Publications by authors named "Hideyuki Shimizu"

255 Publications

Insertion of Impella CP following postcardiotomy cardiogenic shock concomitant with veno-arterial extracorporeal membrane oxygenation.

Gen Thorac Cardiovasc Surg 2021 Mar 31. Epub 2021 Mar 31.

Department of Cardiovascular Surgery, Keio University Hospital, Tokyo, Japan.

Postcardiotomy cardiogenic shock (PCCS) is associated with considerably high rates of mortality. In PCCS, veno-arterial extracorporeal membrane oxygenation has been used despite the high rates of complications and poor outcome. Since the introduction of Impella CP (Abiomed, Danvers, MA, USA), effective left-ventricular unloading and systemic perfusion could be maintained even in patients with severe PCCS. Herein, we describe the successful treatment of PCCS following combined heart surgery in a patient by Impella CP insertion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11748-021-01623-3DOI Listing
March 2021

Intramyocardial Transplantation of Human iPS Cell-Derived Cardiac Spheroids Improves Cardiac Function in Heart Failure Animals.

JACC Basic Transl Sci 2021 Mar 19;6(3):239-254. Epub 2021 Feb 19.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

The severe shortage of donor hearts hampered the cardiac transplantation to patients with advanced heart failure. Therefore, cardiac regenerative therapies are eagerly awaited as a substitution. Human induced pluripotent stem cells (hiPSCs) are realistic cell source for regenerative cardiomyocytes. The hiPSC-derived cardiomyocytes are highly expected to help the recovery of heart. Avoidance of teratoma formation and large-scale culture of cardiomyocytes are definitely necessary for clinical setting. The combination of pure cardiac spheroids and gelatin hydrogel succeeded to recover reduced ejection fraction. The feasible transplantation strategy including transplantation device for regenerative cardiomyocytes are established in this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacbts.2020.11.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987543PMC
March 2021

Small Left Ventricle and Clinical Outcomes After Transcatheter Aortic Valve Replacement.

J Am Heart Assoc 2021 Apr 20;10(7):e019543. Epub 2021 Mar 20.

Department of Cardiology Keio University School of Medicine Tokyo Japan.

Background In patients undergoing transcatheter aortic valve replacement (TAVR), those with small left ventricle (LV) may have an increased risk of poor outcomes, because small LV is associated with low-flow (LF), left ventricular hypertrophy. However, the impact of small LV on patients undergoing TAVR remains unknown. Methods and Results We examined 2584 patients who underwent TAVR between October 2013 and May 2017 using data from the Japanese multicenter registry. On the basis of the American Society of Echocardiography guidelines, small LV was defined as left ventricular end-diastolic dimension <42.0 mm for men or <37.8 mm for women. The 2-year clinical outcomes were compared between patients with and without small LV using multivariable Cox regression analyses and propensity score matching. Subgroup analyses by LF, left ventricular hypertrophy were performed. Of 2584 patients who underwent TAVR, 466 (18.0%) had small LV. Patients with small LV had smaller body size and less comorbidity, and were more likely to have LF status compared with those without. Small LV was associated with a higher 2-year all-cause (20.8% versus 14.3%; adjusted hazard ratio [HR],1.58 [95% CI, 1.20-2.09]; =0.0013) and cardiovascular mortality (8.8% versus 5.5%; adjusted HR, 1.93 [95% CI, 1.25-2.98]; =0.0028). Propensity score matching analysis showed consistent findings. In subgroup analyses, LF, left ventricular hypertrophy did not interact with small LV. Conclusions Small LV, determined by a simple echocardiographic parameter, was associated with poorer clinical outcomes after TAVR regardless of LF, left ventricular hypertrophy. LV size may be useful for assessing clinical outcomes after TAVR. Registration URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000020423.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.120.019543DOI Listing
April 2021

Transcatheter Aortic Valve Replacement in Patients With a Small Annulus - From the Japanese Nationwide Registry (J-TVT).

Circ J 2021 Feb 27. Epub 2021 Feb 27.

Department of Cardiovascular Medicine, Kitasato University.

Background: The details and consequences of a small aortic annulus among transcatheter aortic valve replacement (TAVR) patients remain uncertain. This study investigated the short-term outcomes in patients with small annular size and compared the 30-day outcome between intra- and supra-annular devices, with similar outer casing diameter in this subgroup.Methods and Results:Cases registered in the Japanese national TAVR registry between August 2013 and December 2017 were analyzed. Among a total of 5,870 registered patients, 647 (11.0%) had small annulus (area ≤314 mm) measured by multi-detector computed tomography. Patients with a small annulus had a significantly smaller indexed effective orifice area (iEOA, 1.10 cm/m[0.92-1.35] vs. 1.16 cm/m[0.96-1.39], P<0.001) and higher mean pressure gradient (mPG, 10.0 mmHg [6.9-14.2] vs. 8.5 mmHg [6.0-11.5], P<0.001) compared with a normal-sized annulus. Among patients with a small annulus, those receiving a 20 mm intra-annular device had a smaller iEOA (0.94 cm/m[0.78-1.06] vs. 1.07 cm/m[0.8-1.24], P=0.001) and higher mPG (14.0 mmHg [10.0-18.5] vs. 11.0 [7.0-14.0], P<0.001) compared with those receiving a 23-mm supra-annular device, although the incidence of paravalvular leakage (≥moderate) was similar (14.4% vs. 16.5%, P=0.69).

Conclusions: Patients with a small annulus were associated with less hemodynamic improvement. A supra-annular device is associated with better echocardiographic improvement in patients with a small annulus, without increasing paravalvular leakage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1253/circj.CJ-20-1084DOI Listing
February 2021

Durable ventricular assist device implantation for systemic right ventricle: a case series.

Eur Heart J Case Rep 2020 Dec 18;4(6):1-9. Epub 2020 Nov 18.

Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka 564-8565, Japan.

Background: A systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood.

Case Summary: Four patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients.

Discussion: The indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjcr/ytaa359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891278PMC
December 2020

Surgical exclusion of an idiopathic saccular aneurysm in the left main trunk of the coronary artery.

Surg Today 2021 Feb 19. Epub 2021 Feb 19.

Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 564-8565, Japan.

Purpose: A coronary artery aneurysm (CAA) can result in critical cardiac events such as thromboembolic complications or rupture. A saccular CAA located in the left main trunk (LMT) is the most critical form of this pathology and its surgical repair is challenging. We conducted this single-center study to review the surgical outcomes of patients with a saccular CAA in the LMT.

Methods: Between May, 2012 and June, 2020, five patients with a saccular CAA in the LMT underwent surgery at our center. The median age at operation was 66.5 (59.7-69) years and the median diameter of the CAA was 13.0 mm (IQR 11-14 mm).

Results: The CAA was fully excluded by patch closure of the LMT orifice and direct closure of the distal LMT, supplemented by coronary artery bypass grafting with the exclusive use of arterial conduits. There was no in-hospital mortality, although one patient suffered graft spasm-related myocardial infarction with complete recovery. Post-operative angiography showed a fully excluded LMT in all patients. There was no mortality or adverse cardiac events during follow-up.

Conclusions: Our surgical policy for CAA in the LMT is feasible and safe; however, coronary blood flow is dependent on reliable bypasses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00595-021-02246-0DOI Listing
February 2021

A universal molecular prognostic score for gastrointestinal tumors.

NPJ Genom Med 2021 Feb 4;6(1). Epub 2021 Feb 4.

Department of Molecular and Cellular Biology, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan.

Colorectal and gastric cancers are a leading cause of cancer deaths in developed countries. Precise estimation of prognosis is important with regard to clinical decision making for individuals with such cancers. We here comprehensively compiled a complete atlas of prognostic genes based on an integrated meta-analysis of one of the largest assembled colorectal cancer cohorts. A simple yet robust machine learning approach was then applied to establish a universal molecular prognostic score (mPS_colon) that relies on the expression status of only 16 genes and which was validated with independent data sets. This score was found to be an independent prognostic indicator in multivariate models including cancer stage, to be valid independent of tumor characteristics or patient ethnicity, and to be also applicable to gastric cancer. We conclude that mPS_colon is a universal prognostic classifier for patients with gastrointestinal cancers and that it should prove informative for optimization of personalized therapy for such patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41525-021-00172-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862603PMC
February 2021

Effect of internal limiting membrane peeling on visual field sensitivity in eyes with epiretinal membrane accompanied by glaucoma with hemifield defect and myopia.

Jpn J Ophthalmol 2021 Feb 3. Epub 2021 Feb 3.

Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.

Purpose: To investigate the effects of internal limiting membrane (ILM) peeling on visual field sensitivities in eyes with epiretinal membrane (ERM) accompanied by glaucoma with hemifield defect and myopia.

Study Design: Retrospective clinical study METHODS: We reviewed clinical records of patients with ERM who underwent vitrectomy and ERM/ILM peeling. We first collected clinical data of eyes with ERM and glaucoma with hemifield defect. We recorded visual field sensitivities at 52 points and analyzed differences between before and after surgery. We then compared the changes in visual field sensitivity between glaucomatous and normal hemifields. Next, we collected ERM eyes without glaucoma and stratified them into two groups based on axial length (threshold = 26.0 mm). In these eyes, we also recorded visual field sensitivities at 52 points and analyzed differences between before and after surgery.

Results: The study included 18 eyes with ERM and glaucoma with hemifield defect (11 men; mean age, 68.3 ± 7.2 years). These eyes showed significant sensitivity reductions at 5/26 points, mainly in the nasal area of the glaucomatous hemifield, whereas only 1/26 points exhibited significant sensitivity reduction in the normal hemifield. In eyes with axial length <26.0 mm and axial length ≥26.0 mm, 29 peripheral and seven superior peripheral points showed significant improvements in visual field sensitivities, respectively.

Conclusion: Visual field sensitivity reduction occurred mainly in the nasal region of the glaucomatous hemifield. Differences in axial length alone were not a prominent risk factor for reduced visual field sensitivity after ILM peeling in eyes with ERM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10384-021-00817-9DOI Listing
February 2021

Extended thoracic endovascular aortic repair for residual aortic dissection after type A aortic dissection repair.

Vascular 2021 Jan 21:1708538120988418. Epub 2021 Jan 21.

Department of Cardiovascular Surgery, Keio University, Tokyo, Japan.

Objective: We investigated the outcomes of extended coverage of the descending thoracic aorta by thoracic endovascular aortic repair (TEVAR) for residual chronic type B aortic dissection after type A aortic dissection (TAAD) repair.

Methods: From November 2015 to August 2020, 36 patients underwent extended TEVAR for residual intimal tear after TAAD repair. We specifically investigated the methods and outcomes of this procedure.

Results: TEVAR consisted of isolated TEVARs ( = 29), single-vessel debranching TEVAR (6), and two-vessel debranching TEVAR (1). The mean time from TAAD repair to TEVAR was 27 ± 33 months (2-86 months). The TEVAR devices used were Valiant (28 cases), GORETAG (4), Relay plus (2), and TX2 (2). Technical success of TEVAR was 100%. The distal ends of the stent grafts were T 8 (1 case), T 9 (5), T 10 (6), T 11 (9), and T 12 (15), with an average of T 11 ± 1. The average length of hospital stay after TEVAR was 9 ± 3 days (5-17 days). There were no surgical/hospital deaths or complications. The average postoperative follow-up period was 21 ± 15 months without death or reintervention.

Conclusions: The short-term outcomes of extended TEVAR for residual chronic type B aortic dissection after TAAD repair were acceptable without perioperative SCI. Aggressive descending thoracic aorta coverage may prevent aortic events, and extended TEVAR may be a preemptive treatment for the downstream aorta. Mid- to long-term results should be clarified.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1708538120988418DOI Listing
January 2021

Status of cardiovascular surgery in Japan between 2017 and 2018: a report based on the Japan Cardiovascular Surgery Database. 4. Thoracic aortic surgery.

Asian Cardiovasc Thorac Ann 2020 Dec 20:218492320981456. Epub 2020 Dec 20.

Department of Health Policy and Management, Keio University, Tokyo, Japan.

Aim: We aimed to analyze the current treatment status of thoracic/thoracoabdominal aortic diseases in Japan.

Methods: Using the Japan Cardiovascular Surgery Database, the number of cases, operative mortality, and major morbidities (stroke, renal failure, pneumonia, paraplegia) of thoracic and thoracoabdominal aortic surgery in 2017 and 2018 were analyzed by surgical site (root-ascending, arch, descending, thoracoabdominal aorta), surgical procedure, and age group.

Results: The total number of cases was 39,391 (50.1% aortic dissections, 49.9% non-dissections). The number of cases was highest in patients aged in their 70s. In elderly patients, the rates of root replacement (particularly valve-sparing procedures) in the root-ascending aorta and open-chest surgery in the arch and the descending and thoracoabdominal aorta were decreased. The outcome by procedure analysis showed the lowest mortality and morbidity rates for valve-sparing in the root-ascending region, and lower mortality and morbidity (cerebral infarction, renal failure, pneumonia) in non-open-chest procedures (thoracic endovascular aortic repair with/without branch reconstruction) than in open-chest procedures in the arch, descending, and thoracoabdominal regions. With regards to age, operative mortality in patients aged 80 years or older was significantly higher than in those under 80 years of age for all surgical procedures in the root-ascending, arch, and descending regions.

Conclusions: Thoracic and thoracoabdominal aortic surgery in Japan was most commonly performed in elderly patients in their 70s, with a good overall mortality rate of 5.3%. Mortality and postoperative morbidity rates in patients aged 80 years or older were still high. In the future, further improvements in surgical outcomes are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0218492320981456DOI Listing
December 2020

The provisional extension to induce complete attachment technique is associated with abdominal aortic remodeling and reduces aorta-related adverse events after aortic dissection.

J Vasc Surg 2020 Dec 16. Epub 2020 Dec 16.

Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan.

Objective: This study evaluated the efficacy of the provisional extension to induce complete attachment (PETTICOAT) technique for type B and postoperative residual type B aortic dissections compared with the conventional thoracic endovascular aortic repair (TEVAR) technique.

Methods: In this retrospective study, we compared sequential aortic morphologic changes in consecutive patients with type B and postoperative residual type B aortic dissections treated with the PETTICOAT technique between January 2016 and December 2017 with patients treated with the conventional TEVAR between January 2013 and December 2015. Outcomes included aortic remodeling and aorta-related adverse events for 2 years postoperatively.

Results: Forty-eight patients were included in this study (24 in the PETTICOAT group, 24 patients in the conventional TEVAR group). Although both groups showed aortic remodeling in the descending thoracic aorta, the PETTICOAT group developed significantly better aortic remodeling in the abdominal aorta compared with the conventional TEVAR group during the observation period. The PETTICOAT group had significantly fewer aorta-related adverse events compared with the conventional TEVAR group (8% vs 54%; P < .001). Aorta-related adverse events more commonly occurred in the poor remodeling group compared with in the good remodeling group (P = .001; hazard ratio, 8.32; 95% confidence interval, 2.26-30.64).

Conclusions: This study suggests that the PETTICOAT technique for aortic dissection may promote aortic remodeling and decrease the incidence of aorta-related adverse events. Additional studies are required to confirm these preliminary findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvs.2020.11.038DOI Listing
December 2020

Successful Percutaneous Abscess Drainage and Irrigation for the Treatment of Infected Aortic Aneurysm Post-Thoracic Endovascular Aortic Repair.

CJC Open 2020 Nov 31;2(6):735-738. Epub 2020 Aug 31.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Infected aortic aneurysm (IAA) is a rare, life-threatening disease with rapid progression and a high mortality rate. An 84-year-old man developed IAA caused by urosepsis owing to extended-spectrum β-lactamase-producing infection. Considering surgical risk and perioperative mortality, the patient underwent computed tomography-guided percutaneous abscess drainage and continuous irrigation with optimal antibiotic therapy. We controlled his systemic inflammation without surgery; thus, he was discharged. Six months later, we confirmed that the abscess had almost disappeared in the follow-up computed tomography scan. Percutaneous abscess drainage and irrigation may be an effective therapeutic option for surgical high-risk patients with IAA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cjco.2020.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711014PMC
November 2020

Loss of Fbxw7 Impairs Development of and Induces Heterogeneous Tumor Formation in the Mouse Mammary Gland.

Cancer Res 2020 12 24;80(24):5515-5530. Epub 2020 Nov 24.

Department of Molecular and Cellular Biology, Medical Institute of Bioregulation, Kyushu University, Higashi-ku, Fukuoka, Fukuoka Japan.

Fbxw7 is an F-box protein that contributes to regulation of cell proliferation and cell fate determination as well as to tumor suppression in various tissues. In this study, we generated mice with mammary gland-specific ablation of Fbxw7 ( mice) and found that most neonates born to mutant dams die soon after birth as a result of defective maternal lactation. The mammary gland of mutant dams was markedly atrophic and manifested both excessive cell proliferation and apoptosis in association with the accumulation of Notch1 and p63. Despite the hypoplastic nature of the mutant mammary gland, / mice spontaneously developed mammary tumors that resembled basal-like carcinoma with marked intratumoral heterogeneity. Additional inactivation of in / mice further promoted onset and development of mammary tumors, suggesting that spontaneous mutation of may facilitate transition of hypoplastic mammary lesions to aggressive cancer in mice lacking Fbxw7. RNA-sequencing analysis of epithelial- and mesenchymal-like cell lines from a / mouse tumor revealed an increased mutation rate and structural alterations in the tumor and differential expression of upstream transcription factors including known targets of Fbxw7. Together, our results implicate Fbxw7 in the regulation of cell differentiation and in tumor suppression in the mammary gland. Loss of Fbxw7 increases mutation rate and chromosome instability, activates signaling pathways governed by transcription factors regulated by Fbxw7, and triggers the development of mammary tumors with prominent heterogeneity. SIGNIFICANCE: Mammary gland-specific ablation of Fbxw7 in mice results in defective gland development and spontaneous mammary tumor formation reminiscent of human basal-like carcinoma with intratumoral heterogeneity. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/24/5515/F1.large.jpg.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1158/0008-5472.CAN-20-0271DOI Listing
December 2020

Full PETTICOAT in acute type B aortic dissection with patent false lumen may offer positive remodeling for the distal aorta.

Gen Thorac Cardiovasc Surg 2020 Nov 17. Epub 2020 Nov 17.

Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan.

Objective: The provisional extension to induce complete attachment (PETTICOAT) technique is a unique thoracic endovascular aortic repair (TEVAR) for aortic dissection, which consists of proximal descending aortic endografting plus distal bare-metal stenting. This study aimed to investigate the efficacy of the PETTICOAT technique in patients with acute-sub-acute complicated type B aortic dissections. In particular, we compared the remodeling effect of full PETTICOAT covering down to the abdominal aorta with that of simple entry closure.

Methods: In this retrospective pre-post study, we compared the clinical course of consecutive patients undergoing TEVAR with the PETTICOAT technique in which proximal entry tear was excluded with a covered stent, and extension bare stents were placed down to the abdominal segment for acute-sub-acute complicated type B aortic dissections, between 2015 and 2017, with a control group treated with TEVAR with entry closure between 2011 and 2015. Outcomes included the aortic remodeling rate and the aortic diameter up to 1 year after surgery.

Results: Subjects consisted of 47 patients (21 in full PETTICOAT group, 26 in the simple entry closure group). The remodeling rate of the abdominal aorta in the full PETTICOAT group was significantly higher than in the simple entry closure group (p < 0.05), while that of the thoracic aorta was comparable between the two groups.

Conclusions: This study suggests that the full PETTICOAT technique achieves better aortic remodeling compared to entry closure alone, and might lead to less reintervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11748-020-01548-3DOI Listing
November 2020

Intra- and Postoperative Monitoring of Autologous Neurosensory Retinal Flap Transplantation for Refractory Macular Hole Associated with High Myopia.

Retina 2020 Oct 16. Epub 2020 Oct 16.

Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Purpose: To describe the intra- and postoperative morphological and functional outcomes after autologous neurosensory retinal flap transplantation (ART) for high myopia-related refractory macular hole (MH).

Methods: This prospective interventional study enrolled 5 eyes of 5 patients (age range 54-84 years) with highly myopic refractory MH who underwent ART. All cases were evaluated with intraoperative optical coherence tomography (OCT) and postoperative OCT, OCT angiography, and microperimetry for at least 6 months postoperatively.

Results: Intraoperatively, the MH was covered by an ART flap with a persistent small subretinal space that was filled with the ART flap after 4-6 days. OCT discriminated the original from the transplanted retina. The mean basal diameter of the original MH decreased from 1504 ± 684 μm preoperatively to 1111 ± 356 μm postoperatively. The best-corrected visual acuity improved in 2 cases, was stable in 2 cases, and deterioration in 1 case. Microperimetry demonstrated no obvious postoperative changes in the fixation points and the absolute scotoma corresponding to the base of MHs with chorioretinal atrophy. In 2 eyes, choroidal neovascularization (CNV) developed beneath the transplanted retinas.

Conclusion: Transplanted tissue was in a fixed position by 1 week postoperatively with a decreased diameter of the original MH. Postoperative fixation points were on the original retina at the MH edge. Since CNV may develop, detailed monitoring is required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000003000DOI Listing
October 2020

Dysphagia Aortica Caused by Congenitally Angulated Descending Aorta.

Ann Vasc Surg 2021 Feb 16;71:535.e7-535.e10. Epub 2020 Sep 16.

Department of Cardiovascular Surgery, Keio University, Shinjuku, Tokyo, Japan.

Dysphagia aortica is a rare pathology primarily caused by an aortic aneurysm or Kommerrell's diverticulum. Herein, we describe an extremely rare case of dysphagia aortica due to a congenitally angulated descending aorta in a 50-year-old woman successfully treated by open surgery. The woman underwent David procedure for aortic regurgitation 5 years previously, with the same anatomy of an angulated descending aorta without symptoms. She has difficulty in swallowing solid food from 1 month. Total aortic arch replacement using the elephant trunk technique and secondary descending aortic replacement released the esophageal compression by the abnormal aorta and completely improved her symptom.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2020.09.010DOI Listing
February 2021

Transcatheter aortic valve replacement with Evolut R versus Sapien 3 in Japanese patients with a small aortic annulus: The OCEAN-TAVI registry.

Catheter Cardiovasc Interv 2020 Sep 14. Epub 2020 Sep 14.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Objectives: To compare safety, efficacy, and hemodynamics of transfemoral transcatheter aortic valve replacement (TAVR) using self-expanding and balloon-expandable transcatheter heart valves (THVs) in patients with a small aortic annulus.

Background: Few studies have directly compared TAVR outcomes using third-generation THVs, focusing on patients with small aortic annuli.

Methods: In a multicenter TAVR registry, we analyzed data from 576 patients with a small annulus and who underwent transfemoral TAVR using third-generation THVs. Propensity score matching was used to adjust baseline clinical characteristics.

Results: The device success rate in the overall cohort was 92.0% (Evolut R: 92.1% vs. Sapien 3:92.0%, p = 0.96). One year after TAVR, patients treated with Evolut R maintained a lower mean pressure gradient (mPG) and a higher indexed effective orifice area (iEOA) in the matched cohort {mPG: 9.0 [interquartile range (IQR): 6.0-11.9] vs. 12.0 [IQR: 9.9-16.3] mmHg, p < .001; iEOA: 1.20 [IQR: 1.01-1.46] vs. 1.08 [IQR: 0.90-1.28] cm /m , p < .001}. However, no significant differences were reported in the incidence of severe prosthesis-patient mismatch and aortic regurgitation at 1 year. Furthermore, both groups showed comparable outcomes with no differences in terms of all-cause mortality (log-lank test, p = .81).

Conclusions: TAVR for patients with a small annulus using third-generation THVs was associated with high device success. Evolut R seems to be superior to Sapien 3 in hemodynamic performance for patients with a small annulus and body surface area up to 1 year after TAVR. Nevertheless, all-cause mortality at 1 year was similar between both groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ccd.29259DOI Listing
September 2020

Caveolin-1 Promotes Cellular Senescence in Exchange for Blocking Subretinal Fibrosis in Age-Related Macular Degeneration.

Invest Ophthalmol Vis Sci 2020 09;61(11):21

Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Purpose: To determine whether caveolin-1 (i) prevents epithelial-mesenchymal transition in the RPE and laser-induced subretinal fibrosis and (ii) promotes or inhibits cellular senescence in the RPE.

Methods: We examined laser-induced subretinal fibrosis and RPE cell contraction in wild-type and Caveolin-1 knockout (Cav-1-/-) mice treated with or without cavtratin, a cell-permeable peptide of caveolin-1. The senescence marker p16INK4a was measured in RPE tissues from patients with geographic atrophy and aged mice, laser-induced subretinal fibrosis, and primary human RPE cells. Human RPE was examined by TUNEL staining, reactive oxygen species generation, cell viability, and senescence-associated β-galactosidase staining.

Results: The volume of subretinal fibrosis was significantly smaller in cavtratin-injected eyes from wild-type mice than in control eyes from wild-type, P = 0.0062, and Cav-1-/- mice, P = 0.0095. Cavtratin treatment produced significant improvements in primary RPE cell contraction in wild-type, P = 0.04, and Cav-1-/- mice, P = 0.01. p16INK4a expression in the RPE was higher in patients with than without geographic atrophy. p16INK4a was expressed in 18-month-old but not 2-month-old wild-type mouse eyes. p16INK4a and collagen type I antibodies showed co-localization in subretinal fibrosis. Cavtratin did not affect RPE cell apoptosis or reactive oxygen species generation, but decreased cell viability and increased senescence-associated β-galactosidase-positive cells.

Conclusions: Enhanced expression of caveolin-1 successfully blocked epithelial-mesenchymal transition of RPE and the reduction of subretinal fibrosis in mice. Nevertheless, in exchange for blocking subretinal fibrosis, caveolin-1 promotes RPE cellular senescence and might affect the progression of geographic atrophy in AMD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/iovs.61.11.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490224PMC
September 2020

Lamivudine Inhibits RNA-induced Retinal Pigment Epithelium Degeneration via Anti-inflammatory and Anti-senescence Activities.

Transl Vis Sci Technol 2020 07 1;9(8). Epub 2020 Jul 1.

Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Purpose: Accumulation of the long noncoding element RNA activates the NLRP3 inflammasome and leads to retinal pigment epithelium (RPE) cell death, a key event in the pathogenesis of geographic atrophy during late-stage age-related macular degeneration. Lamivudine (3TC) is a nucleoside analog reverse transcriptase inhibitor known to inhibit the NLRP3 inflammasome. Currently, the intracellular response of the senescence marker p16 to the long noncoding RNA is being actively studied. The present study aimed to assess the efficacy of 3TC against RNA-induced RPE inflammation and senescence by evaluating changes in expression of the proinflammatory cytokines IL-18 and IL-1β and of p16 in RPE cells.

Methods: Cultured human RPE cells and in vivo mouse RPE cells were transfected with an in vitro-transcribed RNA, and changes in IL-18, IL-1β, and p16 expression measured in the presences of 3TC or 3,4-(M)CA as a negative control.

Results: Treatment with 3TC markedly reduced RNA-induced expression of IL-18 and IL-1β in human and mouse RPE cells compared with the negative control. Further, RNA-induced p16 expression was suppressed by 3TC in human RPE cells.

Conclusions: Our data suggest that RNA accumulation contributes to RPE cell senescence in age-related macular degeneration and that this pathogenic process can be suppressed by 3TC.

Translational Relevance: Further verifying this study leads to potential targets for age-related macular degeneration therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/tvst.9.8.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422901PMC
July 2020

Reversible Color and Shape Changes of Nanostructured Fibers of a Macrocyclic π-Extended Thiophene Hexamer Promoted by Adsorption and Desorption of Organic Vapor.

J Am Chem Soc 2020 08 27;142(32):13662-13666. Epub 2020 Jul 27.

Department of Information and Basic Science, Nagoya City University, Nagoya 467-8501, Japan.

A phenyl-substituted macrocyclic π-extended thiophene hexamer , composed of four thienylene-ethynylene and two thienylene-vinylene units, has a solid-state structure in which π-π, CH-π, and van der Waals interactions occur. Slow addition of acetone to a solution of in CS produces a yellow nanostructured fiber containing a 1:1.5:1 ratio of , acetone, and CS. Over a 2 min period at 25 °C, gradually changes to an orange fiber containing a 1:0.5:1 ratio of , acetone, and CS. On exposure to acetone vapor, regenerates (vapochromism), and removal of all solvents from and generates a red-orange fiber , which upon brief immersion in acetone/CS produces . Furthermore, is converted to orange yellow fiber upon exposure to acetone vapor for 1 s at 25 °C. Analysis of the horizontal and vertical profiles of the X-ray diffraction (XRD) patterns shows that removal of solvent from reversibly creates in conjunction with a shape and size change along with arching.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/jacs.0c05340DOI Listing
August 2020

Impact of beta blockers on patients undergoing transcatheter aortic valve replacement: the OCEAN-TAVI registry.

Open Heart 2020 07;7(2)

Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan

Objective: There is paucity of data on optimal medical treatment, including use of beta blockers for patients undergoing transcatheter aortic valve replacement (TAVR). The study aimed to investigate the association of beta blockers and clinical outcomes following TAVR.

Methods: We examined data of 2563 patients who underwent TAVR between October 2013 and May 2017 obtained from a prospective multicentre cohort registry, the optimised catheter valvular intervention-TAVI registry. We compared the 2-year cardiovascular and non-cardiovascular mortality and in-hospital outcomes between patients with and without preprocedural beta-blocker administration by propensity score matching (PSM).

Results: Preprocedural beta blockers were prescribed in 867 patients (33.8%). After PSM, the incidence of in-hospital congestive heart failure was significantly lower in patients with preprocedural beta blocker (p=0.046). No differences were found in 2-year cardiovascular and non-cardiovascular mortality. In the subgroup analyses, beta-blocker administration was associated with a lower cardiovascular mortality within 2 years in patients with a history of coronary artery bypass grafting (CABG; log-rank p=0.017), presence of peripheral artery disease (PAD; log-rank p=0.003) and brain natriuretic peptide (BNP) ≥400 pg/mL (log-rank p=0.003). When stratified by postprocedural left ventricular ejection fraction (post-LVEF), beta-blocker administration was associated with a lower cardiovascular mortality among patients with post-LVEF <50% (log-rank p=0.024).

Conclusions: Preprocedural beta-blocker administration was not associated with 2-year cardiovascular and non-cardiovascular mortality in overall, but was associated with a lower 2-year cardiovascular mortality in patients with a history of CABG, presence of PAD, BNP ≥400 pg/mL and post-LVEF <50%. The findings must be validated using randomised trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/openhrt-2020-001269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342827PMC
July 2020

Congenital Heart Disease After the Fukushima Nuclear Accident: The Japan Cardiovascular Surgery Database Study.

J Am Heart Assoc 2020 07 2;9(13):e014787. Epub 2020 Jul 2.

The Japanese Association for Thoracic Surgery Tokyo Japan.

Background In March 2011, the Fukushima Daiichi nuclear power plant disaster inflicted radiation damage across the Tohoku region of Northern Japan. The consequent harm to pregnant mothers and newborns was a matter of concern. We performed a registry-based analysis of the incidence of congenital heart disease during 2010 to 2013 using the Japan Cardiovascular Surgery Database. Methods and Results We selected patients who had complex congenital heart disease and who were born between January 1, 2010 and December 31, 2013 undergoing surgery, and assessed the trend in the number of first-time surgeries performed for patients aged 2 years and younger by birth year over time. The numbers of first-time surgeries for birth years 2010 to 2013 were 2978, 2924, 3077, and 2940, and no increasing trend was detected. Additionally, no increasing yearly trend was detected when the number of cases was divided by the total number of births in Japan in each birth month. The mortality of first-time surgeries performed for complex diseases, which often involves multiple subsequent surgeries, decreased from 4.7% in 2010 to 2.2% in 2013. Conclusions Our analyses showed no increase in the number of patients with congenital heart disease during 2010 to 2013. The yearly increase in the total number of surgeries following the Fukushima Daiichi nuclear disaster in a previous report can be explained by the decline in the mortality of first-time surgeries for complex cases. Such use of only the increase in the total yearly number of surgeries to claim the effects of a nuclear disaster on the incidence of congenital heart disease is a far too simplistic and dangerous proposition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.119.014787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670522PMC
July 2020

Hemostatic Modification of the Bentall Procedure Using an Overlap Suture Technique.

Aorta (Stamford) 2020 Feb 29;8(1):18-20. Epub 2020 Jun 29.

Department of Cardiovascular Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.

Bleeding from the proximal suture line after replacement of the aortic root can be very difficult to control. Such bleeding is an important predictor of morbidity and mortality. Here, we detail a reliable method that is simple to perform and effectively prevents surgical bleeding. We adopted a technique of overlapping the pledgeted interrupted U-stitches of the proximal sutures on the prosthetic graft, which can eliminate the bleeding from the proximal suture line.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1700998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324253PMC
February 2020

Anatomical Analysis and Feasibility Study of Next-Generation Fenestrated or Branched Stent-Grafts for the Treatment of Arch Aneurysms.

J Endovasc Ther 2020 Oct 26;27(5):777-784. Epub 2020 Jun 26.

Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan.

To analyze the anatomical characteristics of arch aneurysms and evaluate the anatomical feasibility of 4 next-generation stent-grafts with either branched or fenestrated configurations. A retrospective analysis was conducted of 213 patients (mean age 75.0±7.1 years; 179 men) with arch aneurysms treated using total arch replacement or zone 0 or 1 thoracic endovascular aortic repair (TEVAR) from 2007 to 2017 at 2 Japanese hospitals. Anatomical analyses were performed using the centerline of flow technique on a 3-dimensional workstation. The anatomical feasibility of the Zenith A-branch, TAG Thoracic Branch Endoprosthesis (TBE), Terumo Aortic Relay Plus Double Branched (DB), and fenestrated Najuta stent-grafts were evaluated based on the instructions for use (IFU). The mean lengths from the sinotubular junction (STJ) to the innominate artery (IA) and from the IA to the left common carotid artery were 114.9±15.9 and 12.8±5.6 mm, respectively. The mean aortic diameters at the STJ and IA were 31.3±3.4 and 34.1±5.3 mm, respectively. In terms of feasibility, 5.2% of patients were within the Zenith A-branch IFU, 40.8% for the TAG TBE, 24.9% for the Relay Plus DB, and 13.6% for the Najuta. Significant (>50% circumference) thrombus/calcification at the sealing zone affected nearly half of the patients, but there is currently no standardized definition or evaluation method for "significant" thrombus/calcification. Only 5% to 41% of arch aneurysm patients are anatomically suitable for TEVAR using any one of the next-generation branched or fenestrated stent-grafts. Furthermore, a definitive method of evaluating the thrombus/calcification burden needs to be established in future IFU.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1526602820938058DOI Listing
October 2020

A case of a highly tortuous descending thoracic aortic aneurysm treated by surgical exclusion.

SAGE Open Med Case Rep 2020 2;8:2050313X20926440. Epub 2020 Jun 2.

Department of Cardiovascular Surgery, Keio University, Tokyo, Japan.

The patient was a 76-year-old woman with an atypical descending thoracic aortic aneurysm due to a highly tortuous descending aorta. The surgical approach in this case required special consideration because of the aneurysm's location. The main body of the aneurysm was in the right thoracic cavity. Descending thoracic aorta replacement with a prosthetic graft and aneurysmal total exclusion were performed through a left curvilinear thoracoabdominal incision. The patient's postoperative course was uneventful. Surgical exclusion of a thoracic aortic aneurysm may be a useful technique in this special situation. Postoperative follow-up is needed to prevent early and late complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2050313X20926440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268160PMC
June 2020

A novel technique to avoid perforation of the right ventricle by the temporary pacing lead during transcatheter aortic valve implantation.

Cardiovasc Interv Ther 2020 May 30. Epub 2020 May 30.

Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Cardiac tamponade is a life-threatening complication during transcatheter aortic valve implantation (TAVI), often caused by perforation of the right ventricle (RV) by the temporary pacemaker used for rapid pacing during valve deployment. We aimed to assess the feasibility of performing rapid pacing while maintaining inflation of the pacing lead balloon in the RV during TAVI. Among 749 consecutive patients who underwent TAVI with SAPIEN XT valves between October 2013 and July 2015, 726 treated using rapid pacing with a transvenous balloon-tip lead were enrolled in our study, and were stratified into three groups according to the extent of balloon inflation in the RV as follows: full inflation (n = 100), partial inflation (n = 196), and deflation (n = 430). We compared the following clinical outcomes: pacing lead-related RV perforation, rapid pacing failure, valve malpositioning due to rapid pacing failure, device success, and 30-day mortality. Pacing lead-related RV perforation occurred only in patients in the deflation group (6 cases, 1.4%), but the differences among the groups were not statistically significant (p = 0.13). Rapid pacing failure, but no valve malpositioning, occurred most frequently in patients in the full inflation group (4.0% vs. 0.5% in the other groups, p = 0.004). The rate of device success (> 94%) and the 30-day mortality (2.0%) were similar among the three groups. Partial inflation of the balloon of the pacing lead may reduce the risk of RV perforation without increasing the risk of pacing failure or valve malpositioning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12928-020-00676-0DOI Listing
May 2020

Pulmonary valve replacement after tetralogy of Fallot repair in a patient with immune thrombocytopenia.

J Card Surg 2020 Jul 22;35(7):1711-1713. Epub 2020 May 22.

Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.

Marked thrombocytopenia causes significant bleeding in cardiovascular surgery. Herein, we describe the case of a 47-year-old woman with immune thrombocytopenia who underwent successful pulmonary valve replacement for pulmonary valve regurgitation and stenosis after complete repair of tetralogy of Fallot. Her platelet count decreased significantly to less than 5 × 10 /L on postoperative day 3, thus multiple platelet transfusions were given. Pulse steroid therapy with dexamethasone was subsequently administered systemically for 4 days. After the treatment, her platelet count started to recover. There were no significant postoperative bleeding events, and red blood cell transfusion was not required. Other than the platelet event, the postoperative course was uneventful and the patient was discharged on postoperative day 15.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14640DOI Listing
July 2020