Publications by authors named "Kentaro Kiryu"

6 Publications

  • Page 1 of 1

Avoiding anticoagulation drugs for postoperative atrial fibrillation enabled successful conservative treatment of left atrial dissection: a case report.

Surg Case Rep 2021 May 12;7(1):120. Epub 2021 May 12.

Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, Japan.

Background: Left atrial dissection is a rare complication of cardiac surgery, most commonly associated with mitral valve surgery. Herein, we report on the successful conservative treatment of left atrial dissection while avoiding anticoagulation therapy.

Case Presentation: A 64-year-old man developed left atrial dissection during operation for acute type A aortic dissection, most likely due to retrograde cardioplegia cannulation. As there was no connection between the left atrial dissection cavity and the left atrium on enhanced computed tomography, we did not administer anticoagulants to prevent expansion of the left atrial dissection cavity. However, the patient developed atrial fibrillation, which was successfully managed by beta-blocker and amiodarone administration. Follow-up imaging showed gradual left atrial dissection reduction, and the patient was started on anticoagulation therapy.

Conclusion: We were able to resolve left atrial dissection by preventing the use of anticoagulation therapy in the acute stage by managing the atrial fibrillation with antiarrhythmic drugs.
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http://dx.doi.org/10.1186/s40792-021-01194-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116416PMC
May 2021

[Traction-assisted Negative Pressure Wound Therapy for Pediatric Poststernotomy Mediastinitis:Report of Two Cases].

Kyobu Geka 2021 Feb;74(2):121-124

Department of Cardiovascular Surgery, Akita University, Akita, Japan.

We herein report two cases of pediatric poststernotomy mediastinitis treated by traction-assisted negative pressure wound therapy (NPWT) with Zip Surgical Skin Closure (Zip), which is a non-invasive skin closure device. We used this device with NPWT in cases of pediatric poststernotomy mediastinitis to stabilize the sternum and reduce the natural retractive forces of the skin. The patients were two boys (two and three months old), with an onset of infection at 13 and eight postoperative days, respectively. The culture examination detected methicillin-susceptible Staphylococcus aureus in both cases. Traction-assisted NPWT with Zip was performed at-75 mmHg for 16 and 33 days, and the wounds healed completely. In conclusion, this modification was successfully applied to treat pediatric poststernotomy mediastinitis and may help reduce the duration of treatment.
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February 2021

Calcified Aortic Wall Removal for Dysphagia Aortica Caused by Chronic Traumatic Aortic Pseudoaneurysm.

Ann Vasc Surg 2021 Feb 5. Epub 2021 Feb 5.

Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan.

In this study, we report a case of a 45-year-old man with dysphagia aortica secondary to chronic traumatic aortic pseudoaneurysm of the aortic isthmus. He had been involved in a motor vehicle accident 27 years earlier. Computed tomography demonstrated a severely calcified aortic pseudoaneurysm of the aortic isthmus that compressed the esophagus extrinsically. An invasive surgical procedure involving a graft replacement and removal of the calcified aortic wall released the esophageal compression and completely improved the patient's symptoms. To the best of our knowledge, a case of dysphagia aortica caused by calcified pseudoaneurysm has never been reported.
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http://dx.doi.org/10.1016/j.avsg.2021.01.088DOI Listing
February 2021

Direct Abdominal Aortic Access for Thoracic Endovascular Aortic Repair in a Patient with Severe Aortic and Arterial Calcification.

Ann Vasc Surg 2021 May 15;73:509.e21-509.e24. Epub 2021 Jan 15.

Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan.

Aortic and arterial calcification is a complication of advanced atherosclerosis and is a critical intraoperative issue that can reduce the ability to achieve safe and adequate access for stent graft introduction. Different vascular access sites are used to deliver stent grafts when a standard transfemoral or iliac access is not feasible. We report a challenging case of a direct transabdominal aortic thoracic endovascular aortic repair for a thoracic aortic aneurysm complicated with severe aortic and arterial calcification, in which the noncalcified area of the infrarenal abdominal aorta was extremely limited. This may be a reasonable access site, especially for patients with severe aortic and arterial calcification.
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http://dx.doi.org/10.1016/j.avsg.2020.11.001DOI Listing
May 2021

[Thoracic Endovascular Repair for Chronic Aortic Dissection with Aberrant Origin of the Left Vertebral Artery;Report of a Case].

Kyobu Geka 2020 Nov;73(12):1032-1036

Department of Cardiovascular Surgery, Akita University, Akita, Japan.

We herein report a case of thoracic endovascular aortic repair( TEVAR) for chronic aortic dissection with an aberrant left vertebral artery( LVA) originating from the aortic arch. A 51-year-old man with a medical history of Stanford type B acute aortic dissection 2 years ago was transferred to our institution for the treatment of an aortic expansion. Computed tomography showed a large entry just distal to the takeoff of the left subclavian artery and a dilated dissected thoracic aorta. A left cervical incision over the anterior border of the sternocleidomastoid was made, and the LVA was identified. The proximal LVA was ligated and anastomosed to the left common carotid artery in an end-to-side fashion. After completion of the carotid-subclavian bypass, TEVAR was performed in the usual fashion. The postoperative course was uneventful without stroke or spinal cord injury. At the 1-year follow-up, the false lumen had shrunk and the LVA remained patent.
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November 2020

Total arch repair with frozen elephant trunk using the "zone 0 arch repair" strategy for type A acute aortic dissection.

J Thorac Cardiovasc Surg 2019 Feb 15. Epub 2019 Feb 15.

Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan.

Objective: The aim of this study was to investigate the effect of frozen elephant trunk deployment from the zone 0 aorta to the descending aorta on early and midterm postoperative results in patients with acute type A aortic dissection.

Methods: Between October 2014 and April 2018, 108 patients underwent a combined strategy of frozen elephant trunk deployment, ascending aortic replacement, and arch vessel reconstruction ("zone 0 arch repair" strategy) for acute type A aortic dissection (excluding DeBakey type II). Of the 108 patients, 32 (29.6%) had primary tears of the aortic arch or descending aorta.

Results: The 30-day mortality rate was 2.8% (3 patients), and in-hospital mortality rate was 6.5% (7 patients). New-onset permanent neurologic dysfunction and spinal cord injury occurred in 3.7% and 0% of patients, respectively. Five of the 101 survivors underwent thoracic endovascular aortic repair during hospitalization (2 for rapid false lumen enlargement; 3 for true lumen stenosis). The overall survival was 89.8%, 88.1%, and 88.1% at 1, 2, and 3 years, respectively. The cumulative incidence of distal aortic reintervention was 5.8%, 9.1%, and 9.1% at 1, 2, and 3 years, respectively. Two patients underwent thoracic endovascular aortic repair for distal aortic enlargement after discharge.

Conclusions: The use of the "zone 0 arch repair" strategy can eliminate the need for invasive aortic arch resection. It also eliminates the false lumen and produces satisfactory early and midterm postoperative results. Therefore, it can be an alternative to hemiarch and total arch replacements, which are based on a conventional "tear-oriented resection" strategy.
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http://dx.doi.org/10.1016/j.jtcvs.2019.01.125DOI Listing
February 2019