10.1053/j.jvca.2015.02.019 · 1.48 Impact Factor
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    ABSTRACT: Objectives: The surgical indications for non-small cell lung cancer (NSCLC) infiltrating a great vessel or the heart are controversial. We assessed clinical features and surgical outcomes of patients with non-small cell lung cancer who underwent combined resection of a lung and great vessel.Methods: Fourteen patients underwent great vessel resection under a lobectomy (n = 9), sleeve lobectomy (n = 2), or pneumonectomy (n = 3) between 2000 and 2011, in whom the aorta was resected in 6, superior vena cava in 5, right atrium in 1, and left atrium in 2. The histological types were adenocarcinoma (n = 8) and squamous cell carcinoma (n = 6).Results: Complete resection was performed in 12 patients. Of all patients, 7 had pN0 disease, 2 had pN1, and 4 had pN2. The postoperative morbidity rate was 28.6% and mortality rate was 7.1%. The 5-year survival rate was 26.8% for all patients, 46.9% for those with an adenocarcinoma, 0% for those with a squamous cell carcinoma, 53.6% for those with pN0, and 0% for those with pN1-2.Conclusion: Resection of the great vessels and heart involved by NSCLC can be performed with acceptable morbidity and mortality, and results in prolonged survival in patients, with an adenocarcinoma or N0 status.
    Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 02/2015; DOI:10.5761/atcs.oa.14-00191 · 0.69 Impact Factor
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    ABSTRACT: The repair of extensive thoraco-abdominal aortic aneurysms (TAAAs) is invasive and carries a high risk for spinal cord injury (SCI). The aim of this study was to assess the early results and collateral circulation to the spinal cord after hybrid repair for Crawford extent II aortic aneurysms. Between 1997 and 2013, we performed 128 thoracic endovascular aortic repair (TEVAR) procedures for TAAAs. This study reviews 12 patients who underwent hybrid TEVAR for a Crawford extent II aortic aneurysm (mean age: 56 years, 6 men, chronic dissection: 10). Aortic arch repair was performed to create a proximal landing zone and visceral debranching bypass was performed to create a distal landing zone at separate stages prior to TEVAR. Subsequently, a stent graft was deployed to cover the residual downstream aorta. TEVAR was generally performed the day after the final debranching procedure. Cerebrospinal fluid drainage was performed, and the mean blood pressure was maintained at >90 mmHg in all cases. The median operation time for TEVAR was 94 min (range: 71-421 min) and the mean blood loss was 300 ml (range: 130-1350 ml). No SCI or in-hospital death was observed after TEVAR. Multidetector computed tomography identified three arteries (subclavian artery, external iliac artery and internal iliac artery) providing collateral circulation to spinal segmental arteries (SAs). In all cases, mid-thoracic SAs (Th5-8) and low lumbar SAs (L2-5) were fed by the subclavian artery and the internal iliac artery, respectively. Additionally, low thoracic to high lumbar SAs (Th9-L1) communicated with the subclavian artery via the lateral thoracic wall and/or the external iliac artery via the abdominal wall. We achieved satisfactory early and mid-term outcomes with hybrid repair for Crawford extent II TAAAs. Furthermore, collateral circulation to SAs was maintained during and after TEVAR regardless of the extent of the aortic repair. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2015; DOI:10.1093/ejcts/ezv027 · 2.81 Impact Factor
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    ABSTRACT: Background:Feasibility and early results of transfemoral aortic valve implantation using the ACURATE neo/TF(TM)self-expanding stent are reported.Methods and Results:The study group of 15 patients (mean age 83.3±6.0) was enrolled with a mean EuroSCORE and STS score of 21.9±11.6% and 7.5±3.1%, respectively. Clinical and echocardiographic evaluations were performed at baseline, discharge, 30 days and 6 months. The primary endpoint was all-cause mortality at 30 days. Transcatheter aortic valve implantation (TAVI) using the ACURATE neo/TF device was successful in 14 patients; 1 patient underwent valve-in-valve implantation because the prosthetic valve embolized during withdrawal of the delivery system. Conversion to surgery, coronary obstruction, peri-operative stroke, and pacemaker implantation did not occur at 30 days. Mean transvalvular gradients at discharge significantly decreased from 44.2±10.5 mmHg (preprocedural) to 7.7±3.1 mmHg (P<0.0001) and effective orifice area significantly increased from 0.77±0.12 to 1.69±0.25 cm(2)(P<0.0001). None or trace paravalvular leak was revealed in 50.0%, and no patient exhibited moderate or higher paravalvular leak. The overall mortality at 30 days and 6 months was 0% and 6.7%, respectively.Conclusions:A new self-expanding TF TAVI device, ACURATE neo/TF, is safe and effective in the treatment of severe aortic stenosis in elderly patients at high risk for surgery.
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    ABSTRACT: Functional 3D-engineered tissues are successfully harvested from a substrate using stimuli-responsive hydrogel films with dynamic nano-interface. The dynamic wettability control at the interfaces allows cellular detachment, leading to tissue harvesting without serious damage and remaining polymers. This method can be applied to various types of organs and used for tissue transplantation in regenerative medicine. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
    Advanced Healthcare Materials 02/2015; DOI:10.1002/adhm.201500065 · 4.88 Impact Factor
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    ABSTRACT: Background:Little is known about the impact of tricuspid annuloplasty (TAP) on annular dynamics. We assessed tricuspid annular dynamics using 3-D transesophageal echocardiography (3D-TEE) before and after TAP with different types of prosthetic ring.Methods and Results:3D-TEE of the tricuspid valve was acquired in 30 patients (TAP with rigid ring [RR], n=8; TAP with flexible ring [FR], n=10; control, n=12). Tricuspid annular dimensions (circumference, area, annular height, anteroposterior [AP], septolateral [SL] diameter) were measured throughout the cardiac cycle. All postoperative tricuspid annular dimension parameters were significantly reduced by TAP, while the AP/SL ratio was significantly increased (before, 0.96±0.16; after, 1.03±0.06; P<0.05). The difference in annular area between diastole and systole was significantly smaller in the TAP groups (11.6%) than in the control (27.9%, P<0.05). Annular height in the FR patients was significantly lower than in the RR group, while the postoperative AP/SL ratio was lower in the RR than the FR and control groups. Change in annular area was not seen in RR patients, while it was seen in the FR and control groups.Conclusions:Annulus motion and shape differ according to the type of prosthetic ring used, although tricuspid regurgitation was well controlled by all types of ring utilized. The present results provide important information for selection of an appropriate prosthetic ring for TAP.
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    ABSTRACT: Left atrial (LA) dimension can predict atrial fibrillation (AF) recurrence after catheter-based or surgical ablation. Pulmonary vein isolation (PVI) may be a surgical option during aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG), though consensus regarding patient selection and late outcome is lacking. We studied 160 patients (mean age 70 ± 9 years) with paroxysmal AF who underwent radiofrequency-based PVI during AVR and/or CABG, and were followed up postoperatively for at least 6 months. Mean preoperative LA dimension was 44 ± 7 mm. Serial echocardiography was performed to evaluate left ventricular (LV) and LA dimensions, E/e', estimated systolic pulmonary artery (PA) pressure and degree of valvular regurgitation. Follow-up was completed with a mean duration of 47 ± 25 months. At the latest follow-up, 133 patients (83%) remained in sinus rhythm. Preoperative LA dimension was independently associated with increased risk of AF recurrence at 6 months after surgery [adjusted odds ratio 1.3 per 1-mm increase in LA dimension, 95% confidence interval (CI) 1.1-1.6, P < 0.001]. Receiver-operating characteristic curve analysis demonstrated an optimal cut-off value for preoperative LA dimension of 45 mm to predict sinus rhythm restoration (98% for <45 mm vs 55% for ≥45 mm, P < 0.001). Patients with LA dimension ≥45 mm had a significantly lower 5-year survival rate (62 ± 7 vs 82 ± 7%, P = 0.025) and freedom from adverse events defined as cerebral infarction/haemorrhage, admission for heart failure, catheter ablation and permanent pacemaker implantation (58 ± 7 vs 91 ± 4%, P < 0.001). Multivariate analysis showed that preoperative LA dimension ≥45 mm was independently associated with adverse events (adjusted hazards ratio 2.4, 95% CI 1.2-5.1, P = 0.019). Serial echocardiography demonstrated improvement in LV systolic function irrespective of LA dimension, whereas patients with LA dimension ≥45 mm showed less improvement in LA dimension and systolic PA pressure (interaction effect P < 0.001) and persistent higher E/e' (group effect P < 0.001), along with aggravated tricuspid regurgitation. In patients with paroxysmal AF related to aortic valve disease and/or coronary artery disease, a dilated left atrium (≥45 mm) was associated with inferior AF- and event-free survival after PVI, accompanied by persistent abnormalities in cardiac and haemodynamic function. These findings may assist patient selection for PVI during AVR and/or CABG. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2015; DOI:10.1093/ejcts/ezu532 · 2.81 Impact Factor
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    ABSTRACT: In vitro expanded beating cardiac myocytes derived from induced pluripotent stem cells (iPSC-CMs) are a promising source of therapy for cardiac regeneration. Meanwhile, the cell-sheet method has been shown to potentially maximize survival, functionality and integration of the transplanted cells into the heart. It is thus hypothesized that transplanted iPSC-CMs in a cell-sheet manner may contribute to functional recovery via direct mechanical effects on the myocardial infarction (MI) heart. : F344/NJcl-rnu/rnu rat were left coronary artery-ligated (n=30), followed by transplantation of Dsred-labeled iPSC-CMs cell-sheets of murine origin over the infarct heart surface. Effects of the treatment were assessed, including in vivo molecular/cellular evaluations using a synchrotron radiation scattering technique. Ejection fraction and activation recovery interval were significantly greater from day 3 onwards after iPSC-CMs transplantation compared to those after sham operation. A number of transplanted iPSC-CMs were present on the heart surface expressing cardiac myosin or connexin43 over two weeks, assessed by immunoconfocal microscopy, while mitochondria in the transplanted iPSC-CMs gradually showed mature structure as assessed by electronmicroscopy. Of note, X-ray diffraction identified 1,0 and 1,1 equatorial reflections attributable to myosin and actin-myosin lattice planes typical of organized cardiac muscle fibers within the transplanted cell-sheets at 4 weeks, suggesting cyclic systolic myosin mass transfer to actin filaments in the transplanted iPSC-CMs. Transplantation of iPSC-CM cell-sheets into the heart yielded functional and electrical recovery with cyclic contraction of transplanted cells in the rat MI heart, indicating that this strategy may be a promising "cardiac muscle replacement" therapy.
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    ABSTRACT: Adipose stem cells (ASCs) are a source of regenerative cells available for autologous transplantation to hearts. We compared protective actions of ASC sheets on rat myocardial infarction (MI) in comparison with those of skeletal myoblast cell sheets. Their effects on infarcted hearts were evaluated by biological, histochemical as well as physiological analyses. ASC sheets secreted higher concentrations of angiogenic factors (HGF, VEGF, and bFGF; P < 0.05) under normoxic and hypoxic conditions than those of myoblast cell sheets, associated with reduction of cell apoptosis (P < 0.05). Like myoblast cell sheets, ASC sheets improved cardiac function (P < 0.05) and decreased the plasma level of ANP (P < 0.05) in MI hearts. ASC sheets restored cardiac remodeling characterized by fibrosis, cardiac hypertrophy and impaired angiogenesis (P < 0.05), which was associated with increases in angiogenic factors (P < 0.05). In isolated perfused rat hearts, ASC sheets improved both systolic and diastolic functions, which was comparable to cardiac functions of myoblast cell sheets, while both cell sheets failed to restore cardiac contractile response to either isoproterenol, pimobendan or dibutyryl cAMP. These results indicated that ASC sheets improved cardiac function and remodeling of MI hearts mediated by their paracrine action and this improvement was comparable to those by myoblast cell sheets.
    Biomedical research (Tokyo, Japan) 01/2015; 36(1):11-9. DOI:10.2220/biomedres.36.11 · 1.10 Impact Factor
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    ABSTRACT: Poor survival outcomes for patients with severe heart failure (HF) and the donor shortage for heart transplantation warrant the development of myocardial regenerative therapy. We performed a multicenter, phase II study to evaluate the safety and efficacy of autologous skeletal myoblast sheets (TCD-51073).Methods and Results:In 3 study sites, we enrolled 7 patients with severe chronic HF due to ischemic heart disease despite maximal therapy, all of whom underwent transplantation of TCD-51073. No serious arrhythmia was reported, and no changes were noted in the frequency of ventricular extrasystole frequency. The primary efficacy endpoint of the change in left ventricular ejection fraction (LVEF) on gated blood-pool scintigraphy at 26 weeks after transplantation showed that 5 subjects were responders (classified as "improved" or "unchanged"). In addition, LVEF on echocardiography improved over time, with a change in LVEF of 7.1±2.8% at 26 weeks posttransplantation. Among the 7 subjects, 6 showed improvement in New York Heart Association functional class by at least 1 class. The 6-min walk distance was 410.1±136.1 m before transplantation and 455.4±103.7 m at 26 weeks after transplantation. This study demonstrated the feasibility and safety of the transplantation of TCD-51073 in the patients with severe chronic HF due to ischemic heart disease, suggesting that TCD-51073 might maintain or improve cardiac function, symptoms, and physical function. (Circ J 2015; 79: 991-999).
    Circulation Journal 01/2015; 79(5):991-9. DOI:10.1253/circj.CJ-15-0243 · 3.69 Impact Factor
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    ABSTRACT: Adipose-derived stem cells (ASCs) are a promising resource for cell transplantation therapy for damaged heart tissue. Cell death in the graft early after transplantation represents the main cause of unsatisfactory therapeutic efficacy, but tissue-engineered cell sheets grown in temperature-responsive cell culture dishes may enable improved engraftment of transplanted cells. We investigated the therapeutic potential of this method in chronic myocardial ischemia in swine. We created a porcine model of chronic heart failure by implanting an ameroid constrictor around the main trunk of the left anterior descending artery, just distal to the circumflex branch. Simultaneously, ASCs were obtained from a piece of subcutaneous adipose tissue and expanded to form ASC sheets using temperature-responsive dishes. Four weeks after ameroid constrictor placement, triple-layered ASC sheets were transplanted onto the area of the ischemic myocardium (sheet group, n = 7). Controls (n = 7) received no sheet. Just before and 4 weeks after transplantation, left ventriculography (LVG) and coronary angiography (CAG) were performed. LVG revealed a significant improvement in the left ventricular ejection fraction of the sheet group compared with controls (47.6 ± 2.9% vs 41.4 ± 2.8%, P < 0.05). Furthermore, development of collateral vessels was only detected in the sheet group with right CAG. Histologic analysis demonstrated that engrafted ASC sheets grew to form a thickened layer that included newly formed vessels. ASC sheet transplantation therapy is an intriguing therapeutic method for ischemic heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.
    Translational Research 12/2014; DOI:10.1016/j.trsl.2014.12.005 · 4.04 Impact Factor
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    ABSTRACT: Severe donor shortage in Japan makes the waiting period for heart transplantation extremely long and the left ventricular assist devices (LVADs) are often used for bridge-to-transplant. We present three cases of infected and exposed DuraHeart(®) LVAD system treated with free flaps. Four free flaps (two latissimus flaps and two anterolateral thigh flaps) were transferred using the right internal thoracic vessels or left deep inferior epigastric vessels as recipients. The potential significance of the continuous low pressure blood flow generated by the LVAD system on microvascular patency has not been previously reported. All flaps survived and worked efficiently to control the infection and cover the devices. Heart transplantation was conducted in the two of three patients. Free flap transfer is an efficient treatment for the patients with infected and exposed implantable LVAD.
    Journal of Artificial Organs 12/2014; DOI:10.1007/s10047-014-0812-y · 1.39 Impact Factor
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    ABSTRACT: Background:The aim of the present study was to assess the efficacy of a non-invasive method, transient elastography (FibroScan), in measuring liver stiffness (LS), and whether LS can be used as a marker of cardiac - and hence perioperative - status.Methods and Results:Perioperative LS was prospectively measured using a FibroScan in 30 patients (21 male; 42.2±13.3 years old) who underwent left ventricular assist device (LVAD) implantation. LS was checked pre- and postoperatively, then analyzed in regard to perioperative status. Preoperative LS was 13.3±13.0 kPa (normal, <5.5 kPa), and was abnormal in 77% of patients. Four required bilateral VAD. LS in patients with bilateral VAD tended to be higher than in LVAD patients (25.1±22.7 vs. 11.5±10.5 kPa, P=0.051). No patient with LS ≤7.0 kPa required a right VAD. The incidence of major adverse events was lower in patients with LS ≤12.5 kPa (25% vs. 80%, P<0.05). There were also no mortalities among patients with LS ≤12.5 kPa.Conclusions:LS was correlated with preoperative severity in patients with severe heart failure and reflected liver congestion, and may be useful to predict the requirement of right VAD, as well as postoperative complications in patients with LVAD implantation. This novel modality may be a useful non-invasive assessment method for management of severe heart failure.
    Circulation Journal 12/2014; DOI:10.1253/circj.CJ-14-0929 · 3.69 Impact Factor
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    ABSTRACT: Intraoperative two-dimensional echocardiography is technically challenging, given the unique geometry of the right ventricle (RV). It was hypothesized that the RV fractional area change (RVFAC) could be used as a simple method to evaluate RV function during surgery. Therefore, the correlation between the intraoperative RVFAC and the true right ventricular ejection fraction (RVEF), as measured using newly developed three-dimensional (3D) analysis software, was evaluated. Retrospective study. University hospital. Patients who underwent cardiac surgery with transesophageal echocardiography monitoring between March 2014 and June 2014. None. Sixty-two patients were included in this study. After the exclusion of poor imaging data and patients with arrhythmias, 54 data sets were analyzed. RVFAC was measured by one anesthesiologist during surgery, and full-volume 3D echocardiographic data were recorded simultaneously. The 3D data were analyzed postoperatively using off-line 3D analysis software by a second anesthesiologist, who was blinded to the RVFAC results. The mean RVFAC was 38.8%±8.7%, the mean RVEF was 41.4%±8.3%, and there was a good correlation between the RVFAC and the RVEF (r(2) = 0.638; p<0.0001). The RVFAC was well-correlated with the RVEF calculated using 3D echocardiography; therefore, RVFAC provides a simple and useful method for anesthesiologists to evaluate intraoperative RV function. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of cardiothoracic and vascular anesthesia 12/2014; DOI:10.1053/j.jvca.2014.12.005 · 1.48 Impact Factor

Publication Stats

8k Citations
2,343.90 Total Impact Points


  • 1999–2015
    • Osaka City University
      • • Department of Cardiovascular Surgery
      • • Department of Biochemistry
      Ōsaka, Ōsaka, Japan
  • 1995–2015
    • Osaka University
      • • Division of Cardiovascular Surgery
      • • Department of Surgery
      • • Mucosal Immunology Group
      • • Graduate School of Medicine
      Suika, Ōsaka, Japan
  • 2011
    • University of Helsinki
      • Institute of Biomedicine
      Helsinki, Province of Southern Finland, Finland
    • Kumamoto University
      • Department of Cardiovascular Medicine
      Kumamoto, Kumamoto, Japan
  • 2009–2011
    • Sakurabashi Watanabe Hospital
      Ōsaka, Ōsaka, Japan
  • 2009–2010
    • Foundation for Biomedical Research and Innovation
      Kōbe, Hyōgo, Japan
  • 2007–2010
    • Osaka Rosai Hospital
      Ōsaka, Ōsaka, Japan
    • Osaka Medical Center and Research Institute for Maternal and Child Health
      Izumi, Ōsaka, Japan
  • 1998–2007
    • Hyogo College of Medicine
      Nishinomiya, Hyōgo, Japan
    • University of Texas at Dallas
      Richardson, Texas, United States
  • 2006
    • RIKEN
      Вако, Saitama, Japan
    • Okayama University
      Okayama, Okayama, Japan
  • 2005
    • Osaka Minami Medical Center
      Ōsaka, Ōsaka, Japan
  • 2004
    • National Cerebral and Cardiovascular Center
      Ōsaka, Ōsaka, Japan
  • 2000
    • Osaka Police Hospital
      Ōsaka, Ōsaka, Japan