Publications by authors named "Takayuki Kadohama"

28 Publications

  • Page 1 of 1

Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm results.

JTCVS Tech 2022 Aug 31;14:29-38. Epub 2022 May 31.

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

Objectives: To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection.

Methods: Between October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lumen area, aortic lumen area, and false lumen status were assessed at four aortic levels, the proximal and distal descending thoracic aorta (level A and level B, respectively), celiac artery branching (level C), and terminal aorta (level D). Aortic remodeling (postoperative area as a percentage of the preoperative area) was classified into 3 groups, positive (true lumen area ≥120% with aortic lumen <120% or true lumen area ≥80% with aortic lumen <80%), minimal (80% ≤ true lumen area and aortic lumen area <120%), and negative remodeling (all other changes).

Results: In-hospital mortality was 13 (6.6%) patients. The overall survival rate was 85.1% at 5 years. The freedom from distal aortic reintervention was 89.9% at 5 years. The prevalence of completely thrombosed or obliterated false lumen at 2 years was 96.8% at level A, 88.4% at level B, 47.2% at level C, and 27.6% at level D. The prevalence of positive aortic remodeling at 2 years was 84.7% at level A, 75.0% at level B, 29.2% at level C, and 16.7% at level D.

Conclusions: Zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection can avoid invasive aortic arch resection and facilitate aortic remodeling of the descending thoracic aorta. The FET effect on aortic remodeling is limited at the aortic level below the FET stent end.
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http://dx.doi.org/10.1016/j.xjtc.2022.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366877PMC
August 2022

Enhanced strategy against mediastinitis with thoracic vascular graft infection: A combination of hydro-debridement with pulsed lavage and negative pressure wound therapies.

J Card Surg 2022 Sep 30;37(9):2741-2744. Epub 2022 Jun 30.

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

Background: We investigated the effects of hydrodebridement with pulsed lavage (HDPL) and negative pressure (NP) wound therapies, instead of excising the prosthetic graft, in patients with postoperative thoracic vascular graft infection (TVGI).

Methods: Between 2020 and 2021, five TVGI patients aged 49.6 ± 19.4 years old underwent a combined therapy of HDPL and NP. The patients underwent a two-step procedure (first step: re-sternotomy and HDPL; second step: NP) every 3 or 4 days. After negative tissue culture, the patients underwent omentum flap wrapping and skin closure.

Results: No hospital death was observed. The time to skin closure was 10.8 ± 3.4 days. The time to the day in which bacteria were not cultured was 3.5 ± 2.4 days. No recurrent infections occurred for 241 ± 186 postoperative days.

Conclusion: Our strategy for TVGI patients may contribute to (1) sufficient infection control, (2) physical rehabilitation, and (3) less invasiveness for high-risk patients.
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http://dx.doi.org/10.1111/jocs.16705DOI Listing
September 2022

Optimal stent length and distal positioning of frozen elephant trunks deployed from the aortic zone 0 for type A acute aortic dissection.

J Thorac Cardiovasc Surg 2022 Mar 12. Epub 2022 Mar 12.

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

Objectives: To investigate the optimal stent length and distal positioning of frozen elephant trunks (FETs) in patients with type A acute aortic dissection (TAAD).

Methods: Between October 2014 and April 2021, 191 patients (FET-150 group: 37 patients; stent length, 150 mm; 66.3 ± 12.6 years and FET-non-150 group: 154 patients; 60, 90, or 120 mm; 64.1 ± 12.5 years) underwent total arch repair with FETs for TAAD using the "zone 0 arch repair" strategy. In the FET-150 group, the proximal stent end was positioned at the innominate artery origin of the arch. In the FET-non-150 group, the distal stent end was to be positioned just proximal to the aortic valve level using transesophageal echocardiography. The proximal end of the non-stented FET part was sutured to an arch graft together with the aortic wall at 1 to 2 cm proximal to the innominate artery origin.

Results: Distal stent ends were positioned at the thoracic vertebrae (Th) 4-5, 6-7, 8-9, and 10 levels in 0 (0%), 12 (32.4%), 25 (67.6%), and 0 (0%) patients, respectively, in the FET-150 group, and in 6 (3.9%), 98 (63.6%), 49 (31.8%), and 1 (0.7%), respectively, in the FET-non-150 group. No between-group difference in postoperative mortality was noted. The incidence of postoperative residual distal malperfusion and new-onset spinal cord ischemia in the FET-150 versus FET-non-150 groups were 2.7% versus 6.5% (P = .62) and 0% versus 1.9% (P = 1.00), respectively.

Conclusions: FET positioning with the distal stent end at around Th 8 can reduce residual distal malperfusion when a FET with a 150-mm stent is deployed from the aortic zone 0 in patients with TAAD undergoing total arch repair.
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http://dx.doi.org/10.1016/j.jtcvs.2022.03.007DOI Listing
March 2022

Pacemaker Lead-induced Tricuspid Valve Stenosis and Reverse Lutembacher Syndrome.

Ann Thorac Surg 2022 08 16;114(2):e113-e115. Epub 2021 Dec 16.

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

Reverse Lutembacher syndrome is a rare cause of hypoxia characterized by the triad of tricuspid valve stenosis, elevated right atrial pressure, and an interatrial right-to-left shunt. We report a case of pacemaker lead-induced reverse Lutembacher syndrome in a 45-year-old woman who presented with dyspnea. The patient also developed pacemaker lead-induced superior vena cava obstruction accompanied by a right-to-left shunt through systemic-to-pulmonary venous collaterals, which exacerbated the hypoxia. Tricuspid valve replacement using a bioprosthetic valve and patent foramen ovale closure improved her hypoxia.
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http://dx.doi.org/10.1016/j.athoracsur.2021.11.021DOI Listing
August 2022

Aortic remodeling mismatch: A potential risk factor of late distal stent graft-induced new entry after frozen elephant trunk deployment.

JTCVS Tech 2021 Aug 18;8:46-48. Epub 2021 Jun 18.

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

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http://dx.doi.org/10.1016/j.xjtc.2021.04.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350949PMC
August 2021

Endovascular rescue for malpositioned frozen elephant trunk into the false lumen.

J Card Surg 2021 Oct 26;36(10):3948-3951. Epub 2021 Jul 26.

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

We describe a case of frozen elephant trunk deployment unintentionally malpositioned into the false lumen. An 83-year-old man underwent total arch repair with a frozen elephant trunk for type A acute aortic dissection complicated by mesenteric malperfusion. However, intraoperative transesophageal echocardiography showed expansion of the false lumen in the descending aorta, suggesting a malpositioned frozen elephant trunk into the false lumen. Endovascular fenestration of the dissecting flap and subsequent endograft deployment from the inside of the malpositioned frozen elephant trunk graft to the true lumen of the descending aorta was successfully performed under intravascular ultrasound guidance.
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http://dx.doi.org/10.1111/jocs.15846DOI Listing
October 2021

Right coronary ostium occlusion by aortic valve tumor during systole.

J Card Surg 2021 Sep 30;36(9):3393-3395. Epub 2021 Jun 30.

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

Here, we present a case of acute myocardial infarction caused by an aortic valve tumor. Electrocardiography (ECG)-gated four-dimensional computed tomography revealed obstruction of the right coronary ostium by a mobile mass during systole. To ensure an accurate diagnosis of angina in patients without significant coronary artery disease, ECG-gated four-dimensional computed tomography is useful because it can simultaneously visualize the coronary ostium and arteries, aortic valve leaflets, and mass.
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http://dx.doi.org/10.1111/jocs.15777DOI Listing
September 2021

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 Jul 5;74:520.e23-520.e26. 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
July 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

[Tricuspid Valve Replacement Preserving the Leaflets in a Congenitally Corrected Transposition of the Great Arteries;Report of a Case].

Kyobu Geka 2020 Dec;73(13):1109-1112

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

In patients with a congenitally corrected transposition of the great arteries (ccTGA), the regurgitation of the systemic atrioventricular valve (SAVV) increases and anatomical right ventricular (ARV) dysfunction often progressively develops. A low systemic ventricular ejection fraction( SVEF) is a risk factor for mortality. However, in patients with a low ejection fraction of ARV, it is unclear how to best perform valve replacement for patients with regurgitation of SAVV. A 70-year-old female with respirator discomfort was admitted to our hospital and diagnosed to have situs solitus ccTGA, severe SAVV regurgitation, and ARV dysfunction. Her ARV ejection fraction was 25% and she was therefore dependent on inotropic agents. We successfully performed a tricuspid valve replacement while preserving the leaflets, the chorda tendineae's, and papillary muscles, and placing the lead for cardiac resynchronization therapy on the ARV. Her postoperative course was uneventful. Thereafter, she was discharged 6 weeks after surgery.
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December 2020

[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 for type A acute aortic dissection: the "zone 0 arch repair" strategy.

Ann Cardiothorac Surg 2020 May;9(3):251-253

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

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http://dx.doi.org/10.21037/acs.2020.02.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298236PMC
May 2020

Multiple graft injury due to migrated nonbroken sternal wires 2 years after cardiac surgery.

J Card Surg 2020 Jul 2;35(7):1640-1641. Epub 2020 Jun 2.

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

The migration of sternal wires into vital structures is a rare but potentially life-threatening complication and associated with infection in some cases. While a few cases have been reported the sternal wires were broken in those cases. To our knowledge, this is the first report of multiple, nonbroken, migrated sternal wires stabbing vascular grafts.
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http://dx.doi.org/10.1111/jocs.14685DOI Listing
July 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

Serum Neuron-Specific Enolase Level as Predictor of Neurologic Outcome after Aortic Surgery.

Thorac Cardiovasc Surg 2020 06 22;68(4):282-290. Epub 2019 Jan 22.

Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.

Background: This study aimed to evaluate the significance of serum neuron-specific enolase (NSE) level as a predictor of neurologic injury in thoracic aortic surgery.

Methods: We neurologically assessed 60 consecutive patients who underwent thoracic aortic surgery for thoracic aortic aneurysm ( = 26) and aortic dissection ( = 34). Using moderate hypothermic circulatory arrest with antegrade cerebral perfusion, total arch replacement and hemiarch replacement were performed in 37 and 23 patients, respectively. Serum NSE levels in venous blood samples drawn before surgery and at 1 day after surgery were measured. Severity of neurologic injury was categorized as either uncomplicated ( = 48), temporary neurologic dysfunction (TND,  = 5), or permanent neurologic dysfunction (PND,  = 7). The extent of stroke was estimated on computed tomography or magnetic resonance imaging.

Results: The NSE level significantly differed among the three groups (PND > TND > uncomplicated) on the first postoperative day. Receiver-operating characteristic curve analysis showed that the cutoff value of NSE level was 34.14 ng/mL for neurologic injury (sensitivity, 0.769; specificity, 0.851) and 43.56 ng/mL for PND (sensitivity, 1.000; specificity, 0.963). The NSE level significantly correlated with the extent of stroke ( = 0.61,  < 0.001).

Conclusion: Serum NSE level is a significant predictor of adverse neurologic outcomes and extent of stroke after thoracic aortic surgery.
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http://dx.doi.org/10.1055/s-0038-1677511DOI Listing
June 2020

[In situ Replacement with Bovine Pericardial Roll Graft for Infected Aneurysm of the Thoracoabdominal Aorta].

Kyobu Geka 2015 Nov;68(12):976-9

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

A 63-year-old man presented to a nearby doctor with fever and lumbago. Enhanced computed tomography showed a thoracoabdominal aortic aneurysm and enhancement of soft tissue around the aneurysm. He was diagnosed with an infected thoracoabdominal aortic aneurysm and given antibiotics. After 2 weeks, the infection was controlled and he underwent in situ replacement with a bovine pericardial roll graft. A week after the operation, the inflammatory reaction was increased, but the bovine pericardial roll graft was not infected. This suggests that a bovine pericardial roll graft is a suitable material for use in patients with bacterial infections.
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November 2015

Correction of tetralogy of Fallot in an adult using a stented bioprosthetic valved conduit.

Gen Thorac Cardiovasc Surg 2011 Jun 15;59(6):422-5. Epub 2011 Jun 15.

Department of Cardiovascular Surgery, Sapporo-Kosei General Hospital, Kita 3, Higashi 8-5, Chuo-ku, Sapporo, Hokkaido 060-0033, Japan.

A 55-year-old man with tetralogy of Fallot successfully underwent correction using a valved conduit. He was diagnosed as having congenital heart disease during childhood, but no surgical intervention was performed. Cyanosis and dyspnea on effort had progressed gradually. Catheterization showed a left ventricular end diastolic volume of 126 ml, and the pulmonary arteries had sufficient diameters. To prevent postoperative pulmonary regurgitation, we planned to use a bioprosthetic valved conduit for right ventricular outflow tract reconstruction. At 4.5 years after the operation he is in New York Heart Association functional class I. The catheterization performed 1.5 years after the surgery showed no pressure gradient between the right ventricle and the pulmonary artery. Thus, total correction of tetralogy of Fallot in an adult can be achieved safely, and the use of a bioprosthetic stented valved conduit can be beneficial.
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http://dx.doi.org/10.1007/s11748-010-0702-zDOI Listing
June 2011

[Management of arterial access for thoracic endovascular aortic repair].

Kyobu Geka 2011 Jan;64(1):26-9

Department of Cardiovascular Surgery, Shin-Nittetsu Muroran General Hospital, Muroran, Japan.

Problems associated with arterial access can sometimes occur in elder patients with arteriosclerosis. This study examined the management of patients with restricted arterial access using thoracic endovascular aortic repair (TEVAR). Thirty-four consecutive patients underwent TEVAR at our institution. TEVAR was performed using a Gore TAG device (n = 20), Talent thoracic stent graft (n = 10), and a homemade endoprosthesis device (n = 3). The sizes of the applied sheath introducer or delivery catheter were 20 Fr (n = 1), 22 Fr (n = 12), 24 Fr (n = 17), and 25 Fr (n = 4). Although the procedure was completed in all cases, additional procedures for catheter preparation were required in 8 patients (23.5%). Percutaneous transluminal angioplasty (PTA) with stents placed in the iliac artery (n = 3) or the installation of a bypass conduit (n = 4) was also carried out. For the remaining cases, in which advancement of the TAG sheath introducer to the appropriate position was not possible, the endoprosthesis was deployed without the sheath introducer. Two cases required PTA after the procedure due to an injury of the iliac artery. Although some additional procedures may be required, TEVAR can be performed in patients with problems of arterial access.
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January 2011

Vacuum-assisted closure for pediatric post-sternotomy mediastinitis: are low negative pressures sufficient?

Ann Thorac Surg 2008 Mar;85(3):1094-6

Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.

We present 3 cases of pediatric post-sternotomy mediastinitis treated by a vacuum-assisted closure (VAC). The patients 2 girls, aged 6 months and 10 months, and a 2-year-old boy. The onset of infection was at 9, 14, and 32 postoperative days. The culture examination detected coagulase-negative Staphylococci strains in 2 cases, and Staphylococcus aureus in 1 case. A VAC was performed at -50 mm Hg for 10, 12, and 7 days. The wounds were closed without vascularized soft tissue. A VAC under a low negative pressure is a useful and safe procedure for the management of pediatric post-sternotomy mediastinitis.
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http://dx.doi.org/10.1016/j.athoracsur.2007.09.004DOI Listing
March 2008

Perforation of the ascending aorta with a hematoma extending into the left-side upper extrapleural cavity.

Interact Cardiovasc Thorac Surg 2008 Apr 18;7(2):318-9. Epub 2007 Dec 18.

Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.

We herein present an extremely rare case of a perforation of the ascending aorta with a hematoma extending into the left-side upper extrapleural cavity. A 62-year-old male with a sudden onset of severe chest pain was referred to our institution because of an abnormal shadow in the left-side upper lung field. Computed tomography revealed a small fusiform aortic arch aneurysm and a hematoma extending to the left-side upper extrapleural cavity. We diagnosed the patient to have acute aortic syndrome and urgent surgery was thus performed. Major bleeding which might be caused by a progression of the perforation was seen during a dissection of the aorta. The aortic arch was transected and a total arch replacement was performed with a 26 mm Dacron graft. No findings of a rupture of the aortic arch aneurysm or dissection were observed. The histopathology of the aorta revealed a severe atheromatous lesion with calcification and thinning disarrayed elastic fibers. The postoperative course was essentially good except for the development of pericardial effusion which required drainage.
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http://dx.doi.org/10.1510/icvts.2007.166066DOI Listing
April 2008

[Vacuum-assisted wound closure in the management of deep sternal wound infection].

Kyobu Geka 2007 Nov;60(12):1066-8

Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.

We herein present a case who underwent vacuum-assisted wound closure (VAC) therapy for post-sternotomy mediastinitis. A 71-year-old female with chronic renal failure on dialysis underwent a graft replacement of the ascending aortic aorta for the treatment of an acute aortic dissection. After she was discharged from the hospital, a purulent discharge was noted to occur from the median sternal wound. The wound was therefore reopened and all sternal wires were removed. Thereafter, polyurethane foam which was shaped to fit the defect was placed within the cavity. The area was covered with adhesive drape and suction drainage was carried out at -100 mmHg. The polyurethane foam was replaced every few days. The wound was finally closed using a muscle flap at 49 days after surgery. VAC therapy is therefore considered to be a useful treatment modality for deep sternal wound infections.
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November 2007

Staged repair for a chronic dissecting thoracic aortic aneurysm with no transfusion in a Jehovah's Witness patient.

Gen Thorac Cardiovasc Surg 2007 Jun;55(6):262-5

Department of Surgery, Midorigaoka 2-1-1, Asahikawa, Hokkaido 078-8510, Japan.

We present the case of a 59-year-old male Jehovah's Witness who underwent staged repair for a thoracic aortic aneurysm with no transfusion. The primary operation to replace the distal portion of the aortic arch and left subclavian artery reconstruction were performed. We applied axilla femoral artery temporary external bypass. A second operation was carried out 8 months later. We replaced the descending aorta and reconstructed the intercostal arteries under temporary bypass in the same manner as was done during the previous operation. The blood losses and minimum hemoglobin values during the two operations were 2235 and 13,941 ml, respectively, 8.8 and 5.9 g/dl, respectively. Administration of erythropoietin and a drainage blood recovery device were useful. Surgical repair for a thoracic aortic aneurysm using a temporary bypass is thus considered a viable surgical option in such situations and is important for conducting effective perioperative management.
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http://dx.doi.org/10.1007/s11748-007-0118-6DOI Listing
June 2007

Hepatic artery aneurysm involving the proper hepatic and gastroduodenal artery treated using a gastroepiploic artery in situ bypass.

J Vasc Surg 2007 May;45(5):1069-71

Department of Cardiovascular Surgery, Shin-Nittetsu Muroran General Hospital, Muroran, Japan.

We herein present the first known case of common hepatic artery aneurysm involving the proper hepatic artery treated with in situ bypass by using right gastroepiploic artery. A 55-year-old man was hospitalized after the incidental discovery of a low-echogenic mass with blood flow in the hepatic artery. Selective visceral arteriography demonstrated a hepatic artery aneurysm that filled via the superior mesenteric artery. The most proximal part of the common hepatic artery was occluded. A resection of aneurysm was performed, and the arterial blood flow was restored to the liver by mobilizing the right gastroepiploic artery and anastomosing the proper hepatic artery. This technique is preferable to grafting in that only one anastomosis is necessary and predicts that the results may be at least as good as with vein or prosthetic grafts.
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http://dx.doi.org/10.1016/j.jvs.2006.12.047DOI Listing
May 2007

Effects of different types of fluid shear stress on endothelial cell proliferation and survival.

J Cell Physiol 2007 Jul;212(1):244-51

Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.

We attempted to clarify the effect of different types of shear stress on endothelial cell (EC) proliferation and survival. Bovine aortic ECs were subjected to either steady laminar, 1 Hz pulsatile, or 1 Hz to and fro shear at 14 dyne/cm(2). % of BrdU positive EC was 14.3 +/- 1.6% in steady, 21.5 +/- 3.2% in pulsatile, and 11.4 +/- 2.4% in to and fro after 4 h, respectively (P < 0.05). Pulsatile shear compared with static control. Rapamycin reduced BrdU incorporation in all shear regimens (P < 0.001). However, it was still higher in EC exposed to pulsatile shear than the other regimens (P < 0.005). PD98059 completely abolished the increased BrdU incorporation in all shear regimens, including pulsatile shear. Pulsatile shear had significantly elevated ERK1/2 phosphorylation at 5 min compared with steady (P < 0.05) and to and fro shear (P < 0.01) while there was no significant difference in pp70(S6k) phosphorylation between any shear regimen. The ratio of apoptotic cells in serum deprived EC in the presence of steady laminar, pulsatile and to and fro shear for 4 h were 2.7 +/- 0.78%, 2.7 +/- 0.42%, and 2.9 +/- 0.62%, respectively while after the addition of serum for 4 h, it was 4.3 +/- 0.73%. All shear regimens phosphorylated AKT in a time-dependent manner with no significant difference between regimens. Our results demonstrate that different types of shear stress regimens have different effects on EC and may account for the variable response of EC to hemodynamics in the circulation.
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http://dx.doi.org/10.1002/jcp.21024DOI Listing
July 2007

p38 Mitogen-activated protein kinase activation in endothelial cell is implicated in cell alignment and elongation induced by fluid shear stress.

Endothelium 2006 Jan-Feb;13(1):43-50

Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Fluid shear stress is thought to be important in maintaining the phenotype of endothelial cells (ECs) in vivo. The purpose of the study was to determine the effect of varying levels of laminar shear stress on EC elongation and alignment and the role of p38 mitogen-activated protein kinase (MAPK) on the morphologic change induced by shear stress. Cultured bovine aortic ECs were subjected to 1, 4, 7, 14, or 20 dyne/cm(2) laminar steady shear stress. On morphometric analysis of static ECs, the average orientation angle was 41 degrees , whereas after 24 h shear stress at 1, 4, 7, 14, and 20 dyne/cm(2) the angles were 34 degrees, 33 degrees, 16 degrees, 11 degrees, and 10 degrees, respectively. The shape index of static ECs was 0.76, whereas the indexes of ECs exposed to shear stress were 0.72, 0.72, 0.65, 0.50, and 0.47, respectively. The time and the magnitude of activation of p38 MAPK were dependent on the level of shear stress. The results indicate that a minimum shear stress of 7 to 14 dynes/cm(2) is necessary for cell alignment and elongation and this correlates with activity of p38 MAPK. ECs exposed to shear stress in the presence of the p38 MAPK inhibitor SB-203580 did not orient in any manner and the shape index was similar to the static cells.
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http://dx.doi.org/10.1080/10623320600660219DOI Listing
September 2006

Role of AKT in cyclic strain-induced endothelial cell proliferation and survival.

Am J Physiol Cell Physiol 2006 Mar;290(3):C812-21

Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, 333 Cedar St., FMB 137, New Haven, CT 06520-8062, USA.

Endothelial cells (ECs) are exposed to repetitive cyclic strain (CS) in vivo by the beating heart. The aim of this study was to assess the influence of CS amplitude and/or frequency on EC proliferation and survival and to determine the role of AKT in CS-induced EC proliferation and survival. Cultured bovine aortic ECs were exposed to 10% strain at a frequency of 60 (60 cpm-10%) or 100 (100 cpm-10%) cycles/min or 15.6% strain at a frequency of 60 cycles/min (60 cpm-15.6%). AKT, glycogen synthase kinase (GSK)-3beta, BAD, and cleaved caspase-3 were activated by CS in ECs. Increasing the magnitude or frequency of strain resulted in an earlier phosphorylation of GSK-3beta, although the magnitude of phosphorylation was similar. After CS at 60 cpm-10% for 24 h, the number of nontransfected ECs was significantly increased by 8.5% (P < 0.05). We found that the number of apoptotic ECs was slightly decreased with exposure to CS. ECs transfected with kinase-dead AKT (KA179) as well as plasmids containing a point mutation in the pleckstrin homology domain of AKT (RC25) not only prevented AKT, GSK-3beta, and BAD phosphorylation but also inhibited the CS-induced increase in cell number as well as the CS-induced protection against apoptosis (both P < 0.05). The ratio of 5'-bromo-2'-deoxyuridine-positive cells was increased when ECs transfected with RC25 and KA179 as well as nontransfected ECs and ECs transfected with Lipofectamine 2000 were exposed to CS. We conclude that AKT is important in enhancing the survival of ECs exposed to CS but is not involved in EC proliferation.
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http://dx.doi.org/10.1152/ajpcell.00347.2005DOI Listing
March 2006
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