Hitoshi Ogino

Tokyo Medical University, Edo, Tōkyō, Japan

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Publications (173)325.91 Total impact

  • Tomohiro Saito, Hiroaki Sasaki, Hitoshi Ogino
    Artificial Organs 10/2014; 38(10). · 1.96 Impact Factor
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    ABSTRACT: Prosthetic graft infection in the ascending aorta or aortic arch is a life-threatening complication. Redo graft replacement is also associated with high mortality and morbidity rates. Conservative treatments without graft removal recently developed as alternatives to conventional surgical approach have been reported with successful outcomes. We report a case of successful treatment of prosthetic graft infection in the aortic arch, for which percutaneous catheter drainage was initially performed prior to open surgery, followed by graft coverage with an omental flap. <Learning objective: Redo graft replacement for the prosthetic graft infection in the ascending aorta or aortic arch is associated with high mortality and morbidity rates. Conservative treatments without graft removal have recently been developed as alternatives to surgical approaches. Less invasive percutaneous drainage and irrigation would be a useful alternative second-line treatment before radical open repairs for the treatment of aortic graft infection.
    Journal of Cardiology Cases 09/2014;
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    ABSTRACT: We present a 52-year-old male with a syphilitic aortic arch aneurysm accompanied by relevant extensive cerebral infarction. He was admitted to a local hospital for sudden loss of consciousness, where he was diagnosed with serious cerebral infarction. During his treatment, a multilocular aortic arch aneurysm involving the arch vessels was found incidentally. He was transferred to our hospital for surgical treatment. A preoperative routine laboratory test for syphilis was highly positive, which suggested that the aneurysm was likely caused by syphilis and the cerebral infarction was also induced by the involvement of syphilitic aortitis or arteritis. After 2 weeks of antibiotic therapy for syphilis, total arch replacement was performed successfully using meticulous brain protection with antegrade selective cerebral perfusion and deep hypothermia. He recovered without any further cerebral deficits. The pathological examination of the surgical specimen showed some characteristic changes of syphilitic aortitis.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 02/2014;
  • Hitoshi Ogino
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    ABSTRACT: Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) remains challenging with some difficulties, although it has been a well-established procedure. Its current situation including indications, surgical techniques with perioperative management, early and late outcome, and risk factors for mortality and poor hemodynamic improvement are reviewed. With the recent advancement of PEA including perioperative management and the accumulation of experiences, early outcome has been improved with low mortality rates, which are 5-10 % in most or <5 % in experienced centers. The risk factors for mortality were high pulmonary vascular resistance before and immediately after surgery, poor preoperative exercise capacity (NYHA-class IV), and advanced age. Reperfusion lung injury and residual pulmonary hypertension remain problematic as the most serious complications. The latter occurs in cases with surgically inaccessible distal lesions. For them, more careful perioperative management using pharmacological agents in conjunction with skillful PEA is required, occasionally with prompt use of percutaneous cardiopulmonary support. Although there have been a few reports on the long-term outcome, it is also favorable with good survival and event-free rates, which are affected by residual pulmonary hypertension. The recurrence of CTEPH after PEA is extremely rare. Consequently, as the first-line treatment for CTEPH, PEA can be performed safely with hemodynamic improvement and favorable early and long-term outcomes, except for potentially high-risk patients with distal lesions, elevated pulmonary vascular resistance, poor exercise capacity, and advanced age. Recently advanced balloon pulmonary angioplasty might be a promising alternative for such difficult patients.
    General Thoracic and Cardiovascular Surgery 09/2013;
  • Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 07/2013; 58(1):217. · 3.52 Impact Factor
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    ABSTRACT: Heparin-induced thrombocytopenia (HIT) can often result in devastating thromboembolic outcomes. Argatroban is frequently administered as an alternative anticoagulant to heparin. We present a complicated case of HIT in which off-pump coronary artery bypass grafting was performed using anticoagulation with argatroban. Although the active clotting time was maintained between 220 and 270 s using argatroban, intraoperative thrombotic complications and postoperative prolonged coagulopathy were encountered.<Learning objective: The use of argatroban involves a potential risk of inadequate anticoagulation or life-threatening postoperative bleeding depending on the dose. We recommend that the target ACT during off-pump coronary artery bypass grafting with argatroban should be strictly maintained over 250 s, although an ACT exceeding 300 s may cause prolonged coagulopathy>.
    Journal of Cardiology Cases 07/2013; 8(1):e1–e2.
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    ABSTRACT: Bleeding from the distal anastomosis suture line in total arch replacement is a serious and major concern for surgeons. We present a simple, flanged elephant trunk technique to reduce or eliminate bleeding from the distal anastomosis suture line in total arch replacement using a multibranched arch graft. This method allows not only a secure and reinforced distal anastomosis, but also simultaneous elephant trunk insertion.
    Annals of Vascular Surgery 03/2013; · 0.99 Impact Factor
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    ABSTRACT: Since the first report by Cooley and colleagues in 1975 [Cooley DA, Norman JC, Mullins CE, Grace R. Left ventricle to abdominal aorta conduit for relief of aortic stenosis. Cardiovasc Dis 1975;2:376-83], an apicoaortic valved conduit bypass has been usually administrated to selected patients presenting with certain clinical conditions or complications such as aortic stenosis associated with porcelain aorta, unclampable atherosclerotic aorta, resternotomy, or previous coronary bypass surgery. On the other hand, thoracic endovascular aortic repair for various aortic lesions has become a promising and less invasive therapy. We encountered a critical case of a patient suffering from aortic graft stenosis due to malformation of a previous thoracic endovascular aortic repair procedure originally performed for acute type A aortic dissection. Because of a deep sternal wound infection, apicoaortic valved conduit bypass from the left ventricular apex to the abdominal aorta was successfully performed.
    The Annals of thoracic surgery 01/2013; 95(1):323-5. · 3.45 Impact Factor
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    ABSTRACT: Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we often experience aneurysmal change, but there are no commercially available devices which are urgently needed. Companies are competing keenly to develop devices. To our knowledge, more than 4 manufacturers are involved in the development of functionally new stent grafts in this area. The introduction of branched stent grafts may not be faraway.
    Annals of Vascular Diseases 01/2013; 6(2):129-36.
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    ABSTRACT: OBJECTIVE: With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. METHODS: From 2001 to 2011, 1007 patients (median age, 72 years) underwent open arch repair with selective cerebral perfusion through the right axillary artery and hypothermic circulatory arrest: deep (<25°C) in 48% and moderate (25°-28°C) in 52%. Of the 1007 patients, 73% underwent total arch replacement and 26% emergent surgery for aneurysm rupture or acute aortic dissection. RESULTS: The early mortality was 4.7% for all patients. Permanent and temporary neurologic dysfunction occurred in 3.5% and 6.7%, respectively. No spinal cord injury occurred, even with moderate hypothermia. The independent predictors of in-hospital mortality included chronic obstructive pulmonary disease, liver dysfunction, chronic kidney disease, and concomitant coronary artery bypass. The independent predictors of permanent neurologic dysfunction included cerebrovascular disease, emergency surgery, and concomitant coronary artery bypass. The cumulative survival rate was 80.4% and 71.2% at 5 and 8 years, respectively. Freedom from reoperation related to the initial arch repair was 98.0% and 96.9% at 5 and 8 years, respectively. CONCLUSIONS: Conventional open arch repair yielded satisfactory outcomes and should remain the standard therapy, with good long-term durability in all but high-risk patients.
    The Journal of thoracic and cardiovascular surgery 12/2012; · 3.41 Impact Factor
  • Journal of Cardiology Cases 12/2012; 6(6):e173–e175.
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    ABSTRACT: Primary dissecting aneurysms of the hepatic artery are extremely rare and only15 cases, including the present case, have been reported in the literature. Surgery was performed in 5 cases, of which 3 cases were successfully treated. This report presents a case of a dissecting aneurysm of the proper hepatic artery that was successfully treated by aneurysmorraphy and vein patch angioplasty.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 11/2012;
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    ABSTRACT: In-situ right gastroepiploic artery (RGEA) has been used as one of the reliable conduits for coronary artery bypass grafting (CABG). We report a case of thoracoabdominal aortic aneurysm (TAAA) repair in a patient who had previous CABG using the RGEA graft. There is a great potential risk for critical myocardial ischemia when performing open repair for TAAA in those patients.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 11/2012;
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    ABSTRACT: Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder (CTD) caused by mutations in transforming growth factor-beta receptor (TGFBR)1 and TGFBR2. Surgical outcomes of aortic repair in patients with LDS are poorly known. We enrolled 16 patients with TGFBR mutations identified by gene analysis in this study. Between 1993 and 2011, they underwent 41 aortic surgical procedures. Ten patients (group D: dissection group) underwent aortic repair for acute or chronic aortic dissection as a first surgical intervention, and 6 patients (group N: nondissection group) underwent surgical treatment for aortic root dilatation. The mean follow-up period was 103.7 ± 92.3 months (range, 2- 276 months). There were no in-hospital deaths. In group N, valve-sparing root replacement (VSRR) was performed in all patients. The residual aorta in 9 patients (90%) from group D required further repairs, 3 times on average. Moreover, in 4 patients (40%), the aorta was entirely replaced in serial procedures. In group N, aortic dissection occurred in only 1 patient (17%). The aortic event-free rates at 5 years were 40% in group D and 80% in group N, respectively (p = 0.819). One late death due to arrhythmia occurred 1 month after VSRR. The cumulative survival rates at 5 years were 100% in group D and 83% in group N, respectively (p = 0.197). Surgical outcomes for patients with LDS were satisfactory. Once aortic dissection occurred, the aorta expanded rapidly, requiring further operations. Therefore, early surgical intervention may improve prognosis by preventing a fatal aortic event.
    The Annals of thoracic surgery 08/2012; 94(5):1413-7. · 3.45 Impact Factor
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    ABSTRACT: PURPOSE: Thoracic endovascular aortic repair (TEVAR) an emerging less invasive alternative to surgery, is now being increasingly employed, but spinal cord ischemia (SCI) is still a threat with this procedure. Delayed paraplegia has been frequently observed after TEVAR, suggesting there may be different courses of SCI between TEVAR and the conventional open surgical repair (OSR) of thoracic and thoracoabdominal aneurysms. Therefore, we conducted a study to investigate the risk factors for and the course of SCI after TEVAR and OSR. METHODS: We studied a series of 414 OSR and 94 TEVAR patients prospectively. Postoperative motor function, sensory disturbance, and bladder disturbance were assessed daily to evaluate the course of SCI. Previously reported risk factors for SCI were investigated. RESULTS: Spinal cord ischemia occurred in 6 patients (6.4 %) in the TEVAR group, and in 18 patients (4.3 %) in the OSR group, resulting in no significant difference (p = 0.401). A greater percentage of patients (n = 4, 66.7 %) with SCI in the TEVAR group had a delayed onset, compared with 16.7 % (n = 3) in the OSR group (p = 0.038). The rate of recovery of walking function after SCI and the incidence of sensory disturbance and bladder dysfunction was similar in the two groups. Multivariate analysis demonstrated that, in the TEVAR group, the stent length of aortic coverage was a significant risk factor for SCI. CONCLUSION: The incidence of SCI was similar in the OSR and TEVAR groups, but delayed SCI occurred more frequently in the TEVAR group. Except for the delayed onset of SCI, SCI showed a similar course of recovery in the two groups.
    Journal of Anesthesia 07/2012; · 0.87 Impact Factor
  • Hitoshi Ogino, Hideyuki Shimizu
    Kyobu geka. The Japanese journal of thoracic surgery 03/2012; 65(3):194-5.
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    ABSTRACT: Three cases with lesions in the right aortic arch (RAA) are presented. For two patients, whose RAA contained a retroesophageal segment, the primary treatment was total arch replacement (TAR) for acute type A dissection or severe arch angulation with thoracic endovascular aneurysm repair (TEVAR) as second-stage surgery. The third patient, who had RAA with mirror image branching, underwent supra-aortic bypass followed by TEVAR. There was no operative mortality, but the condition of two patients who underwent TAR was complicated by bilateral recurrent nerve palsy, which can be critical. The combination of TEVAR and supra-aortic bypass might thus be preferable for patients with RAA.
    Annals of Vascular Diseases 01/2012; 5(1):61-4.
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    ABSTRACT: We examined the expression of ephrin-B1 and its cognate receptor EphB2, key regulators of angiogenesis and embryogenesis, in human abdominal aortic aneurysm (AAA) and analyzed their functional roles in cell migration. From 10 patients (9 males and 1 female; age, 68.5 ± 2.4) who underwent vascular surgery for AAA, we obtained AAA and adjacent control tissues. Using real-time RT-PCR, we analyzed expression of ephrin-B1 and EphB2. We also histologically localized these molecules in AAA tissues. Finally, effects of ephrin-B1 and EphB2 on inflammatory cell chemotaxis were examined by cell migration assay. Expression levels of ephrin-B1 (0.410 ± 0.046 versus 1.198 ± 0.252, P = 0.027) and EphB2 (0.764 ± 0.212 versus 1.272 ± 0.137, P = 0.594) were higher in AAA than normal control. Both ephrin-B1 and EphB2 were expressed in macrophages, T lymphocytes, and endothelial cells within AAA. In chemotaxis assay, ephrin-B1 and EphB2 inhibited mononuclear-cell chemotaxis induced by stromal derived factor-1 down to 54.7 ± 12.7% (P = 0.01) and 50.7 ± 13.1% (P = 0.01), respectively. These data suggest that ephrin-B1 and EphB2 might be functional in human adult inflammatory cells and involved in the pathogenesis of AAA, although specific roles of these molecules should further be sought.
    International journal of vascular medicine 01/2012; 2012:127149.
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    ABSTRACT: Paraplegia is a serious complication of descending and thoracoabdominal aortic aneurysms (dTAAs and TAAAs) surgery. Motor evoked potentials (MEPs) enable monitoring the functional integrity of motor pathways during dTAA and TAAA surgery. Although MEPs are sensitive to temperature changes, there are few human data on changes of MEPs during mild and deep hypothermia. Therefore, we investigated changes of MEPs in deep hypothermic circulatory arrest (DHCA) in dTAA and TAAA surgery. Fifteen consecutive patients undergoing dTAA and TAAA surgery using DHCA were enrolled. MEPs were elicited and recorded during each degree Celsius change in nasopharyngeal temperature during both the cooling and rewarming phases. Hand and leg skin temperature were also recorded simultaneously. In the cooling phase MEP amplitude decreased lineally in both the hand and leg. The MEP disappeared at ~16°C in both the hand and leg in 10 of 15 patients, but was still elicited in 5 patients. In the rewarming phase MEP in the hand recovered before the temperature reached 20°C for eight patients and 25°C for the other seven patients. In contrast, MEP in the leg recovered below 20°C for two patients and 30°C for three patients. For the other eight patients MEP waves did not recover during the rewarming phase. In the cooling phase of DHCA, MEP disappeared at ~16°C in some patients but was still elicited in others. MEP recovered below 25°C in the hand. Recovery of MEP in the leg was, however, extremely variable.
    Journal of Anesthesia 12/2011; 26(2):160-7. · 0.87 Impact Factor
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    ABSTRACT: BACKGROUND: The aim of the present study was to review the clinical profile and outcome of emergency surgery for complicated acute type B aortic dissection. METHODS AND RESULTS: A total of 34 consecutive patients requiring surgical treatment for complicated acute type B aortic dissection between 2003 and 2010 were examined. The median age was 64.0 years (range, 19-82 years). Indication for emergency surgery was aortic rupture in 11 patients, rapid expansion of the dissecting aorta in 5, dissection involving a non-dissecting aneurysm in 6, and organ malperfusion in 12. All of 3 patients with open aortic rupture died during surgery. Operative mortality was 9.7% (central operation, 14.2%; peripheral operation, 7.1%; thoracic endovascular aneurysm repair, 0%). There were 2 aortic ruptures within 1 week after operation. Two patients suffered from persistent organ malperfusion after emergency surgical relief of ischemia and died. The 1- and 5-year survival rates were 74.1 ± 8.1% and 64.8 ± 11.2%. The actual rate of freedom from aortic events at 1- and 5- years was 83.0 ± 7.0% and 58.7 ± 11.4%. Conclusions: Emergency surgery for complicated acute type B dissection still has a high mortality rate for patients with open rupture and critical visceral ischemia. Medical treatment is best given immediately after admission, and adequate surgical treatment without delay is crucial.
    Circulation Journal 12/2011; 76(3):650-4. · 3.58 Impact Factor

Publication Stats

1k Citations
325.91 Total Impact Points


  • 2011–2014
    • Tokyo Medical University
      • Division of Cardiovascular Surgery
      Edo, Tōkyō, Japan
    • Kyoto University
      • Department of Cardiovascular Surgery
      Kyoto, Kyoto-fu, Japan
  • 2001–2014
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
  • 2006
    • National Cancer Center, Japan
      Edo, Tōkyō, Japan
  • 2004
    • University of Occupational and Environmental Health
      • School of Medicine
      Kitakyūshū, Fukuoka-ken, Japan
  • 1985–2002
    • Tenri Yorozu Hospital
      Тэнри, Nara, Japan