Publications by authors named "Homare Okamura"

64 Publications

Impact of prosthesis-patient mismatch on late outcomes after bioprosthetic mitral valve replacement for mitral regurgitation.

J Artif Organs 2021 Oct 19. Epub 2021 Oct 19.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.

Negative impact of prosthesis-patient mismatch on long-term survival after valve replacement has been reported. However, the effect of prosthesis-patient mismatch after bioprosthetic mitral valve replacement has not yet been well examined. The purpose of this study was to investigate the effect of prosthesis-patient mismatch on late outcomes after bioprosthetic mitral valve replacement for mitral regurgitation. A total of 181 patients underwent bioprosthetic mitral valve replacement between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed before discharge for all patients and the effective orifice area of bioprosthetic mitral valve was calculated using the formula: 220/pressure half-time, and the effective orifice area index was calculated by the formula: effective orifice area/body surface area. Prosthesis-patient mismatch was defined as a postoperative effective orifice area index ≤ 1.2 cm/m. The characteristics and outcomes were compared between the groups. There were 34 patients (26.6%) with prosthesis-patient mismatch and 94 patients (73.4%) without prosthesis-patient mismatch. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that prosthesis-patient mismatch was an independent predictor of late mortality (hazard ratio 3.38; 95% confidence interval 1.69-6.75; p = 0.001) and death from heart failure (hazard ratio 31.03, 95% confidence interval 4.49-214.40, p < 0.001). Prosthesis-patient mismatch at discharge after mitral valve replacement for mitral regurgitation was associated with long-term mortality and death from heart failure.
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http://dx.doi.org/10.1007/s10047-021-01299-9DOI Listing
October 2021

Commentary: Navigating the pitfalls in the surgical management of pseudoxanthoma elasticum.

Authors:
Homare Okamura

JTCVS Tech 2021 Oct 6;9:42-43. Epub 2021 Aug 6.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.xjtc.2021.07.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501245PMC
October 2021

A three-dimensional biomodel of type A aortic dissection for endovascular interventions.

J Artif Organs 2021 Oct 5. Epub 2021 Oct 5.

Department of Cardiovascular Surgery, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma, Omiya-Ku, Saitama, 330-8503, Japan.

Thoracic endovascular aortic repair is widely used for type B aortic dissection. However, there is no favorable stent-graft for type A aortic dissection. A significant limitation for device development is the lack of an experimental model for type A aortic dissection. We developed a novel three-dimensional biomodel of type A aortic dissection for endovascular interventions. Based on Digital Imaging and Communication in Medicine data from the computed tomography image of a patient with a type A aortic dissection, a three-dimensional biomodel with a true lumen, a false lumen, and an entry tear located at the ascending aorta was created using laser stereolithography and subsequent vacuum casting. The biomodel was connected to a pulsatile mock circuit. We conducted four tests: an endurance test for clinical hemodynamics, wire insertion into the biomodel, rapid pacing, and simulation of stent-graft placement. The biomodel successfully simulated clinical hemodynamics; the target blood pressure and cardiac output were achieved. The guidewire crossed both true and false lumens via the entry tear. The pressure and flow dropped upon rapid pacing and recovered after it was stopped. This simulation biomodel detected decreased false luminal flow by stent-graft placement and detected residual leak. The three-dimensional biomodel of type A aortic dissection with a pulsatile mock circuit achieved target clinical hemodynamics, demonstrated feasibility for future use during the simulated endovascular procedure, and evaluated changes in the hemodynamics.
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http://dx.doi.org/10.1007/s10047-021-01294-0DOI Listing
October 2021

Long-term outcomes after aortic valve replacement using a 19-mm bioprosthesis.

Eur J Cardiothorac Surg 2021 Aug 25. Epub 2021 Aug 25.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Objectives: Transcatheter aortic valve replacement is known to be associated with improved haemodynamics in patients with aortic stenosis and a small aortic annulus. However, limited benchmark data are available regarding the long-term outcomes in patients treated with surgical aortic valve replacement (SAVR). We investigated the long-term outcomes of SAVR using a 19-mm bioprosthesis.

Methods: This study included consecutive patients who underwent SAVR using a 19-mm bioprosthesis at our hospital between 2008 and 2012.

Results: In a total of 132 patients, moderate and severe prosthesis-patient mismatch occurred in 36 (27.3%) and 7 patients (5.3%), respectively. The median follow-up period was 7.7 years. The overall 5- and 10-year survival rates were 79.4% and 52.9%, respectively. The 5- and 10-year freedom from major adverse valve-related events rates were 89.6% and 74.2%, respectively. Neither moderate nor severe prosthesis-patient mismatch was associated with late mortality, major adverse valve-related events or heart failure. Follow-up echocardiographic data were obtained at a median interval of 4.8 years in 80% of patients who survived ≥6 months postoperatively. Follow-up echocardiographic data showed a significantly increased left ventricular ejection fraction, decreased mean transvalvular/transprosthetic pressure gradients and a decreased mean left ventricular mass. At follow-up, we observed moderate or severe haemodynamic structural valve deterioration in 17 patients; however, structural valve deterioration did not affect late survival or freedom from major adverse valve-related events rates, or heart failure.

Conclusions: SAVR using the 19-mm bioprosthesis was associated with satisfactory long-term clinical and haemodynamic outcomes.
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http://dx.doi.org/10.1093/ejcts/ezab379DOI Listing
August 2021

Prevention of postoperative delirium after cardiovascular surgery: A team-based approach.

J Thorac Cardiovasc Surg 2021 Jul 24. Epub 2021 Jul 24.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan. Electronic address:

Objective: We investigated the efficacy of the Delirium Team Approach program for delirium prevention after cardiovascular surgery.

Methods: We retrospectively investigated 256 patients who underwent cardiac or thoracic vascular surgery between May 2017 and May 2020. We compared the outcomes before and after implementation of the Delirium Team Approach program in December 2018. The program included the following components: (a) educational sessions for the medical team regarding delirium and its management, (b) review of preprinted physician orders for insomnia and agitation, and (c) routine screening for delirium. We investigated the early outcomes and effects of the Delirium Team Approach program on postoperative delirium.

Results: The incidence of postoperative delirium significantly decreased from 53.3% to 37.0% after implementation of the Delirium Team Approach program (P = .008). Although no intergroup differences were observed in the rates of stroke and reexploration for bleeding, the length of intensive care unit stay and the overall length of postoperative hospital stay were shorter in the postintervention group. Hospital costs, excluding surgery, and the cost during intensive care unit stay were lower in the postintervention group. Multivariable analysis showed that the Delirium Team Approach program was associated with a reduction in postoperative delirium (odds ratio, 0.38; 95% confidence interval, 0.21-0.67; P = .001). Other predictors of delirium included age, dementia, chronic kidney disease, and intubation time. After risk adjustment using propensity score matching, the rate of postoperative delirium was lower in the postintervention group.

Conclusions: Implementation of the Delirium Team Approach program was associated with a lower incidence of postoperative delirium in patients who underwent cardiovascular surgery.
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http://dx.doi.org/10.1016/j.jtcvs.2021.07.027DOI Listing
July 2021

Bail-Out Pull-Through Pull-Back Technique for Accidental Coverage of the Left Common Carotid Artery During Thoracic Endovascular Aortic Repair.

J Endovasc Ther 2021 Aug 6:15266028211036482. Epub 2021 Aug 6.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

Purpose: We describe a pull-through pull-back technique to revascularize the left common carotid artery (LCCA) that was unintentionally covered during thoracic endovascular aortic repair (TEVAR).

Case Report: A 69-year-old man presented with back pain secondary to acute type B aortic dissection with an intimal tear in the proximal descending aorta. Serial computed tomography (CT) revealed an enlarged descending aorta and proximal progression of the aortic dissection. He underwent left carotid-subclavian artery bypass and TEVAR, 10 days after admission. The Valiant Navion stent graft without a bare stent was deployed proximally; however, the LCCA was unintentionally covered by the stent graft during this procedure. A pull-through form was created between the left axillary and femoral arteries using a 0.035-inch guide wire. The pull-through guide wire was gently pulled, and the greater curvature of the proximal end of the stent graft was displaced distally. Angiography confirmed restoration of antegrade blood flow into the LCCA. The patient's postoperative course was uneventful. Follow-up CT performed 6 months postoperatively confirmed preserved blood flow into the LCCA without endoleak nor stent migration.

Conclusion: The pull-through pull-back technique is a feasible troubleshooting strategy for accidental coverage of supra-aortic vessels during TEVAR.
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http://dx.doi.org/10.1177/15266028211036482DOI Listing
August 2021

Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection.

Eur J Cardiothorac Surg 2021 04;59(4):765-772

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

Objectives: We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection.

Methods: We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain. Nine patients presented with malperfusion and 1 with cardiac arrest, preoperatively. A FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision. Single fenestration was made in the FET in 15 patients, 2 fenestrations in 5 patients and a total fenestrated technique in 2 patients. Concomitant procedures were performed in 5 patients.

Results: The cardiopulmonary bypass, aortic cross-clamp and hypothermic circulatory arrest times were 181 ± 49, 106 ± 43 and 37 ± 7 min, respectively. In-hospital mortality, stroke, or recurrent nerve injury did not occur in any patient. One patient developed paraparesis, which completely recovered at discharge. During the follow-up period (mean 18 ± 7 months), 1 patient died of heart failure. Fenestration site occlusion did not occur. Follow-up computed tomography (mean 12 ± 6 months postoperatively) revealed that the maximal aortic diameter remained unchanged at the levels of the distal end of the FET, the 10th thoracic vertebra and the coeliac artery; however, the aortic diameter was significantly reduced at the level of the pulmonary artery bifurcation.

Conclusions: The fenestrated FET technique is a simple, safe and effective procedure for selected patients with acute type A aortic dissection.
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http://dx.doi.org/10.1093/ejcts/ezaa411DOI Listing
April 2021

REPLY: IS EXTRACORPOREAL MEMBRANE OXYGENATION USEFUL IN CARDIAC TAMPONADE?

Authors:
Homare Okamura

J Thorac Cardiovasc Surg 2020 Nov 7. Epub 2020 Nov 7.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan; Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2020.07.112DOI Listing
November 2020

Common carotid artery true lumen flow impairment in patients with type A aortic dissection.

Eur J Cardiothorac Surg 2020 Nov 3. Epub 2020 Nov 3.

Department of Cardiovascular Surgery, Jichi Medical University, Saitama Medical Centre, Saitama, Japan.

Objectives: Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection.

Methods: Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded.

Results: Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023).

Conclusions: Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.
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http://dx.doi.org/10.1093/ejcts/ezaa322DOI Listing
November 2020

Successful transcatheter removal of a catheter migrating into the coronary sinus.

Asian Cardiovasc Thorac Ann 2021 May 26;29(4):343-344. Epub 2020 Oct 26.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1177/0218492320970020DOI Listing
May 2021

Long-Term Outcomes and Echocardiographic Data After Aortic Valve Replacement With a 17-mm Mechanical Valve.

Circ J 2020 11 24;84(12):2312-2319. Epub 2020 Oct 24.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University.

Background: We investigated the long-term clinical and hemodynamic outcomes after aortic valve replacement (AVR) with a 17-mm mechanical valve.Methods and Results:Between January 2005 and December 2011, 80 patients with aortic stenosis underwent AVR with the 17-mm St. Jude Medical Regent prosthetic valve. Echocardiography was performed preoperatively, at discharge, and at follow-up, which was performed at least 2 years postoperatively (median interval, 7.3 years). Prosthesis-patient mismatch (PPM) was defined as an indexed effective orifice area <0.85 cm/mat discharge and occurred in 25 patients (31%). The median follow-up period was 8.7 years (100% complete). Overall in-hospital mortality was 2.5% (2 patients) with 27 late deaths (34%). The 5- and 10-year survival rates were 78.7% and 63.0%, respectively. Peripheral arterial disease and concomitant mitral valve repair were independent predictors of late mortality. The 5- and 10-year freedom from major adverse valve-related events (MAVRE) rates were 91.6% and 83.5%, respectively. PPM at discharge did not affect long-term survival, freedom from MAVRE, or freedom from heart failure. Echocardiographic data at follow-up revealed a significant reduction in the mean left ventricular mass index (LVMI). LVMI reduction observed at follow-up was similar between patients with and without PPM.

Conclusions: AVR with the 17-mm mechanical prosthesis had acceptable long-term clinical and hemodynamic outcomes. Significant reduction in LVMI was observed regardless of PPM.
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http://dx.doi.org/10.1253/circj.CJ-20-0201DOI Listing
November 2020

Double-patch and glue repair of a postinfarction left ventricular pseudoaneurysm.

Asian Cardiovasc Thorac Ann 2021 Feb 30;29(2):116-118. Epub 2020 Aug 30.

Department of Cardiovascular Surgery, 83943Nerima Hikarigaoka Hospital, Tokyo, Japan.

An 85-year-old man with appetite loss, lightheadedness, and leg edema was referred to our institution. Computed tomography and transthoracic echocardiography revealed a left ventricular pseudoaneurysm with a maximal diameter of 80 mm and severe mitral regurgitation. Coronary angiography showed 90% stenosis and total occlusion of the left circumflex artery at segments 11 and 12, respectively. He was diagnosed with postinfarction left ventricular pseudoaneurysm and underwent patch repair using two bovine pericardium patches and biological glue, mitral valve replacement, and coronary artery bypass grafting. His postoperative course was uneventful.
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http://dx.doi.org/10.1177/0218492320957168DOI Listing
February 2021

Clinical outcome of acute thoracic aortic syndrome in nonagenarians.

Asian Cardiovasc Thorac Ann 2020 Nov 20;28(9):577-582. Epub 2020 Aug 20.

Department of Cardiovascular Surgery, 83943Nerima Hikarigaoka Hospital, Tokyo, Japan.

Background: Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians.

Methods: After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months.

Results: Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group.

Conclusion: Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).
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http://dx.doi.org/10.1177/0218492320952654DOI Listing
November 2020

Total arch and descending aorta replacement via left thoracotomy for infected post-thoracic endovascular aortic repair type B aortic dissection.

Gen Thorac Cardiovasc Surg 2021 Feb 27;69(2):346-349. Epub 2020 Jul 27.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, 179-0072, Japan.

A 38-year-old man underwent thoracic endovascular aortic repair for impending rupture of acute type B aortic dissection. Computed tomography revealed abscess formation around the proximal descending aorta 4 weeks after endovascular treatment. He underwent one-stage total arch and descending aorta replacement and omental wrapping via left thoracotomy. At the 6-month follow-up, his postoperative course was uneventful.
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http://dx.doi.org/10.1007/s11748-020-01446-8DOI Listing
February 2021

Sandwich repair for postinfarction ventricular septal rupture and left ventricular rupture.

Gen Thorac Cardiovasc Surg 2021 Jan 11;69(1):110-113. Epub 2020 Jun 11.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, 179-0072, Japan.

A 77-year-old woman who presented with chest pain was diagnosed with acute anterior myocardial infarction. Echocardiography revealed pericardial effusion, and she underwent sutureless repair for postinfarction left ventricular free wall rupture. Echocardiography performed 2 days postoperatively revealed ventricular septal rupture and left ventricular acute dilatation. Hemodynamic instability with ventricular tachycardia and rapid decline of kidney function developed. Four days after the primary surgery, we performed successful sandwich repair for ventricular septal rupture and the dilatation. Her postoperative course was uneventful, and postoperative evaluation did not show a residual shunt or left ventricular dilatation.
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http://dx.doi.org/10.1007/s11748-020-01405-3DOI Listing
January 2021

Minimized perfusion circuit for acute type A aortic dissection surgery.

Artif Organs 2020 Nov 7;44(11):E470-E481. Epub 2020 Jun 7.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

A minimized perfusion circuit (MPC) may reduce transfusion requirement and inflammatory response. Its use, however, has not been standardized for complicated cardiovascular surgery. We assessed outcomes of surgery for acute type A aortic dissection (ATAAD) performed with a MPC under circulatory arrest. The study involved 706 patients treated surgically for ATAAD (by hemiarch repair [n = 571] or total arch repair [n = 135]). Total arch repair was performed using selective antegrade cerebral perfusion. Our MPC, a semi-closed bypass system, incorporating a completely closed circuit and a level-sensing reservoir in the venous circuit, was used. Clinical variables, transfusion volume, and outcomes were investigated in patients who underwent hemiarch repair or total arch repair. The overall incidences of shock, organ ischemia, and coagulopathy (prothrombin time-international normalized ratio >1.5) were 26%, 35%, and 8%, respectively. Mean extracorporeal circulation (ECC) time was 149 minutes for the hemiarch repair group and 241 minutes for the total arch repair group, respectively. No patient required conversion to conventional ECC, and there were no complications related to the use of the MPC. The need for transfusion (98% vs. 91%, P = .017) and median transfusion volume (1970 vs. 1680 mL, P = .002) was increased in the total arch repair group. Neither in-hospital mortality (total arch; 12% vs. hemiarch; 7%, P = .11) nor 10-year survival (74.4% vs. 68.4%, P = .79) differed significantly. Outcomes of surgery for ATAAD performed with the MPC were acceptable. The possibility of transfusion and transfusion volume remains high during such surgery, despite the use of the MPC.
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http://dx.doi.org/10.1111/aor.13724DOI Listing
November 2020

Hybrid surgery for anomalous systemic arterial supply to the basal segments of the lung.

Interact Cardiovasc Thorac Surg 2020 Mar 28. Epub 2020 Mar 28.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1093/icvts/ivaa029DOI Listing
March 2020

Preoperative sarcopenia is associated with late mortality after off-pump coronary artery bypass grafting.

Eur J Cardiothorac Surg 2020 07;58(1):121-129

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Objectives: We investigated the association between sarcopenia (a marker of frailty) and outcomes after coronary artery bypass grafting (CABG).

Methods: This study included 304 patients who underwent elective isolated off-pump CABG at our hospital between October 2008 and August 2013. Psoas muscle area was measured on preoperative computed tomography scans. Sarcopenia was defined as the lowest sex-specific quartile of the psoas muscle area index (the psoas muscle area normalized for height). Patients were categorized into a sarcopenia group (76 patients) and a non-sarcopenia group (228 patients). Patients in the sarcopenia group were older and showed a lower body mass index, lower serum haemoglobin and albumin levels and lower prevalence of dyslipidaemia but higher prevalence of renal dysfunction and peripheral artery disease. The mean follow-up period was 4.5 ± 2.3 years.

Results: The cut-off values for sarcopenia were psoas muscle area index 215 and 142 mm2/m2 in men and women, respectively. No intergroup difference was observed in the in-hospital mortality and morbidity rates. After risk adjustment using inverse probability weighting analysis, late mortality rates were significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.022). Multivariable analysis showed that preoperative sarcopenia was an independent predictor of late mortality (hazard ratio 4.25, 95% confidence interval 2.18-8.28; P < 0.001). Preoperative sarcopenia was not associated with major adverse cardiac and cerebrovascular events during follow-up.

Conclusions: Preoperative sarcopenia (assessed by psoas muscle area index) was associated with late mortality after CABG and effectively predicts postoperative prognosis.
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http://dx.doi.org/10.1093/ejcts/ezz378DOI Listing
July 2020

Preoperative neurological deficit in acute type A aortic dissection.

Interact Cardiovasc Thorac Surg 2020 04;30(4):613-619

Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Objectives: Our goal was to evaluate postoperative outcomes in patients with type A aortic dissection with preoperative neurological deficits independent of shock.

Methods: Between 2002 and 2017, 150 of 1600 patients, operated on for aortic dissection type A in 3 centres, presented with preoperative new onset neurological deficits. Postoperative outcomes were classified using a modified Rankin Scale (mRS) as 'no to moderate disability' (mRS 0-3) or as 'poor clinical outcome' (mRS 4-6). Clinical and radiographic data were analysed.

Results: Ninety-three patients (62%) had no to moderate disability and 57 (38%) had a poor clinical outcome. The in-hospital mortality rate was 18% (28 patients). Patients with poor clinical outcomes were significantly older (P = 0.01) and had a significantly higher incidence of hypertension (P = 0.04), history of stroke (P = 0.03) and common carotid artery occlusion (left common carotid artery: P = 0.01; right common carotid artery: P < 0.01). One-third of all patients developed haemodynamic instability (P = 0.27). Cardiopulmonary bypass (P < 0.01) and cross-clamp (P = 0.03) times were significantly longer in patients with poor clinical outcomes. Age (odds ratio 1.041; P = 0.02) and history of stroke (odds ratio 2.651; P = 0.03) were predictive of poor clinical outcome; coma was not. Haemorrhagic transformation occurred in 7 patients without any independent predictors.

Conclusions: Most patients with preoperative neurological deficit have no to moderate disability postoperatively but commonly develop preoperative haemodynamic instability. This study suggests that an immediate surgical approach may be reasonable in patients with preoperative neurological deficit or coma.
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http://dx.doi.org/10.1093/icvts/ivz311DOI Listing
April 2020

Acute type A aortic dissection complicated with an aorto-right atrial fistula.

JTCVS Tech 2020 Mar 11;1:1-3. Epub 2020 Jan 11.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.xjtc.2020.01.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288752PMC
March 2020

Staged treatments of multiple pseudoaneurysms after total arch replacement.

J Card Surg 2020 Feb 25;35(2):467-469. Epub 2019 Nov 25.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

Background: An aortic pseudoaneurysm after cardiovascular surgery can be fatal.

Methods/results: Here, we describe the staged successful treatments of three pseudoaneurysms in a 77-year-old female patient who underwent total arch replacement and coronary artery bypass grafting 5 years ago. Computed tomography revealed three pseudoaneurysms: in the distal anastomosis of the total arch replacement, in the anastomosis of the left common carotid artery, and in the proximal anastomosis of the saphenous vein graft. Endovascular treatment and surgical repair were performed to treat these three pseudoaneurysms.

Discussion: An aortic pseudoaneurysm is a rare complication after cardiac or aortic surgery. Here, we present a case of combined endovascular and surgical repairs of three pseudoaneurysms in one patient.
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http://dx.doi.org/10.1111/jocs.14361DOI Listing
February 2020

Contemporary outcomes of composite aortic root replacement in elderly patients.

Interact Cardiovasc Thorac Surg 2020 03;30(3):443-450

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Figure 4.

Objectives: We investigated the clinical and haemodynamic outcomes in elderly patients undergoing composite aortic root replacement.

Methods: Between 2005 and 2017, 135 patients underwent aortic root surgery at our hospital. Of these 135 patients, 47 patients aged ≥65 years were included in this study. Pathologies included aneurysms in 31, chronic aortic dissection in 6, acute aortic dissection in 4 and other causes in 6 patients. A bioprosthesis was used in 27 and a mechanical valve in 20 patients. The mean age was 71.0 ± 4.3 years. The mean follow-up period was 61 ± 35 months. Follow-up echocardiographic data (average 48 months after surgery) were collected in 35 patients (74%).

Results: The in-hospital mortality rate was 2.1% (1 patient). Seven late deaths occurred during follow-up. The 1-, 5- and 8-year overall survival was 93.6%, 82.9% and 82.9%, respectively. Infective endocarditis, Marfan syndrome and diabetes were independent predictors of poorer survival. During the follow-up, thromboembolism occurred in 1 patient, major bleeding events in 5 patients, or proximal reoperation for prosthetic valve endocarditis in 1 patient. The type of valve, mechanical or biological valve, did not affect late mortality and morbidity. Follow-up echocardiography revealed significantly improved left ventricular ejection fraction compared with that at discharge.

Conclusions: Composite aortic root replacement provided satisfactory midterm outcomes in patients aged ≥65 years. Further studies with a longer follow-up are warranted to evaluate late valve-related events.
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http://dx.doi.org/10.1093/icvts/ivz267DOI Listing
March 2020

Ischaemic papillary muscle rupture without significant coronary artery lesion.

Interact Cardiovasc Thorac Surg 2019 12;29(6):971-972

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

Papillary muscle rupture is a rare but life-threatening complication of myocardial infarction (MI). Here, we describe a case of papillary muscle rupture caused by a microscopic MI. A 76-year-old woman was referred to our institution, where she developed cardiac arrest upon admission. Severe mitral regurgitation was noted without significant coronary artery lesions. Emergency surgery was performed, and posteromedial papillary muscle rupture was observed. Postoperatively, cardiac magnetic resonance imaging revealed a microscopic MI of the posteromedial papillary muscle.
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http://dx.doi.org/10.1093/icvts/ivz201DOI Listing
December 2019

REPLY: Optimal management of left ventricular free wall rupture considering the probability of rerupture.

Authors:
Homare Okamura

J Thorac Cardiovasc Surg 2019 09 3;158(3):e99-e100. Epub 2019 Jul 3.

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan; Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2019.05.072DOI Listing
September 2019

Incidence of postoperative atrial fibrillation in transdermal β-blocker patch users is lower than that in oral β-blocker users after cardiac and/or thoracic aortic surgery.

Gen Thorac Cardiovasc Surg 2019 Dec 2;67(12):1007-1013. Epub 2019 May 2.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, 179-0072, Japan.

Objective: Postoperative atrial fibrillation (POAF) after open heart surgery is associated with a high risk of mortality and morbidity. Although oral β-blockers are usually recommended to prevent POAF, the efficacy of a transdermal β-blocker patch in preventing POAF is unclear. We compared the incidence of POAF between users of oral and transdermal bisoprolol.

Methods: We investigated 108 patients who underwent cardiac and/or thoracic aortic surgery between April 2016 and February 2018. We compared perioperative clinical and hemodynamic variables between 49 patients treated with a transdermal bisoprolol patch and 59 patients treated with an oral bisoprolol fumarate.

Results: POAF occurred in 24% of patients in the transdermal and in 46% of patients in the oral bisoprolol groups (p = 0.027). No intergroup difference was observed in in-hospital mortality, perioperative blood pressures and heart rates, and other morbidities. Multivariable logistic regression analysis revealed that the use of transdermal bisoprolol was independently associated with a lower rate of POAF (odds ratio 0.21, 95% confidence interval 0.05-0.84, p = 0.027).

Conclusions: A transdermal bisoprolol patch is an effective and safe β-blocker drug delivery system. The incidence of POAF in this group was lower than that in users of oral bisoprolol.
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http://dx.doi.org/10.1007/s11748-019-01131-5DOI Listing
December 2019

Combined thoracoabdominal aortic repair and coronary artery bypass grafting in a patient with impaired left ventricular function.

J Thorac Cardiovasc Surg 2019 08 22;158(2):e35-e37. Epub 2019 Mar 22.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2019.03.018DOI Listing
August 2019

Impact of Carotid Artery Involvement in Type A Aortic Dissection.

Circulation 2019 04;139(16):1977-1978

Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (M.K., P.V., W.Y.S., J.E.B., N.D.D.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.038099DOI Listing
April 2019

Preoperative frailty is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery.

Gen Thorac Cardiovasc Surg 2019 Nov 5;67(11):917-924. Epub 2019 Apr 5.

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, Japan.

Objective: Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR.

Methods: Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100 m walking within 7 days after surgery (successful CR group) and 31 patients who achieved 100 m walking later than 8 days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale.

Results: The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18-1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30-10.51, p = 0.014).

Conclusions: Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.
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http://dx.doi.org/10.1007/s11748-019-01121-7DOI Listing
November 2019

How is preoperative sarcopenia assessed in patients undergoing heart valve surgery?

J Thorac Cardiovasc Surg 2019 04;157(4):e199-e200

Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jtcvs.2018.10.126DOI Listing
April 2019
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