Hitoshi Ogino

National Cerebral and Cardiovascular Center, Ōsaka, Ōsaka, Japan

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Publications (176)402.27 Total impact

  • Tomohiro Saito · Hiroaki Sasaki · Hitoshi Ogino ·

    Artificial Organs 10/2014; 38(10). DOI:10.1111/aor.12285 · 2.05 Impact Factor
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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; 145(3). DOI:10.1016/j.jtcvs.2012.11.047 · 4.17 Impact Factor
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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. DOI:10.1016/j.athoracsur.2012.05.111 · 3.85 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; 26(6). DOI:10.1007/s00540-012-1434-2 · 1.18 Impact Factor
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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 07/2012; 2012(10):127149. DOI:10.1155/2012/127149

  • 01/2012; 52(January):1-4. DOI:10.7133/jca.52.1
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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. DOI:10.3400/avd.cr.11.00032
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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. DOI:10.1007/s00540-011-1313-2 · 1.18 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. DOI:10.1253/circj.CJ-11-0982 · 3.94 Impact Factor
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    ABSTRACT: A 31-year-old woman with Marfan syndrome required aortic root repair for annuloaortic ectasia in the 16th week of her first pregnancy. Aortic root reimplantation was successfully performed with a higher-flow-rate cardiopulmonary bypass of 3.4-3.6 l/min/m2 at normothermia for fetal survival. During the surgery, a cardiotocography and transesophageal echo probe attached on the patient's abdomen allowed adequate monitoring of the fetal heartbeat. The postoperative course was uneventful, and a healthy baby was delivered by cesarean section at 37 weeks' gestation.
    Surgery Today 11/2011; 42(3):285-7. DOI:10.1007/s00595-011-0069-5 · 1.53 Impact Factor
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    ABSTRACT: This study determined the midterm outcome of valve-sparing aortic root replacement for patients with inherited connective tissue disorders. From 1993 to 2008, 94 patients underwent valve-sparing aortic root replacement. Sixty patients (64%), average age 33 years (range, 15 to 61 years), had inherited connective tissue disorders: Marfan syndrome, 54 (92%); Loeys-Dietz syndrome, 5 (8%); and smooth muscle α-actin (ACTA2) mutation in 1. Median preoperative sinus diameter was 52 mm (range, 42 to 76 mm), and moderate/severe aortic regurgitation was present in 14 (23%). Seven (12%, 1993 to 1999) underwent remodeling procedures, and 53 had reimplantation procedures. Cusp repair was performed in 4. Median follow-up was 55 months (range, 1 to 149 months). There were 15 patients in the early term (1993 to 2000) and 45 in the late term (2001 to 2008). Four late deaths occurred (cardiac, 3; aortic, 1), with 10-year survival of 86%. Rates of freedom from aortic valve replacement at 5 and 10 years were 85% and 58% in remodeling and 96% and 58% in reimplantation. Risk factors for reoperations were postprocedure intraoperative aortic insufficiency greater than mild (p = 0.046), remodeling procedure (p = 0.016), and early term (p = 0.0002). One patient (2%) with none/trivial postprocedure aortic insufficiency required aortic valve replacement. Freedom from reoperation in patients with none/trivial postprocedure aortic insufficiency at 5 and 10 years was 100% and 67%. Meticulous control of aortic insufficiency during operation would bring favorable midterm durability in valve-sparing aortic root replacement using a reimplantation technique, even in patients with inherited connective tissue disorders.
    The Annals of thoracic surgery 11/2011; 92(5):1646-9; discussion 1649-50. DOI:10.1016/j.athoracsur.2011.06.090 · 3.85 Impact Factor
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    ABSTRACT: Cold agglutinin disease is an uncommon condition characterized by hemagglutination and microvascular thrombosis of red blood cells at low temperatures during cardiopulmonary bypass. We report the rare case of an ambulatory 74-year-old woman with a relatively high thermal amplitude for antibody activation. We performed aortic arch repair for type A aortic dissection using moderately hypothermic cardiopulmonary bypass and warm blood cardioplegia in a retrograde manner. This case report provides evidence that these are safe and suitable techniques for selected aortic arch repair patients with cold agglutinin disease.
    The Annals of thoracic surgery 08/2011; 92(2):722-3. DOI:10.1016/j.athoracsur.2011.02.019 · 3.85 Impact Factor
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    ABSTRACT: For aortic arch aneurysms, conventional total arch replacement has been the standard surgical option. In selected high-risk patients, we have attempted less invasive hybrid procedure involving supra-aortic bypass and endovascular stent-graft placement. We review the early and midterm outcomes to clarify the impact of the hybrid procedure. Between October 2007 and December 2010, 27 patients were treated with the hybrid procedure. During the same period, 191 patients underwent elective conventional total arch replacement. On retrospective analysis, the hybrid procedure was feasible in 103 patients (hybrid feasible) and not feasible in 88 patients (hybrid impossible). Patients undergoing the hybrid procedure attained significantly higher additive (11.6 ± 2.2 vs 9.5 ± 2.4, 10.3 ± 2.8, P < .001, P = .044) and logistic (31.1 ± 14.1 vs 18.8 ± 12.6, 23.7 ± 16.0, P < .001, P = .047) European System for Cardiac Operative Risk Evaluation scores than hybrid-feasible and hybrid-impossible groups. Although the patients in the hybrid group had significantly higher risk, the early outcomes including mortality and morbidity were similar among the 3 groups, as were the 2-year survivals during the follow-up period: 85.9% for the hybrid group, 89.6% for the hybrid-feasible group, and 86.7% for the hybrid-impossible group (P = .510, .850, log-rank test). In the hybrid group, 2 patients required reintervention for type I endoleak. The early and midterm outcomes of the hybrid procedure for aortic arch aneurysms were satisfactory. This procedure has the potential to be an alternative for conventional total arch replacement for high-risk patients.
    The Journal of thoracic and cardiovascular surgery 07/2011; 143(5):1007-13. DOI:10.1016/j.jtcvs.2011.06.024 · 4.17 Impact Factor
  • Hiroshi Tanaka · Hitoshi Ogino · Hitoshi Matsuda · Hiroaki Sasaki ·

    The Journal of thoracic and cardiovascular surgery 04/2011; 142(5):1274-5. DOI:10.1016/j.jtcvs.2011.03.016 · 4.17 Impact Factor
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    ABSTRACT: We reviewed our clinical experiences with cardiovascular homografts harvested and preserved at our institutional tissue banks. Since our bank was first established in Japan in 1990, 74 patients have undergone various surgical procedures using homografts. We classified them into five groups according to the procedure: Group I, subcoronary implantation of a homograft aortic valve; Group II, homograft aortic root replacement for active native or prosthetic endocarditis; Group III, homograft aortic replacement for mycotic aortic aneurysms or infected grafts; Group IV, pulmonary homografts in the Ross operation; and Group V, pulmonary homograft conduits for complex congenital heart diseases. The 9- to 10-year survival rates were good and acceptable, respectively, for the patients in all five groups. The infection recurrence rate was low (8%). Cardiac event-free rates, including deaths, were 0.57 in Group I, 0.58 Group in II, 0.75 in Group III, 0.81 in Group IV, and 0.69 in Group V operations. The rates of structural homograft deterioration suggest that homografts deteriorate more rapidly after subcoronary implantation than aortic root replacements (P = 0.058). Subcoronary implantation should probably be abandoned for routine aortic valve replacement, but the continued use of homografts will provide valuable alternatives for patients with active infectious cardiovascular diseases. For the Ross operation, pulmonary valve homografts showed good durability.
    Surgery Today 04/2011; 41(4):500-9. DOI:10.1007/s00595-010-4459-x · 1.53 Impact Factor
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    ABSTRACT: We report here a rare case of ascending aortic aneurysm associated with a tricuspitalized quadricuspid aortic valve. A 45-year-old man had a fusiform ascending aortic aneurysm with aortic valve regurgitation. Transthoracic echocardiography revealed grade III aortic regurgitation. Chest computed tomography showed an ascending aortic aneurysm with a diameter of 48 mm. Surgery revealed that the aortic valve was a tricuspitalized quadricuspid aortic valve with an accessory cusp between the right coronary cusp and left coronary cusp.
    General Thoracic and Cardiovascular Surgery 03/2011; 59(3):179-80. DOI:10.1007/s11748-010-0645-4
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    ABSTRACT: Pulmonary thromboendarterectomy (PEA) is a curative therapy for chronic thromboembolic pulmonary hypertension (CTEPH), but the postoperative mortality remains unsatisfactory (4-10%). Residual pulmonary hypertension is the most common cause of perioperative death. Although PEA specimens seem to contain lesions responsible for hemodynamic improvement, relevant histopathological findings have still to be identified.The aim of this study was to identify histopathological findings that predict postoperative residual pulmonary hypertension after PEA.PEA specimens obtained from 51 consecutive patients with CTEPH were histopathologically assessed. The patient characteristics and disease location were reviewed by medical records. The associations with residual pulmonary hypertension were analyzed.The mean values of preoperative and postoperative vascular resistance (PVR) were 1142 ± 454 and 496 ± 368 dynes•sec/cm(-5), respectively. Twenty of 51 patients (39%), including 2 patients who died, continued to have residual pulmonary hypertension (PVR ≥ 500 dynes•sec/cm(-5)). Statistical tests indicated that male, proximal disease type and the presence of histopathological multiple recanalized thrombus were associated with good surgical outcome (PVR < 500 dynes•sec/cm(-5)). The positive and negative predictive values for surgical outcome estimated by the presence of multiple recanalized lesions were higher than the values estimated by proximal disease type (85% and 88% versus 73% and 71%, respectively). Moreover, the number of multiple recanalize lesions was significantly correlated to the reduction in PVR (P = 0.03).The presence of histopathological multiple recanalized lesions was significantly associated with a decrease in PVR after PEA. Histopathological study may be a potent diagnostic strategy for accurately predicting surgical outcome in the early perioperative period.
    International Heart Journal 01/2011; 52(6):377-81. DOI:10.1536/ihj.52.377 · 1.07 Impact Factor

  • 01/2011; 40(4):164-167. DOI:10.4326/jjcvs.40.164
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    ABSTRACT: Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is still challenging. The outcome of patients with proximal pulmonary artery disease is generally better than that of a distal lesion. However, we experienced poor results in two difficult cases having predominant proximal lesions even after effective PEA. Both of them had a long-time history of CTEPH and preoperative condition was critical. Although relatively large amount of thickened intima with massive thrombi were extracted from the proximal pulmonary arteries, they required postoperative percutaneous cardiopulmonary support due to residual pulmonary hypertension. Both of them finally died from pulmonary bleeding and adult respiratory distress syndrome.
    Annals of Vascular Diseases 01/2011; 4(2):157-60. DOI:10.3400/avd.cr.11.00003
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    ABSTRACT: This article discusses the multidisciplinary approach to prevent spinal cord ischemia (SCI) with reference to the incidence of SCI after thoracic endovascular aneurysm repair (TEVAR) associated with closure of the intercostal-lumbar artery that supplies the Adamkiewicz artery (ICA-AKA). We reviewed 60 patients [49 men, 57 to 89 years old] who underwent TEVAR (TAG [W. L. Gore & Associates, Flagstaff, AZ] 42; the Matsui-Kitamura (Kanazawa, Japan) 10; Talent [Medtronic Inc, Santa Rosa, CA] 5; TAG and Talent 3) for part of or the entire distal descending aorta between T7 and L2. These patients had frequently undergone aortic surgeries: ascending aorta (4), aortic arch (25), descending aorta (4), thoracoabdominal aorta (3), and abdominal aorta (19). The multidisciplinary approach consists of identification of the ICA-AKA by magnetic resonance angiography or computed tomographic angiography to avoid unnecessary coverage of the ICA-AKA, in combination with monitoring of motor evoked potentials, augmentation of mean arterial pressure (> 80 mm Hg), and cerebrospinal fluid drainage. Spinal cord ischemia occurred in 4 patients and patent ICA-AKAs were covered in 3 of them. The overall incidence of SCI was 6.7% and 9.4% in the group of 32 patients whose patent ICA-AKAs were covered by TEVAR. After treatment for SCI, 3 patients regained full ambulatory ability. Significant risk factors were identified as the artificial graft at the proximal landing zone, the number of covered zones (>8), the length of aortic coverage (>250 or >300 mm), and the length of the uncovered distal aorta (<60 mm). A multidisciplinary approach is essential to prevent SCI after TEVAR for the distal descending aorta. This approach includes the preservation of patent ICA-AKAs after their identification, early diagnosis of SCI during TEVAR by monitoring motor evoked potentials, and prophylaxis and treatment of SCI by increasing mean arterial pressure to at least 80 mm Hg and performing cerebrospinal fluid drainage.
    The Annals of thoracic surgery 08/2010; 90(2):561-5. DOI:10.1016/j.athoracsur.2010.04.067 · 3.85 Impact Factor

Publication Stats

2k Citations
402.27 Total Impact Points


  • 2001-2014
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
  • 2012
    • Tokyo Medical University
      • Division of Cardiovascular Surgery
      Edo, Tōkyō, Japan
  • 2009
    • University of Dallas
      Irving, Texas, United States
  • 2007
    • Fujita Health University
      • Department of Cardiovascular Surgery
      Nagoya, Aichi, Japan
  • 2006
    • National Cancer Center, Japan
      Edo, Tōkyō, Japan
  • 1997-2002
    • Tenri Yorozu Hospital
      Тэнри, Nara, Japan
  • 1998
    • University Hospital of Lausanne
      Lausanne, Vaud, Switzerland
  • 1985
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada