Hiroyuki Tsukui

Tokyo Women's Medical University, Edo, Tōkyō, Japan

Are you Hiroyuki Tsukui?

Claim your profile

Publications (29)41.37 Total impact

  • Hiroyuki Tsukui, Shigeyuki Aomi, Kenji Yamazaki
    Journal of Thoracic and Cardiovascular Surgery 07/2014; 148(1):361-2. · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 55-year-old gentleman diagnosed with severe aortic insufficiency and annuloaortic ectasia underwent modified Bentall procedure using mechanical valve. Anticoagulation therapy with warfarin was introduced after surgery, but sufficient anticoagulation effect was not achieved with a large amount of dosage. After discontinuing the use of the Clostridium butyricum preparation on postoperative day 29, sufficient anticoagulationt effect was obtained within several days. Clostridium butyricum might change the vitamin K production in the intestinal bacterial flora and attenuated the anticoagulation effect of warfarin.
    Kyobu geka. The Japanese journal of thoracic surgery 06/2014; 67(6):505-507.
  • Hiroyuki Tsukui, Shigeyuki Aomi, Kenji Yamazaki
    [Show abstract] [Hide abstract]
    ABSTRACT: Kommerell's diverticulum is a rare congenital aortic arch anomaly. Various surgical techniques have been reported; however, the surgical strategy is still controversial. In our institute, total arch replacement (TAR) and anatomic reconstruction of the subclavian artery (SCA) has been selected for the treatment of Kommerell's diverticulum to release the vascular ring completely and prevent postoperative complications, including dissection, rupture, hand ischemia, and subclavian steal syndrome. From 2000 to 2012, 4 patients (aged 38-72 years) underwent TAR and anatomic reconstruction of the SCA for Kommerell's diverticulum. All patients had a right aortic arch with an aberrant left SCA. The indications for surgery were dysphagia and dilatation of Kommerell's diverticulum. TAR, using hypothermic cardiopulmonary bypass and circulatory arrest, was performed through a median sternotomy and right anterolateral thoracotomy. After resection of Kommerell's diverticulum, the SCA was reconstructed with a graft. No hospital deaths or major complications occurred, but a 72-year-old patient required prolonged hospitalization for respiratory failure. All patients were discharged from the hospital and were free of symptoms, rupture, dissection, hand ischemia, and subclavian steal syndrome at 5 months to 11 years postoperatively. TAR is a reasonable surgical technique for Kommerell's diverticulum, because it enables the vascular ring to be completely released, preventing recurrence, rupture, and dissection. Anatomic reconstruction of the SCA was effective to prevent hand ischemia and subclavian steal syndrome.
    The Journal of thoracic and cardiovascular surgery 12/2013; · 3.41 Impact Factor
  • Hiroyuki Tsukui, Kenji Yamazaki
    [Show abstract] [Hide abstract]
    ABSTRACT: The number of patients with aortic stenosis (AS) has been increasing over recent decades with the longer life expectancy of the general population. AS is life-threatening without surgery and since many elderly patients have a variety of comorbid conditions, 30-40 % of those with severe AS have been denied surgery. However, recent data on standard aortic valve replacement (AVR) for octogenarians have revealed excellent outcomes, with 2.4-6.8 % early mortality and similar survival rates of octogenarians who undergo AVR vs. the general population. The reported incidences of postoperative stroke, dialysis, and pacemaker implantation were 2.4, 2.6, and 4.6 %, respectively. Transcatheter aortic valve replacement (TAVR) is the alternative therapy for patients who are not able to undergo standard AVR and it is developing rapidly. The placement of aortic transcatheter valves (PARTNER) trial showed acceptable early outcomes. The mortality rates from any cause were 3.4 % in the TAVR group and 6.5 % in the AVR group at 30 days, 24.2 and 26.8 % at 1 year, and 33.9 and 35.0 % at 2 years, respectively. Stroke rate was higher in the TAVR group than in the AVR group (3.4 vs. 1.9 %). Vascular complications and paravalvular leakage are frequent procedure-related complications, which must be addressed because they are associated with increased mortality.
    Surgery Today 07/2013; · 0.96 Impact Factor
  • Hiroyuki Tsukui
    The Journal of thoracic and cardiovascular surgery 06/2013; 145(6):1687. · 3.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The EVAHEART(Sun Medical Technology Research Co, JAPAN) is centrifugal left ventricular assist system providing highly pulsed flow designed for long-term circulatory support. We report the clinical outcomes of 85 patients implanted with the EVAHEART as a bridge to cardiac transplantation in JAPAN. Methods and Materials Eighty-five patients with advanced heart failure (INTERMACS profile I-III, eligible for heart transplantation, who was eligible for cardiac transplantation) were implanted with the EVAHEART between 2006 and Oct 2012 in 13 clinical site. Median age was 43 (range: 18-60) and 18 of these patients received the device as a part of the Japanese multi-center clinical trial. Survival analyses and other safety and performance data were analyzed. Adverse events data were collected from Japanese Registry for Mechanical Assisted Circulatory Support (J-MACS). Results Mean support duration was 407.8days with a cumulative duration of 95.0 Patient-years. Sixty-three patients (74%) remain ongoing, 11 transplanted, and 11 died during support. The Kaplan-Meier survival rate during support was 94.8% at 6months, 89.4% at 1 year, and 83.5% at 3year. Major adverse events in pos PMDA approval study included drive line infection (19.4%), Cerebral infarction (19.4%), and right heart failure requiring RVAD (0.0%), GI bleeding (1.5%)and pump thrombosis (1.5%). There was no incidence of pump exchange for mechanical failure. Conclusions 1. The EVAHEART was able to provide safe and reliable long-term circulatory support with an improved survival in advanced heart failure patients in Japan where waiting period for transplantation is extremely longer. 2. The incidence of RV failure, GI bleeding, and mechanical failure was extremely rare in patients with highly pulsatile implantable centrifugal pump.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S11–S12. · 5.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: Leaflet resection represents the reference standard for mitral valve regurgitation. However, the resection technique is irreversible and requires leaflet cutting and reapproximation. Folding mitral valve repair is a nonresectional technique with inversion of the prolapsed segment into the left ventricle. The present study evaluated the effectiveness of this technique. METHODS: The prolapsed segment was inverted into the left ventricle vertically. A pilot suture was placed at the free edge of the leaflet. After confirming no mitral valve regurgitation with a pressure test, additional sutures were placed toward the annulus. If the test still showed mitral valve regurgitation, the suture was removed and repositioned. Ring annuloplasty was performed in all patients, except those with active infectious endocarditis. The repaired mitral valve was evaluated using echocardiography. RESULTS: A total of 60 patients (37 men; mean age, 62.4 years) underwent folding mitral valve repair from January 2007 to September 2011. Of these patients, 38 (63%) had moderate and 18 (30%) had severe mitral valve regurgitation preoperatively. Folding mitral valve repair was applied to the anterior leaflet and posterior leaflet. The mean cardiopulmonary bypass time and crossclamp time were 148 and 90 minutes, respectively. No patient had systolic anterior motion. Postoperative echocardiography revealed no mitral valve regurgitation to trivial mitral valve regurgitation in 48 and mild mitral valve regurgitation in 12 patients. No patient required reoperation for recurrent mitral valve regurgitation. CONCLUSIONS: Folding mitral valve repair is an easily fine-tuned technique with a pilot suture, which can be easily removed and repositioned, if unsatisfactory. This reversibility is a significant advantage of this technique. Long-term follow-up is necessary to assess the durability of this technique.
    The Journal of thoracic and cardiovascular surgery 11/2012; · 3.41 Impact Factor
  • Hiroyuki Tsukui, Kenji Yamazaki
    Kyobu geka. The Japanese journal of thoracic surgery 11/2012; 65(12):1076-9.
  • Hiroyuki Tsukui, Nobuhiro Umehara, Kenji Yamazaki
    [Show abstract] [Hide abstract]
    ABSTRACT: We describe a simple technique for left ventricular aneurysm without ventriculotomy. After confirming there is no thrombus in the left ventricular aneurysm, the aneurysm is pushed into the left ventricle and fixed with horizontal mattress sutures and running vertical sutures. This technique has quite low risk of bleeding.
    Heart and Vessels 07/2012; · 2.13 Impact Factor
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Thromboembolism and bleeding remain significant complications of ventricular assist device (VAD) support. Increasing the amount of biocompatibility data collected during preclinical studies can provide additional criteria to evaluate device refinements, while design changes may be implemented before entering clinical use. Twenty bovines were implanted with the EVAHEART centrifugal VAD for durations from 30 to 196 days. Titanium alloy pumps were coated with either diamond-like carbon or 2-methoxyethyloylphosphoryl choline (MPC). Activated platelets and platelet microaggregates were quantified by flow cytometry, including two new assays to quantify bovine platelets expressing CD62P and CD63. Temporally, all assays were low preoperatively, then significantly increased following VAD implantation, before declining to a lower, but still elevated level over 2-3 weeks. MPC-coated VADs produced significantly fewer activated platelets after implant trauma effects diminished. Three animals receiving no postoperative anticoagulation had similar amounts of circulating activated platelets and platelet microaggregates as animals receiving warfarin anticoagulation. Two new methods to quantify bovine activated platelets using antibodies to CD62P and CD63 were characterized and applied. These measures, along with previously described assays, were able to differentiate between two biocompatible coatings and assess effects of anticoagulation regimen in VAD preclinical testing.
    Journal of Biomedical Materials Research Part A 05/2007; 81(1):85-92. · 2.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Infection and thromboembolism remain significant complications associated with ventricular assist device (VAD) support, including the newer rotary VADs, limiting wider adoption of this promising technology. These complications persist in spite of extensive preclinical testing in large animal models. The amount of biocompatibility information collected during preclinical trials is limited due to a lack of available assays. We thus developed three flow cytometric assays to measure leukocyte-platelet aggregates and monocyte tissue factor expression and applied them to 26 bovines implanted with two types of rotary VADs. All animals displayed low levels of circulating aggregates and monocytes expressing tissue factor prior to device implant. The assay values significantly increased following VAD implant, then usually declined to a lower, yet significantly elevated versus baseline, level indicative of ongoing inflammation. The implementation of more robust biocompatibility assays for the evaluation of cardiovascular device performance and modification might ultimately contribute to the development of safer artificial organs.
    Artificial Organs 03/2007; 31(2):126-31. · 1.96 Impact Factor
  • Asaio Journal - ASAIO J. 01/2005; 51(2).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although continuous flow (CFVAD) and pulsatile (PVAD) ventricular assist devices (VADs) are being clinically used, their effects upon aortic blood flow as a measure of overall blood distribution remain unclear. The objective of this study was to compare the effects of CFVAD and PVAD support for ascending (AscA) and descending (DA) aorta outflow cannulation upon mean aortic blood flow and waveform morphology. Six experiments were conducted in a normal, acute calf model, in which an inflow cannula was implanted in the left ventricle apex and outflow cannulae were anastomosed to both the AscA and DA. Flow probes were placed around the pulmonary artery, pump outflow, brachiocephalic trunk, and aorta proximal and distal to the DA outflow. For each acute experiment, calves received randomly selected levels of VAD support (0-100% of cardiac output) and pump failure (VAD off and outflow cannula unclamped) for each of four randomly selected test conditions: (1) PVAD and AscA, (2) PVAD and DA, (3) CFVAD and AscA, and (4) CFVAD and DA. Regardless of pump type or support level, proximal and distal aorta mean flows were lower (p < 0.05) for DA compared with the AscA. No differences in mean aortic flows between pump types at either outflow graft location were discerned. Differences in morphologic features of blood flow waveforms between PVAD and CFVAD were observed. During simulated pump failure, retrograde aortic blood flow in both the aortic arch and DA was observed. Partial ventricular suction was also observed during the greatest levels of CFVAD support and suggested pronounced effects upon both the right and left ventricle. Collectively, these findings imply that VAD outflow location may have an important role in patient response and recovery. Investigation of the long-term pathophysiologic responses to pump type and outflow location is ongoing.
    ASAIO Journal 01/2004; 50(5):432-7. · 1.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare the arch-first technique with conventional aortic arch reconstruction 19 patients were randomly assigned to either procedure. Nine patients underwent the arch-first technique (group A) and 10 underwent the conventional technique (group B). There were no hospital deaths and no significant differences between groups in terms of intraoperative bleeding or the duration of operation cardiopulmonary bypass aortic crossclamping recovery from anesthesia or intensive care. The mean duration of retrograde cerebral perfusion via the superior vena cava was significantly shorter in group A (41.7 +/- 10.4 min) than group B (63.9 +/- 10 min). Transient neurologic dysfunction was noted in 4 (44%) patients in group A 6 (60%) in group B postoperatively but there was no permanent neurologic dysfunction in either group. The arch-first technique makes it possible to reduce the duration of cerebral ischemia retrograde cerebral perfusion via the superior vena cava reestablish antegrade cerebral perfusion earlier without damaging severely atheromatous arch vessels or conducting retrograde cerebral perfusion via a femoral artery. This technique has the potential to reduce the incidence of neurologic dysfunction.
    Asian cardiovascular & thoracic annals 01/2003; 10(4):318-21.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical treatment of acute aortic dissection in a patient with idiopathic dilated cardiomyopathy is rare. A 57-year-old man diagnosed with idiopathic dilated cardiomyopathy with left ventricular dimension of 59 mm in diastole, left ventricular dimension of 47 mm in systole, and fractional shortening of 0.19 on echocardiography developed type A acute aortic dissection. Emergency surgery was conducted for ascending aorta and hemiarch repair for ascending aorta redissection and dilation. The postoperative course was uneventful under appropriate hemodynamic control. Standardized criteria for aortic dissection in a patient with poor left ventricular contraction have not established, but surgery should be considered for all patients in good preoperative condition when it is the only effective life-saving alternative.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 08/2002; 50(7):309-10.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A surgical treatment of ventricular tachycardia (VT) that induced a congenital left ventricular aneurysm (LVA) in a 12-year-old boy was performed. The VT disappeared after epicardial cryoablation and a reinforcement of LVA with a composite patch. Epicardial cryoablation, based on an intraoperative electrophysiologic study (EPS), is effective in treating VT resistant to antiarrhythmia drugs.
    Minerva pediatrica 03/2002; 54(1):53-6. · 0.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Coronary ostial stenosis between an interposition graft and coronary artery is rare and fatal. A 46-year-old woman who had reconstruction of both coronary arteries using interposition grafts for type A acute dissecting aneurysm presented with acute chest pain. Emergent coronary artery bypass grafting was done with saphenous vein grafts. Inappropriate use of gelatin-resorcinol-formaldehyde glue can be associated with ostial stenosis in the long term. Transesophageal echocardiography is useful to diagnose ostial stenosis of the coronary arteries.
    The Annals of Thoracic Surgery 12/2001; 72(5):1733-5. · 3.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Blood conservation has become one of the most important issues in cardiac surgery. We clarified preoperative predictors of the need for blood transfusions during coronary artery bypass graft surgery. Subjects were 89 patients--66 men (74%) and 23 women (26%) 40 to 84 years old (mean: 66.2 +/- 8.3 years)--undergoing isolated coronary artery bypass surgery from September 1997 to December 1999. Of these, 66 patients (74%) received transfusion during hospitalization and 23 (26%) did not. Nine risk factors detected by univariate study were entered in a multivariate logistic regression model of the relationship between preoperative variables and blood transfusion. Independent predictors were emergency surgery (P = .0023), lower hematocrit (P = .0027), older age (P = .0043), and the presence of peripheral vascular disease (P = .0070). Optimal cutoff of hematocrit for blood transfusion was 39% and age 64 years via receiver-operating characteristics curves based on the relation between sensitivity and specificity. Patients older than 64 years with hematocrit less than 39% and/or peripheral vascular disease should be treated routinely using preoperative storage of autologous blood whenever the patient's condition permits. For patients undergoing emergency surgery, further studies are required, including lowering transfusion threshold and using determinants other than hematocrit.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 08/2001; 49(7):438-42.
  • [Show abstract] [Hide abstract]
    ABSTRACT: We experienced two cases of rupture of an abdominal aortic aneurysm during the early postoperative period of coronary artery bypass grafting (CABG). A 71-year-old man on hemodialysis (HD) was diagnosed with ischemic heart disease (IHD) and abdominal aortic aneurysm (AAA) of 70 mm in size. After CABG, he developed symptoms of acute pancreatitis and died of rupture of AAA on the 12th postoperative day. A 74-year-old man with early gastric cancer was diagnosed with IHD and AAA of 70 mm. After CABG and gastrectomy, he died of rupture of AAA due to anticoagulant therapy on the 3rd postoperative day. One-stage operation should be performed in patients with IHD, AAA more than 60 mm in size and other organ disease. It is important to control blood pressure and anticoagulant therapy appropriately during the early postoperative period when graft replacement for AAA is not performed simultaneously. Careful observation is required to establish the differential diagnosis of acute pancreatitis and impending rupture of AAA in patients on HD.
    Kyobu geka. The Japanese journal of thoracic surgery 06/2001; 54(5):370-3.