Language：English   Publisher：The Japanese Society of Internal Medicine  

<p>A 67-year-old man on intense immunosuppressive therapy after heart transplantation for end-stage hypertrophic cardiomyopathy 7 years ago developed severe dyspnea and was admitted to our hospital. His serum severe acute respiratory syndrome coronavirus 2 antigen test was positive, and he was diagnosed with coronavirus disease 2019 (COVID-19)-related pneumonia. He was started on ventilatory management for severe respiratory failure and remdesivir for COVID-19, with careful adjustment of immunosuppressive drugs. However, unexpectedly prolonged muscle weakness necessitated transfer to a rehabilitation facility. Although the COVID-19 pandemic has subsided, it is still considered a risk in post-transplant cases. Infection control is considered critical in heart transplant recipients, especially in those receiving intensified immunosuppressive drugs. </p>

DOI： 10.2169/internalmedicine.5254-25

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Language：English   Publisher：Heartrhythm Case Reports  

DOI： 10.1016/j.hrcr.2025.03.008

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Language：English   Publisher：(一社)日本内科学会  

Language：English   Publisher：Journal of Echocardiography  

Background: Vector Flow Mapping (VFM) is a novel technique for visualizing intracardiac blood flow. A few reports have been made regarding the reproducibility of energy loss (EL) measurements using VFM. This study aims to elucidate the intra-class and inter-class correlation coefficient (intra-ICC and inter-ICC) in the EL measurements. Methods: Seven healthy participants were enrolled, and echocardiographic data were obtained by two cardiac sonographers (14 images). Three independent analysts analyzed all images in three different cardiac cycles three times: 378 data points (14 images × analysts × 3 cardiac cycles × 3 times). The intra-ICC (1, 1) and inter-ICC (2, 1) were calculated. Furthermore, the intra-ICC (1, k) and inter-ICC (2, k) were applied using the averaged EL value in three cardiac cycles. An ICC value greater than 0.75 was defined as acceptable reproducibility. Results: In diastole, the intra-ICC (1, 1) by the three analysts was 0.890, 0.830, and 0.802; the intra-ICC (1, k), using the average EL value was 0.986, 0.978, and 0.973. In systole, the intra-ICC (1, 1) was 0.729, 0.698, and 0.733; the intra-ICC (1, k) was 0.960, 0.954, and 0.961. In diastole, the inter-ICC (2, 1) was 0.950, and the inter-ICC (2, k) was 0.958. In contrast, in systole, the inter-ICC (2, 1) was 0.772, and the inter-ICC (2, k) was 0.774; these values were lower than those in diastole. Conclusions: These findings indicate that the intra- and inter-measurer reproducibility of diastolic and systolic EL is favorable for clinical use.

DOI： 10.1007/s12574-025-00688-w

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Language：English   Publisher：European Heart Journal Case Reports  

DOI： 10.1093/ehjcr/ytaf154

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Publisher：南江堂  

DOI： 10.15106/j_kyobu78_249

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Language：Japanese  

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Language：English   Publisher：The Japanese Coronary Association  

Ventricular septal rupture is a serious complication of acute myocardial infarction. We encountered a rare case of ventricular septal rupture with intramyocardial dissection extending to the right ventricular free wall. Significant tricuspid valve regurgitation was also observed. The patient underwent a trans-right ventricular double-patch repair for ventricular septal rupture. Intraoperative findings revealed a detached inferior papillary muscle of the tricuspid valve secondary to intramyocardial dissection, which necessitated tricuspid valve replacement. In addition, because the edge of the ventricular septal rupture was extremely close to the mitral valve annulus, concomitant mitral valve replacement was performed to achieve a better fit of the left ventricular side patch. The postoperative course was uneventful, and echocardiography revealed no residual shunt flow. Double valve replacement combined with trans-right ventricular patch repair was useful in addressing this rare situation.

DOI： 10.7793/jcad.31.24-00021

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Language：English   Publisher：(NPO)日本冠疾患学会  

Language：English   Publisher：Journal of Echocardiography  

DOI： 10.1007/s12574-024-00647-x

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Language：English   Publisher：Jtcvs Techniques  

DOI： 10.1016/j.xjtc.2024.09.022

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Language：English   Publisher：Oxford University Press  

原発性悪性心臓腫瘍における心血管系合併症の発生率と特徴を後ろ向きに調査し、心血管系合併症の管理について検討した。2010年1月から2021年8月までに当院で治療を受けた原発性悪性心臓腫瘍患者13例(年齢31～81歳)の内訳は、血管肉腫5例、内膜肉腫3例、び漫性大細胞型B細胞リンパ腫3例、ユーイング肉腫1例、線維肉腫1例であった。心血管イベントは10例(77%)に認められ、その内訳は心機能不全6例、不整脈5例、右心不全2例、ワルファリンと化学療法の併用によるプロトロンビン時間の過剰延長が1例であった。症例Aは69歳女性で、左心房内膜肉腫の手術を受け、術後にドキソルビシン+イホスファミドによる化学療法と放射線治療を受けた。化学療法と放射線療法を3サイクル行った後、左室駆出率は34%に低下し、心不全治療が必要となった。症例Bは66歳男性で、原発性心筋リンパ腫に対して化学療法を受けた。その結果、腫瘍は縮小した。しかし、腫瘍が心室中隔に浸潤したため房室ブロックが発症し、心臓ペースメーカーの植え込みが必要となった。以上より、原発性悪性心臓腫瘍に対する集学的治療中に、心不全と不整脈の高い発生率が観察された。

Language：English   Publisher：Scientific Reports  

Intensive care unit-acquired weakness (ICU-AW) is recognized as newly-acquired bilateral muscle weakness, which is a complication of critical illness in the ICU; however, there are no reports on the pathogenesis and early predictors of ICU-AW specifically associated with cardiogenic shock (CS). Therefore, this study aimed to investigate the clinical characteristics of ICU-AW in patients with CS requiring mechanical circulatory support (MCS). This study was a single-center, prospective, and observational study. Patients aged 16 years and older who underwent MCS for CS were included. ICU-AW was diagnosed based on Medical Research Council (MRC) score after awakening. The ICU-AW group included patients with the MRC score < 48 points, and the non-ICU-AW group included those with ≥ 48 points. Twenty-eight cases were enrolled on admission and MRC score was evaluated in 23 cases after awakening. Eleven patients were included in the non-ICU-AW group and 12 patients (52%) were in the ICU-AW group. The ICU-AW group showed a higher prevalence of extracorporeal membrane oxygenation and ventilator use. Creatine kinase, troponin T, interleukin (IL)-15 levels on admission were significantly higher, whereas hemoglobin and albumin levels were significantly lower in the ICU-AW group. A strong negative correlation was observed between the initial MRC scores and IL-15 levels. ICU-AW occurred 52% of patients with CS using MCS, indicating the significance of recognizing and managing this complication for those patients. In addition, IL-15 can be a potential biomarker for the early prediction of ICU-AW.

DOI： 10.1038/s41598-025-87381-1

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Language：English   Publisher：Pediatrics and Neonatology  

Background: To assess the performance of pediatric extracorporeal membrane oxygenation (ECMO) centers, outcomes were compared between metropolitan and other areas. Methods: A retrospective cohort study was conducted at three regional centers on Kyushu Island and the largest center in the Tokyo metropolitan area of Japan. The clinical outcomes of patients of ≤15 years of age who received ECMO during 2010–2019 were investigated, targeting the survival and performance at discharge from intensive care units (ICUs), using medical charts. Results: One hundred and fifty-five patients were analyzed (regional, n = 70; metropolitan, n = 85). Survival rates at ICU discharge were similar between the two areas (64%). In regional centers, deterioration of Pediatric Cerebral Performance Category (PCPC) scores were more frequent (65.7% vs. 49.4%; p = 0.042), but survival rates and ΔPCPC scores (PCPC at ICU discharge–PCPC before admission) improved in the second half of the study period (p = 0.005 and p = 0.046, respectively). Veno-arterial ECMO (odds ratio [OR], 3.00; p < 0.03), extracorporeal cardiopulmonary resuscitation (OR, 8.98; p < 0.01), and absence of myocarditis (OR, 5.47; p < 0.01) were independent risk factors for deterioration of the PCPC score. A sub-analysis of patients with acute myocarditis (n = 51), the main indicator for ECMO, revealed a significantly higher proportion of cases with deteriorated PCPC scores in regional centers (51.9% vs. 25.0%; p = 0.049). Conclusions: The survival rates of pediatric patients supported by ECMO in regional centers were similar to those in a metropolitan center. However, neurological outcomes must be improved, particularly in patients with acute myocarditis.

DOI： 10.1016/j.pedneo.2024.04.005

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Language：English  

DOI： 10.1186/s44215-024-00182-2

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Language：Japanese   Publisher：Japanese Society of Sonographers  

<p>症例は70代女性．労作時息切れの増悪のため近医を受診したところ，心房中隔欠損症を指摘され当院へ紹介受診となった．2次元経胸壁心エコー図検査で心房中隔に複数の欠損孔と左右短絡血流が認められたことから多孔性心房中隔欠損症（Multiple-ASD）と診断されたが，欠損孔の位置，個数，形態など解剖学的位置関係の把握には限界があり，3次元経胸壁心エコー図検査の機能も併用することで3カ所の欠損孔を同定することができた．術中経食道心エコー図検査では3次元経胸壁心エコー図検査で指摘した所見と同様の所見が得られ，経皮的心房中隔欠損閉鎖術において最も大きい欠損孔を含む2カ所を閉鎖し手技終了となった．</p><p>2次元経胸壁心エコー図検査と併用した3次元経胸壁心エコー図検査の様々な機能を活用することで，multiple-ASDの欠損孔の位置や形態評価に有用であった症例を経験したので報告する．</p>

DOI： 10.11272/jss.429

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Language：Japanese   Publisher：(一社)日本超音波検査学会  

症例は70歳女性.労作時息切れの増悪のため近医を受診したところ,心房中隔欠損症を指摘され当院へ紹介受診となった.2次元経胸壁心エコー図検査で心房中隔に複数の欠損孔と左右短絡血流が認められたことから多孔性心房中隔欠損症(Multiple-ASD)と診断されたが,欠損孔の位置,個数,形態など解剖学的位置関係の把握には限界があり,3次元経胸壁心エコー図検査の機能も併用することで3ヶ所の欠損孔を同定することができた.術中経食道心エコー図検査では3次元経胸壁心エコー図検査で指摘した所見と同様の所見が得られ,経皮的心房中隔欠損閉鎖術において最も大きい欠損孔を含む2ヶ所を閉鎖し手技終了となった.2次元経胸壁心エコー図検査と併用した3次元経胸壁心エコー図検査の様々な機能を活用することで,multiple-ASDの欠損孔の位置や形態評価に有用であった症例を経験したので報告する.(著者抄録)

Language：English   Publisher：BioMed Central  

症例は76歳女性で、重症大動脈弁と虚血性心疾患に対し、21mm Carpentier-Edwards Perimount弁を用いた大動脈弁置換術(AVR)および左内胸動脈-左前下行枝バイパス術を施行した。術中に高安動脈炎(TA)が疑われたが、病理診断は確定せず、術後のステロイドや免疫抑制療法は行われなかった。術後14年で構造的弁劣化による大動脈硬化症を発症し、経胸壁心エコーで弁の硬化と運動障害を認めた。CTで上行大動脈の拡張(最大径42mm)と生体弁が左室流出路内に完全逸脱していることが判明したため、再手術を施行した。正中切開にて再胸骨切開を行い、人工心肺を確立した。上行大動脈と大動脈根部には強い癒着があり、TAの炎症後変化と考えられた。大動脈遮断後、弁を確認すると、生体弁が左室流出路に完全に逸脱し、大動脈-僧帽弁連続部に強固に固定されていた。右冠動脈周囲には石灰化を伴う強固な癒着があり、コンポジットグラフト置換は回避し、上行大動脈置換術とAVRを施行した。術後経過は順調で、術後エコーでは弁機能正常で傍弁逆流や弁揺動を認めなかった。

Language：English   Publisher：シュプリンガー・ジャパン(株)  

経皮的心室補助装置の日本レジストリー(J-PVAD)を用いて、経皮カテーテル型心臓ポンプ(Impella)移植を受けた患者の30日生存率と出血合併症を分析した。対象は2017年10月～2020年1月にImpella移植を受けた患者1344人で、そのうち653人はImpella単独、685人は静脈動脈体外式膜型人工肺とImpella(ECPELLA)の併用で、6人ではImpella移植が失敗した。患者の30日生存率は67.0%で、Impella単独群が81.9%、ECPELLA群が52.7%であった。有害事象では、Impellaとの関連有り、または関連を否定できずの出血/血腫が6.92%で、医療機器アクセス部位からの血腫と出血の発生率は1.41%と4.09%であった。これらの事象の病因には差がなかった。以上より、Impella移植患者の実際の出血有害事象の頻度は、以前の報告から予想される範囲内であった。

Language：English   Publisher：Journal of Artificial Organs  

Purpose: Bleeding complication is a critical risk factor for outcomes of acute heart failure patients requiring mechanical circulatory support (MCS), including percutaneous catheter-type heart pumps (Impella). The Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD) is an ongoing, large-scale, real-world registry to characterize Japanese patients requiring Impella. Here we analyzed bleeding complication profiles in patients who received Impella. Methods: All consecutive Japanese patients who received Impella from October 2017 to January 2020 were enrolled. The 30-day survival and bleeding complications were analyzed. Results: A total of 1344 patients were included: 653 patients received Impella alone, 685 patients received a combination of veno-arterial extracorporeal membrane oxygenation and Impella (ECPELLA), and 6 patients had failed Impella delivery. Overall 30-day survival was 67.0%, with Impella alone at 81.9% and ECPELLA at 52.7%. Overall bleeding/hematoma adverse events with a relation or not-excluded relation to Impella was 6.92%. Among them, the rates of hematoma and bleeding from medical device access sites were 1.41% and 4.09%, respectively. There was no difference between etiologies for these events. Conclusion: This study represents the first 3-year survival and the safety profile focused on bleeding adverse events from the J-PVAD registry. The results show that the real-world frequency of bleeding adverse events for patients who received Impella was an expected range from previous reports, and future real-world studies should aim to expand this data set to improve outcomes and adverse events.

DOI： 10.1007/s10047-023-01429-5

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Language：English   Publisher：International Heart Journal Association  

<p>An 18-year-old man experienced refractory cardiogenic shock due to dilated cardiomyopathy of unknown aetiology, and was referred to our hospital to undergo a paracorporeal left ventricular assist device (LVAD) implantation. After surgery, the patient lost consciousness, with subsequent head computed tomography revealing low-density areas in the bilateral basal ganglia. Metabolic acidosis and hyperammonaemia also appeared. Metabolic evaluation and genetic tests led to a diagnosis of propionic acidemia. Following appropriate management of heart failure and propionic acidemia, his neurological and cardiac functions gradually recovered, and the paracorporeal LVAD was successfully explanted. Dilated cardiomyopathy and heart failure are rare manifestations of adult-onset propionic acidemia. This is the first reported case of cardiogenic shock due to propionic acidemia-associated cardiomyopathy successfully treated with a combination of mechanical circulatory support and medical therapy for heart failure and propionic acidemia.</p>

DOI： 10.1536/ihj.24-364

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Language：English  

DOI： 10.1186/s44215-024-00176-0

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Publisher：南江堂  

DOI： 10.15106/j_kyobu77_1017

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Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

症例は18歳男性で、精神運動発達遅滞の既往があった。労作時呼吸困難を主訴に近医を受診し、急性非代償性心不全と診断された。心不全はうっ血および低灌流所見を認めるwet-cold型であった。強心剤と利尿剤が投与されたが症状が改善せず、心原性ショックを呈したため、当院に搬送された。搬送時の血圧は84/70mmHg、心拍数は134bpmであった。胸部X線で肺うっ血を認め、心胸比は69%であった。心エコー検査で左室拡張末期径は69mmで、左室駆出率は16%であった。心臓カテーテル検査で肺動脈楔入圧は28mmHg、心係数は1.8L/min/m2であった。心内膜心筋生検で心筋症を認めた。難治性心原性ショックに対して植込み型補助人工心臓(LVAD)の植込み術を施行した。4日後に意識消失し、代謝性アシドーシスと高アンモニア血症を認めた。タンデムマス法でプロピオニルカルニチン(C3)の増加を認め、遺伝学的検査でPCCA遺伝子変異が検出された。プロピオン酸血症と診断し、栄養療法とカルベジロールを含む薬物療法を開始した。心機能は徐々に改善し、118日後にLVADから離脱した。左室駆出率は45%に増加し、173日後に退院となった。

Language：Japanese   Publisher：(株)南江堂  

症例は82歳男性で、労作時呼吸困難、下腿浮腫を主訴とした。約5年前より大動脈弁狭窄兼閉鎖不全症にて加療されるも心不全症状は改善せず、大動脈弁置換術の方針となった。心エコー所見では大動脈弁の石灰化や中等度～高度狭窄、中等度の逆流がみられ、四尖弁は確認できなかったが、術中所見で大動脈弁の右冠尖と左冠尖(LCC)の間に副冠尖(ACC)を認めたため大動脈四尖弁と確定診断した。4尖と弁輪の石灰化を切除または摘除後、LCCとACCの交連部を人工弁の交連部に合わせ、左右の冠状動脈の入口部を閉塞しないように人工弁を縫着した。その結果、術後心エコーでは大動脈弁周囲の逆流を認めず、心機能も良好であった。本症例は石灰化により可動性が低下した大動脈弁であったため、術前検査では診断に至らなかったが、大動脈四尖弁では弁尖の形態を把握し、冠状動脈の閉塞や損傷がないよう人工弁を縫着することが重要である。

Language：English   Publisher：BioMed Central  

症例は54歳男性で、好酸球増加症候群(HES)で悪化した弁膜症のため26歳から、4回の正中切開を介する弁置換手術(3回の僧帽弁置換と1回の二弁置換)が行われた。すべての弁が生物由来であった。受診時に、重篤な狭窄により人工動脈弁の構造的悪化が認められた。人工僧帽弁は軽度の逆流のみで介入の基準を満たしていなかった。以前の4回の手術で移植された人工僧帽弁は好酸球浸潤を示し、HESコントロール不良によりシクロスポリン投与が導入された。生体人工動脈弁を用いて5回目の正中切開を介した動脈弁置換を行った。移植弁について好酸球浸潤は観察されなかった。患者は合併症を発症せず、術後15日目に退院した。

Language：English   Publisher：Japanese Journal of Clinical Oncology  

Background: Malignant primary cardiac tumors require multimodal approaches including surgery, chemotherapy and radiotherapy, but these treatments can be associated with cardiovascular complications. However, few reports have described the cardiovascular complications related to primary cardiac tumor treatment because of their rarity. Methods: Clinical records of patients with primary cardiac tumors treated at Kyushu University Hospital from January 2010 to August 2021 were retrospectively examined. Results: Of the 47 primary cardiac tumor patients, 13 (28%) were diagnosed with malignancy, including 5 angiosarcomas, 3 intimal sarcomas, 3 diffuse large B-cell lymphomas, 1 Ewing’s sarcoma and 1 fibrosarcoma. Cardiovascular events were observed in 10 patients (77%), including cardiac dysfunction in 6 patients, arrhythmias in 5 patients, right heart failure in 2 patients, and excessively prolonged prothrombin time due to the combination of warfarin and chemotherapy in 1 patient. Two patients who showed notable cardiac complications are described. Case A involved a 69-year-old woman who underwent surgery for a left atrial intimal sarcoma, followed by postoperative chemotherapy with doxorubicin plus ifosfamide and radiotherapy. After three cycles of chemotherapy and sequential radiotherapy, her left ventricular ejection fraction decreased to 34%, and ongoing heart failure therapy was required. Case B involved a 66-year-old man who received chemotherapy for primary cardiac lymphoma, resulting in tumor shrinkage. However, due to tumor involvement of the intraventricular septum, atrioventricular block developed, requiring cardiac pacemaker implantation. Conclusion: High incidences of cardiac failure and arrhythmias were observed during multimodal treatments for malignant primary cardiac tumors. Proper management of complications may lead to a favorable prognosis in patients with malignant primary cardiac tumors.

DOI： 10.1093/jjco/hyae138

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Language：English   Publisher：European Heart Journal Case Reports  

Background Early bioprosthetic valve dysfunction (BVD) due to pannus formation is uncommon in elderly patients, and only a limited number of cases have been reported. Case summary An 84-year-old man presented with exertional dyspnoea 3 years after surgical aortic valve replacement (SAVR) with a 19 mm Epic™ valve (Abbott, Santa Clara, CA, USA). Transthoracic echocardiography demonstrated progressive BVD, and cardiac computed tomography (CT) revealed sub-aortic pannus formation. Re-operative SAVR was performed using a 19 mm INSPIRIS RESILIA® valve (Edwards Lifesciences, Irvine, CA, USA), and pathological examination confirmed valve leaflet deformation caused by pannus overgrowth. At the 18-month follow-up, the patient exhibited favourable progress, with no indications of BVD or pannus recurrence. Discussion This case highlights the importance of recognizing early pannus formation as a cause of BVD, even in elderly patients. Early detection of BVD based on clinical symptoms and echocardiography is vital to allow timely surgical intervention before the deterioration of cardiac function. Cardiac CT helps to differentiate pannus from thrombus formation and guide treatment decisions.

DOI： 10.1093/ehjcr/ytae518

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Language：English   Publisher：Journal of Artificial Organs  

Collaboration between the implantation centers, management centers, and regional core hospitals is a key factor in securing long-term implantable ventricular assist device (VAD) management. In Kyushu, a management system for patients with implantable VADs has been established at the prefectural and regional levels. Presently, six implantable VAD implantation centers and seven management centers exists in the eight prefectures of Kyushu and Okinawa, with at least one specialized VAD centers in each prefecture. This collaborative management system allows patients with VADs to receive seamless treatment based on the same management concept wherever they live. In fact, approximately half of the present outpatients treated at our center reside outside the prefecture and are managed in collaboration with management centers and regional core hospitals. Among our patients, there were no significant differences in survival or rehospitalization-free rates between patients with VADs in and out of the prefecture, suggesting that the place of residence did not affect the outcome. With the increase in the number of patients with VADs and the diversification of patients, patient management has become more complex. Mutual collaboration between the implantation centers, management centers, and regional core hospitals, is essential to improve the quality of VAD management. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 85–88), with some modifications.

DOI： 10.1007/s10047-024-01451-1

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DOI： 10.1016/j.jjcc.2024.04.006

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Language：English   Publisher：シュプリンガー・ジャパン(株)  

Avalon Elite(AE)カニューレが有用であった小児の3症例を報告した。症例1は6歳男児で、術後の重度肺損傷と心原性肺水腫による無気肺に対する特発性僧帽弁断裂による急性僧帽弁逆流症であった。症例2は6歳男児で、肺移植施設への安全な搬送を目的とした末期放射線肺炎であった。症例3は7歳女児で、心原性肺水腫による重度の無気肺を伴う劇症心筋炎の回復期症例であった。いずれの症例でもAEカニューレを用いてVV-ECMOを確立し、期待通りの十分な支援を確保し、AEカニューレ関連の重度合併症もなく、良好な臨床経過を得た。

Language：English   Publisher：Journal of Artificial Organs  

The “Avalon Elite^®” cannula is a double-lumen cannula used to establish veno-venous extracorporeal membrane oxygenation support. The reported advantages are that extracorporeal circulation can be established by cannulating through the right internal jugular vein only, and there is less re-circulation than with a two-cannula technique. It is available in a wide range of cannula sizes and can be used in a variety of patients, from children to adults. We herein report three pediatric cases in which an Avalon Elite^® cannula was useful. The first was a case of acute mitral regurgitation due to idiopathic chordal rupture for postoperative severe lung injury and atelectasis due to cardiogenic pulmonary edema. The second was a case of end-stage radiation pneumonitis for safe transfer to facility of lung transplantation. The third was a convalescent case of fulminant myocarditis with severe atelectasis due to cardiogenic pulmonary edema. In each case, veno-venous extracorporeal membrane oxygenation using an Avalon Elite^® cannula was established, the expected sufficient support was secured, and a good clinical course was obtained without major complications associated with an Avalon Elite^® cannula.

DOI： 10.1007/s10047-023-01412-0

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PubMed

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b>  Several studies have shown that sodium-glucose cotransporter-2 inhibitors have a renoprotective effect on acute kidney injury (AKI), but their effect on cardiac surgery-associated AKI is unknown.</p><p><b><i>Methods and Results:</i></b>  AKI was induced in 25 rabbits without diabetes mellitus by cardiopulmonary bypass (CPB) for 2 h and they were divided into 5 groups: sham; dapagliflozin-treated sham; CPB; dapagliflozin-treated CPB; and furosemide-treated CPB (n=5 in each group). Dapagliflozin was administered via the femoral vein before initiating CPB. Kidney tissue and urine and blood samples were collected after the surgical procedure. There were no differences in the hemodynamic variables of each group. Dapagliflozin reduced serum creatinine and blood urea nitrogen concentrations, and increased overall urine output (all P<0.05). Hematoxylin and eosin staining showed that the tubular injury score was improved after dapagliflozin administration (P<0.01). Dapagliflozin administration mitigated reactive oxygen species and kidney injury molecule-1 as assessed by immunohistochemistry (both P<0.0001). Protein expression analysis showed improvement of inflammatory cytokines and apoptosis, and antioxidant enzyme expression was elevated (all P<0.05) through activation of the nuclear factor erythroid 2-related factor 2 pathway (P<0.01) by dapagliflozin.</p><p><b><i>Conclusions:</i></b>  Acute intravenous administration of dapagliflozin protects against CPB-induced AKI. Dapagliflozin may have direct renoprotective effects in renal tubular cells.</p>

DOI： 10.1253/circj.cj-23-0864

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CiNii Research

Publisher：南江堂  

DOI： 10.15106/j_kyobu77_574

CiNii Research

Language：Japanese   Publisher：(株)南江堂  

症例は78歳女性で、呂律不良、右片麻痺を主訴に、心エコー・造影CT所見より腹腔内膿瘍を感染源とする感染性心内膜炎(IE)と診断し、重度のMRを呈していたため、緊急で僧帽弁手術の方針とした。手術所見では僧帽弁後尖に巨大な円筒状の疣贅を認めた。疣贅は非常に脆く、一部崩壊していたため、疣贅を周囲の健常組織と一塊にして切除した。入院時の血液培養と術中の疣贅からParvimonas micraが検出され、meropenem投与を行った。術後3日目の大腸内視鏡検査で進行大腸癌が確認され、術後15日目に腹腔鏡下直腸前方切除術を行った。術後はIEの再燃なく、良好な経過が得られた。本症例は大腸癌から腹腔内膿瘍およびP.micraによるIEを発症し、MRをきたしたと考えられた。

Language：English   Publisher：(一社)日本循環器学会  

非糖尿病ウサギを用いて、心臓手術関連急性腎障害(AKI)に対する急性期ダパグリフロジン(Dapa)投与の腎保護作用を調べた。12～16週齢の非糖尿病ウサギ25匹を、5匹ずつシャム手術群、Dapa+シャム手術群、心肺バイパス(CPB)群、Dapa+CPB群、フロセミド+CPB(F+CPB)群に分けた。Dapa+シャム手術群とDapa+CPB群には、CPB開始前に右大腿静脈から0.5mg/kgのDapaを投与した。処置から24時間後にウサギを犠死させ、腎組織と尿・血液検体を採取した。血行動態は各群の5群間で差が認められなかった。Dapaは、血清クレアチニンおよび血中尿素窒素濃度を低下させ、全尿量を有意に増加させた。HE染色により、Dapa投与後に尿細管傷害スコアが有意に改善していた。Dapa投与により、免疫組織化学的評価で活性酸素種およびkidney injury molecule-1が有意に軽減した。タンパク質発現解析では、炎症性サイトカインおよびアポトーシスが有意に改善し、抗酸化酵素の発現が上昇していた。これは、DapaによるNrf2経路の活性化によるものであると考えられた。

Language：English   Publisher：International Heart Journal Association  

<p>Although anemia is a common comorbidity that often coexists with heart failure (HF), its clinical impact in patients with advanced HF remains unclear. We investigated the impact of hemoglobin levels on clinical outcomes in patients with advanced HF listed for heart transplantation without intravenous inotropes or mechanical circulatory support.</p><p>We retrospectively reviewed the clinical data of patients listed for heart transplantation at our institute who did not receive intravenous inotropes or mechanical circulatory support between 2011 and 2022. We divided the patients into those with hemoglobin levels lower or higher than the median value and compared the composite of all-cause death and HF hospitalization within 1 year from the listing date.</p><p>We enrolled consecutive 38 HF patients (27 males, 49.1 ± 10.8 years old). The median hemoglobin value at the time of listing for heart transplantation was 12.9 g/dL, and 66.7% of the patients had iron deficiency. None of the patients in either group died within 1 year. The HF hospitalization-free survival rate was significantly lower in the lower hemoglobin group (40.9% versus 81.9% at 1 year, <i>P</i> = 0.020). Multivariate Cox proportional hazards model analysis showed that hemoglobin as a continuous variable was an independent predictor for HF hospitalization (odds ratio 0.70, 95% confidence interval 0.49-0.97, <i>P</i> = 0.030).</p><p>Hemoglobin level at the time of listing for heart transplantation was a predictor of hospitalization in heart-transplant candidates without intravenous inotropes or mechanical circulatory support.</p>

DOI： 10.1536/ihj.24-067

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CiNii Research

Language：English   Publisher：Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery  

DOI： 10.1177/15569845241258973

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PubMed

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

2011～2022年に単施設で強心薬または機械的循環補助による介入を行っていない心臓移植待機中の進行心不全患者38例(平均49.1±10.8歳、男性71.1%)を対象に、臨床アウトカムに対するヘモグロビン(Hb)値の影響を後ろ向きに評価した。心臓移植のリストに掲載時のHb中央値(12.9g/dL)により、Hb低値群(19例)とHb高値群(19例)に分類した。24例(66.7%)が鉄欠乏症であった。1年以内の死亡は認められなかった。Hb低値群ではHb高値群と比べて、1年後時点での心不全による入院を認めない患者での生存率が有意に低かった。多変量Cox比例ハザード比モデル解析において、連続変数としてのHb値は心不全による入院の独立した有意な予測因子であった。

Publisher：Critical Care Medicine  

OBJECTIVES: This study aimed to investigate the current use and impact of pulmonary artery catheters (PACs) in patients with cardiogenic shock (CS) who underwent Impella support. DESIGN: This was a prospective multicenter observational study between January 2020 and December 2021 that registered all patients with drug-refractory acute heart failure and in whom the placement of an Impella 2.5, CP, or 5.0 pump was attempted or successful in Japan. SETTING: Cardiac ICUs in Japan. PATIENTS: Between January 2020 and December 2021, a total of 3112 patients treated with an Impella were prospectively enrolled in the Japan registry for percutaneous ventricular assist device (J-PVAD). Among them, 2063 patients with CS were divided into two groups according to the PAC use. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the 30-day mortality, and the secondary endpoints were hemolysis, acute kidney injury, sepsis, major bleeding unrelated to the Impella, and ventricular arrhythmias within 30 days. PACs were used in 1358 patients (65.8%) who underwent an Impella implantation. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) was significantly higher in the patients with PACs than in those without. Factors associated with PAC use were the prevalence of hypertension, out-of-hospital cardiac arrest, New York Heart Association classification IV, the lesser prevalence of a heart rate less than 50, and the use of any catecholamine. The primary and secondary endpoints did not significantly differ according to the PAC use. Focusing on the patients with VA-ECMO use, the 30-day mortality and hemolysis were univariately lower in the patients with PACs. CONCLUSIONS: The J-PVAD findings indicated that PAC use did not have a significant impact on the short-term outcomes in CS patients undergoing Impella support. Further prospective studies are required to explore the clinical implications of PAC-guided intensive treatment strategies in these patients.

DOI： 10.1097/CCM.0000000000006225

Scopus

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Annals of Vascular Surgery  

Background: In endovascular aortic repair (EVAR), preemptive embolization of sac branch vessels is effective in preventing postoperative type II endoleak (T2EL). However, this technique has not been widely adopted especially for lumbar arteries (LAs) because of technical difficulties and time constraints. This study aimed to investigate the efficacy of nonselective sac coil embolization, which is a simpler surgical method, in postoperative sac shrinkage for patients at a high risk of T2EL from LAs. Methods: We retrospectively assessed 76 patients who underwent elective EVAR for abdominal aortic aneurysm with 4 or more patent LAs or at least 1 patent LA of ≥2 mm at our hospital between January 2014 and December 2022. The patients who underwent sac coil embolization were included in Group Ⅰ (n = 20), and the others were divided into 2 groups: those with an inferior mesenteric artery that was originally occluded or embolized by coils or stent graft bodies (Group Ⅱ, n = 21), and those without that (Group Ⅲ, n = 35). In Group Ⅰ, 0.035-inch coils were inserted into the sac after complete stent graft deployment. The cumulative incidence of sac shrinkage (≥5 mm) was compared between the groups. Further, univariable and multivariable Cox regression analyses were used to determine the predictors of sac shrinkage. Results: Sac shrinkage (≥5 mm) was observed more frequently in Group Ⅰ (50%) than in Group Ⅱ (19%) and Group Ⅲ (17%) (P = 0.052 and 0.043, respectively). The cumulative incidence of sac shrinkage was significantly higher in Group Ⅰ than in Group Ⅱ (log-rank P = 0.039) and Group Ⅲ (log-rank P = 0.024). Multivariable Cox regression analyses revealed that sac embolization was a significant predictor of sac shrinkage (hazard ratio, 4.23; 95% confidence interval, 1.66–10.8; P = 0.003). Conclusions: Nonselective sac coil embolization in EVAR is potentially effective for sac shrinkage in the early postoperative phase in patients at high risk of T2EL from LAs. This simple procedure may improve prognosis after EVAR.

DOI： 10.1016/j.avsg.2023.12.069

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PubMed

Language：English   Publisher：Jtcvs Techniques  

DOI： 10.1016/j.xjtc.2024.03.015

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PubMed

Language：English   Publisher：Journal of Echocardiography  

DOI： 10.1007/s12574-023-00613-z

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PubMed

Language：Japanese   Publisher：Japanese Society for Adult Congenital Heart Disease  

Most ventricular septal defects (VSDs) are diagnosed in childhood and are often closed spontaneously or operated on by the time they reach adulthood, and surgery is rarely indicated in adulthood. VSDs in adulthood may be small VSDs with a small shunt volume or VSDs already diagnosed with pulmonary hypertension and not indicated for surgery. In particular, there are cases of VSD with severe pulmonary hypertension diagnosed as Eisenmenger’s syndrome and followed up with only conservative treatment. However, with recent advances in pulmonary hypertension medications, it has been reported that “treat and repair”, in which VSD with severe pulmonary hypertension is treated with pulmonary hypertension medications followed by surgical treatment, can be effective. In this report, we describe two cases of VSD with severe pulmonary hypertension that were successfully treated surgically by “treat and repair”.

DOI： 10.34376/jsachd.c-2023-0004

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-23-0698

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CiNii Research

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

心室中隔欠損症(VSD)の多くは幼少期に診断され,成人期到達時には自然閉鎖,または手術されていることが多く,成人期で手術適応となることは稀である.成人期のVSDではシャント量の少ない小さなVSDか,すでに肺高血圧を伴い治療適応外と診断されたVSDが見られる.特に重症肺高血圧を伴うVSDではEisenmenger症候群と診断され,保存的な治療のみで経過観察されてきた症例が存在する.しかし近年肺高血圧治療薬の進歩により,重症肺高血圧を伴うVSDであっても,肺高血圧治療薬で治療した後に外科的治療を行う"treat and repair"が有用であると報告されている.今回,重症肺高血圧を伴うVSDに対して"treat and repair"で外科的治療に到達し得た2例を報告する.(著者抄録)

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は49歳男性で、胃過形成性ポリープからの慢性出血に伴う貧血の加療目的に当院を紹介された。劇症心筋炎による重症心不全に対して左心補助循環装置(LVAD)を埋め込まれており、抗血栓薬としてクロピドグレルとワルファリン、酸分泌阻害剤としてボノプラザンが処方されていた。食道胃十二指腸鏡(EGD)検査で胃体部から胃洞部にかけて紅斑性ポリープを認め、内視鏡的粘膜切除術(EMR)によってポリープを摘出し、創部をクリップ閉鎖した。術後はボノプラザンを投与し絶食としていたが、3日後に下血し、EGDでEMR後の潰瘍からの出血がみられたため高周波凝固を行った。しかし、その後も下血は続き、高周波凝固に加えてポリグルコール酸シート、局所止血剤を用いるも出血のコントロールは得られなかった。術後13日目のEGDで胃洞部の潰瘍からの活動性出血を確認、内視鏡的手縫い縫合法を行った。V-Loc 180吸収性barbed suture糸と軟性ニードルホルダーを用いて4回にわたる縫合を行った。術後のEGD所見では創部の縫合が得られ出血はみられず、その後も出血はなく、25日後、潰瘍部の瘢痕形成が認められた。

Language：English   Publisher：Den Open  

We herein describe a 49-year-old man with severe heart failure due to fulminant myocarditis who underwent left ventricular assist device implantation and received clopidogrel and warfarin as antithrombotic agents. The patient developed anemia secondary to chronic bleeding gastric hyperplastic polyps, necessitating endoscopic mucosal resection. Despite attempts to manage post-endoscopic mucosal resection bleeding from a gastric ulcer by endoscopic hemostasis using hemostatic forceps, local hemostatic agents, and polyglycolic acid sheets, the bleeding persisted. Hemostasis of the refractory bleeding was finally achieved by endoscopic hand-suturing of the ulcer. One month later, the ulcer was almost completely scarred. This case has important clinical value in that it demonstrates the efficacy of endoscopic hand-suturing even in challenging cases such as refractory bleeding gastric ulcers in patients with left ventricular assist devices.

DOI： 10.1002/deo2.369

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Publisher：Circulation Journal  

Background: The introduction of transcatheter edge-to-edge repair for moderate-to-severe or severe mitral regurgitation (MR) utilizing the MitraClip system became reimbursed and clinically accessible in Japan in April 2018. This study presents the 2-year clinical outcomes of all consecutively treated patients who underwent MitraClip implantation in Japan and were prospectively enrolled in the Japanese Circulation Society-oriented J-MITRA registry. Methods and Results: Analysis encompassed 2,739 consecutive patients enrolled in the J-MITRA registry with informed consent (mean age: 78.3}9.6 years, 1,550 males, STS risk score 11.7}8.9), comprising 1,999 cases of functional MR, 644 of degenerative MR and 96 in a mixed group (DMR and FMR). The acute procedure success rate was 88.9%. After MitraClip implantation, >80% exhibited an MR grade ≤2+ and the trend was sustained over the 2 years. Within this observation period, the mortality rate was 19.3% and the rate of heart failure readmissions was 20.6%. The primary composite endpoint, inclusive of cardiovascular death and heart failure readmission, was significantly higher in patients with functional MR than in with degenerative MR (32.0% vs. 17.5%, P<0.001). Conclusions: The 2-year clinical outcomes after MitraClip implantation were deduced from comprehensive data within an all-Japan registry.

DOI： 10.1253/circj.CJ-23-0924

Scopus

Language：English   Publisher：ASAIO Journal  

Fulminant myocarditis requiring peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has a high mortality rate. We investigated clinical outcomes of combined use of VA-ECMO and percutaneous left ventricular assist device (VAD) (Impella) for fulminant myocarditis in 104 consecutive patients enrolled in the Japan Registry for Percutaneous VAD (J-pVAD) between October 2017 and January 2020. Patients were followed until hospital discharge and predictors of survival were analyzed with a Cox proportional hazards model. The median support duration of combined use of VA-ECMO and Impella (ECMO/Impella) was 6 days, and the median left ventricular ejection fraction improved from 15% to 52% during support (p < 0.0001). Overall, 66 patients (63%) survived to discharge. Multivariate analysis revealed ECMO/Impella support at a transplant center as an independent predictor of survival (p = 0.0231). Patients treated at transplant centers had better 60 days survival rates when compared to nontransplant centers (83% vs. 55%, p = 0.005). However, baseline characteristics and treatment strategies differed between the two groups. This real-world national registry database suggested the difference in survival after ECMO/Impella support for fulminant myocarditis between transplant and nontransplant centers, which may indicate hospital variations regarding patient management, although further controlled studies are needed.

DOI： 10.1097/MAT.0000000000002104

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Publisher：メディカルレビュー社  

DOI： 10.18885/hv.0000001512

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery  

Objective: Lower-limb ischemia is a complication of minimally invasive cardiac surgery with femoral cannulation. Herein, we verified our strategy using distal perfusion cannulation (DPC) against this complication. Methods: We retrospectively assessed 91 cases of aortic valve replacement with femoral cannulation between January 2019 and March 2023. DPC was applied when lower-limb tissue oxygenation index declined by ≥20%. The cannula to femoral artery diameter ratio (C/FA) was calculated by dividing the cannula size (Fr) divided by 3 by the femoral artery inner diameter (mm). Postoperative maximum creatinine kinase (CK<inf>max</inf>), lactate dehydrogenase (LDH<inf>max</inf>), and lactate levels were analyzed, and univariable logistic regression and receiver operating characteristic curve analyses were employed to determine DPC predictors and the cutoff C/FA for DPC, respectively. Patients without DPC were divided into 2 subgroups based on the cutoff C/FA for further comparisons. Results: DPC was required in 9 patients. Symptomatic ischemia was not observed. All laboratory data were similar in the DPC and non-DPC groups. C/FA was significantly associated with DPC (odds ratio = 1.27, 95% confidence interval: 1.09 to 1.47, P = 0.002), and the cutoff C/FA was 0.70 (sensitivity = 0.89, specificity = 0.80). In the non-DPC group, CK<inf>max</inf> (P = 0.027) and LDH<inf>max</inf> (P = 0.041) were significantly higher in patients with C/FA ≥0.7 (n = 16) than in those with C/FA <0.7 (n = 66). Conclusions: Our strategy for preventing symptomatic ischemia is reasonable and could be almost achieved without DPC when C/FA is <0.7. C/FA also predicts asymptomatic potential ischemia, and proactive DPC is preferable when C/FA is ≥0.7.

DOI： 10.1177/15569845241237212

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Language：English   Publisher：Annals of Vascular Surgery  

Background: Although open surgical repair (OSR) is the gold standard for treating arch aneurysms, thoracic endovascular aortic repair (TEVAR) may be a less invasive alternative. However, it remains unclear which of the 2 methods yields better outcomes. In this study, we compared the perioperative outcomes of both procedures for arch aneurysms using a nationwide surgical database. Methods: Data of patients who underwent elective aortic repair for true arch aneurysms were extracted from the National Clinical Database of Japan. Patients who underwent OSR and Zone 0/1 TEVAR were matched in a 1:1 ratio using propensity scores and their mortality and morbidity rates were compared. Results: A total of 2,815 and 1,125 patients underwent OSR and Zone 0/1 TEVAR, respectively. After propensity score matching, 1,058 patients were included in both groups. Compared with OSR, Zone 0/1 TEVAR was associated with a significantly higher incidence of stroke (5.8 vs. 10.0%, P < 0.001) and paraplegia/paraparesis (1.6 vs. 4.4%, P < 0.001). However, there were no significant differences in the 30-day and operative mortality rates between the 2 groups (2.2 vs. 2.7% and 4.5 vs. 5.4%, respectively). In the Zone 0/1 TEVAR group, postoperative computed tomography was performed in 92.4% of patients, and types I and III endoleaks were identified in 6.4% and 1.1% of patients, respectively. Conclusions: Zone 0/1 TEVAR has higher incidences of stroke and paraplegia/paraparesis than OSR, with a risk of postoperative endoleaks. Resolving these problems is the key for expanding the application of Zone 0/1 TEVAR and in the meantime OSR remains the gold standard for surgically fit patients.

DOI： 10.1016/j.avsg.2023.10.012

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PubMed

Language：English  

DOI： 10.1186/s44215-024-00126-w

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Genes to Cells  

The hydrogen peroxide (H<inf>2</inf>O<inf>2</inf>)-producing NADPH oxidase Nox4, forming a heterodimer with p22^phox, is expressed in a variety of cells including those in the heart to mediate adaptive responses to cellular stresses such as hypoxia. Since Nox4 is constitutively active, H<inf>2</inf>O<inf>2</inf> production is controlled by its protein abundance. Hypoxia-induced Nox4 expression is observed in various types of cells and generally thought to be regulated at the transcriptional level. Here we show that hypoxia upregulates the Nox4 protein level and Nox4-catalyzed H<inf>2</inf>O<inf>2</inf> production without increasing the Nox4 mRNA in rat H9c2 cardiomyocytes. In these cells, the Nox4 protein is stabilized under hypoxic conditions in a manner dependent on the presence of p22^phox. Cell treatment with the proteasome inhibitor MG132 results in a marked decrease of the Nox4 protein under both normoxic and hypoxic conditions, indicating that the proteasome pathway does not play a major role in Nox4 degradation. The decrease is partially restored by the autophagy inhibitor 3-methyladenine. Furthermore, the Nox4 protein level is upregulated by the lysosome inhibitors bafilomycin A1 and chloroquine. Thus, in cardiomyocytes, Nox4 appears to be degraded via an autophagy-related pathway, and its suppression by hypoxia likely stabilizes Nox4, leading to upregulation of Nox4-catalyzed H<inf>2</inf>O<inf>2</inf> production.

DOI： 10.1111/gtc.13085

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Language：English   Publisher：BioMed Central  

症例は43歳女性で肺動脈閉鎖および心室中隔欠損症と診断されていた。1歳時にleft original Blalock-Taussigシャント術、6歳時にRastelli手術が施行されていた。修正術後に生体弁付き導管による右室流出路(RVOT)導管置換術を2回、生体弁による三尖弁置換術(TVR)が2回された。直近のRVOT導管置換術は23歳時に行われた。TVRは33歳時にも行われた。33歳時には洞不全症候群のため経静脈的ペースメーカー植え込み術が施行された。30歳頃に右心不全と蛋白喪失性腸症(PLE)を発症し、その後もPLEの再発を繰り返していた。43歳時に3回目のTVRと4回目の機械弁による肺動脈弁置換術を行った。さらに、本患者は高度房室ブロックを発症するリスクが高いことから、ペースメーカーを、心外膜リードを用いるDDDシステムに変更した。術後は右心不全のため比較的長期にわたって薬物療法が必要であったが、PLEの緩和と良好な術後経過が得られた。その後、PLEの再発もなく、5年以上経過している。

Language：Japanese   Publisher：Japanese Society of Sonographers  

DOI： 10.11272/jssabst.49.0_s143

CiNii Research

Language：Japanese   Publisher：Japanese Society for Medical and Biological Engineering  

<p>　植込型補助人工心臓（left ventricular assist device, LVAD）は、重症心不全患者の予後および生活の質を劇的に向上させるデバイスである。わが国では2011年に臨床使用が開始され、2022年末までに1300名を超える新規植込み手術が施行されている。LVAD患者は心不全症状から解放され、自宅に戻り、社会復帰も期待できるが、一方でLVADに伴う様々な合併症を予防するために在宅管理（セルフケア）が重要となる。</p><p>　LVADの在宅管理において、日々の血圧測定は極めて重要な要素の一つである。LVAD患者の血圧高値は脳血管障害や心不全、大動脈弁逆流といった合併症と関連していることが知られており、最新のガイドラインでも平均血圧で75-90mmHgが推奨されている。患者は自宅で日々の血圧を測定して記録し、定期通院時に持参することが求められている。しかし、現在のLVADは遠心ポンプもしくは軸流ポンプを用いた連続流式であるため、多くの患者の脈圧は小さく、現在使用可能な家庭用血圧計では血圧測定が困難であったり、複数回の測定を余儀なくされたりする場合もある。</p><p>　本演題では、現在のわが国におけるLVAD治療の現状と、特に血圧管理に焦点を当てて在宅管理における問題点について概説する。</p>

DOI： 10.11239/jsmbe.annual62.87_2

CiNii Research

Language：English  

DOI： 10.1253/circj.CJ-23-0269

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Language：English   Publisher：Jtcvs Techniques  

DOI： 10.1016/j.xjtc.2023.10.010

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Language：English  

DOI： 10.1016/j.atssr.2023.05.022

PubMed

Language：English   Publisher：(一社)日本循環器学会  

日本国内の集団におけるMicra VRリードレスペースメーカー(以下、本製品)の性能と安全性を調査し、全世界の既報試験の結果と比較した。本試験(Micra Acute Performance Japan試験)は前向き観察非無作為化試験として2019年4月26日～2022年4月30日に実施した。国内15センターで本製品の移植術を受けた患者300名(女性48.7%、平均82.6±9.7歳)を組み入れた。全ての患者で本製品の移植術に成功し、平均7.23±2.83ヵ月の経過観察が行われた。主要評価項目とした30日急性主要合併症発症率は人数ベースで3.33%(95%CI 1.61～6.04%)となった。心嚢液貯留は4名(1.33%)で発症し、うち3名は重大な貯留であった。処置または装置に関連した死亡は発生しなかった。フレイルはベースラインから経過観察時にかけて有意に改善していた。以上から、日本人コホートでは本製品移植の成功率は高く主要合併症の発症率は低いことが示された。世界で行われていたMicraの試験の結果と比較した場合、日本人コホートの方がより高齢で、体格がより小柄で、リスクはより高い状態にあったにもかかわらず、同製品が移植された時の安全性と性能は世界の試験結果に合致するものであった。

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Annals of Vascular Surgery  

Background: Delayed-onset paraplegia is a disastrous complication after thoracoabdominal aortic open surgery and thoracic endovascular aortic repair. Studies have revealed that transient spinal cord ischemia caused by temporary occlusion of the aorta induces delayed motor neuron death owing to apoptosis and necroptosis. Recently, necrostatin-1 (Nec-1), a necroptosis inhibitor, has been reported to reduce cerebral and myocardial infarction in rats or pigs. In this study, we investigated the efficacy of Nec-1 in delayed paraplegia after transient spinal cord ischemia in rabbits and assessed the expression of necroptosis- and apoptosis-related proteins in motor neurons. Methods: This study used rabbit transient spinal cord ischemia models using a balloon catheter. They were divided into a vehicle-treated group (n = 24), Nec-1-treated group (n = 24), and sham-controls (n = 6). In the Nec-1-treated group, 1 mg/kg of Nec-1 was intravascularly administered immediately before ischemia induction. Neurological function was assessed using the modified Tarlov score, and the spinal cord was removed 8 hr and 1, 2, and 7 days after reperfusion. Morphological changes were examined using hematoxylin and eosin staining. The expression levels of necroptosis-related proteins (receptor-interacting protein kinase [RIP] 1 and 3) and apoptosis-related proteins (Bax and caspase-8) were assessed using western blotting and histochemical analysis. We also performed double-fluorescence immunohistochemical studies of RIP1, RIP3, Bax, and caspase-8. Results: Neurological function significantly improved in the Nec-1-treated group compared with that in the vehicle-treated group 7 days after reperfusion (median 3 and 0, P = 0.025). Motor neurons observed 7 days after reperfusion were significantly decreased in both groups compared with the sham group (vehicle-treated, P < 0.001; Nec-1-treated, P < 0.001). However, significantly more motor neurons survived in the Nec-1-treated group than in the vehicle-treated group (P < 0.001). Western blot analysis revealed RIP1, RIP3, Bax, and caspase-8 upregulation 8 hr after reperfusion in the vehicle-treated group (RIP1, P = 0.001; RIP3, P = 0.045; Bax, P = 0.042; caspase-8, P = 0.047). In the Nec-1-treated group, the upregulation of RIP1 and RIP3 was not observed at any time point, whereas that of Bax and caspase-8 was observed 8 hr after reperfusion (Bax, P = 0.029; caspase-8, P = 0.021). Immunohistochemical study revealed the immunoreactivity of these proteins in motor neurons. Double-fluorescence immunohistochemistry revealed the induction of RIP1 and RIP3, and that of Bax and caspase-8, in the same motor neurons. Conclusions: These data suggest that Nec-1 reduces delayed motor neuron death and attenuates delayed paraplegia after transient spinal cord ischemia in rabbits by selectively inhibiting necroptosis of motor neurons with minimal effect on their apoptosis.

DOI： 10.1016/j.avsg.2023.05.011

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Publisher：南江堂  

DOI： 10.15106/j_kyobu76_804

CiNii Research

Language：Japanese  

PubMed

Language：English   Publisher：European Heart Journal Case Reports  

Background Cystic myxomas are quite rare. Moreover, few reports have evaluated the causes that constituted them. Case summary A 73-year-old Asian man presented for pre-operative examination of osteoarthritis, and transthoracic echocardiography (TTE) revealed an incidental intracardiac mass. Therefore, he was referred to our department for further evaluation. He had no specific symptoms or family history related to tumours and heart failure. The TTE showed a 32 × 24 mm spherical mass adherent to the left atrial septum. The upper part of the mass was cystic in formation and hypoechoic inside and resembled a light bulb. Transoesophageal echocardiography showed the feeding arteries flowing from the bottom into the cystic part. In addition, two jet strips drained from the cystic part in the direction of the mitral valve. Coronary angiography revealed the feeding arteries, which consisted mainly of the right coronary artery conus branch and the left circumflex branch, and the blood flowed into the saccular area from the feeding arteries and excreted towards the mitral valve. Surgical resection was performed due to the mobility, and the histopathology confirmed a cystic myxoma. Discussion We described the unique anatomical formation of a cystic myxoma, which consisted of an exquisite balance between the tumour feeding arteries and the draining outlet vessels.

DOI： 10.1093/ehjcr/ytad331

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DOI： 10.1253/circj.CJ-23-0264

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Language：English   Publisher：Interdisciplinary Cardiovascular and Thoracic Surgery  

We report the case of a 19-month-old girl with a right-dominant unbalanced atrioventricular septal defect and severe right-sided atrioventricular valve regurgitation who underwent biventricular repair using basal chordae resection, artificial chordae reconstruction and a left-sided atrioventricular valvuloplasty. At 14-month postoperative follow-up, the patient had minimal heart failure, gained weight and adapted to biventricular circulation.

DOI： 10.1093/icvts/ivad109

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Virchows Archiv  

Angiosarcoma is a malignant vascular endothelial neoplasm with various histological patterns. Despite its highly malignant potential, histological prognostic prediction has not been adopted for angiosarcoma. This study aimed to establish a method of predicting the prognosis of primary angiosarcoma. Formalin-fixed, paraffin-embedded samples from 104 primary angiosarcomas were prepared. All the cases were reviewed based on histological examinations with H&E staining. Because the French Fédération Nationale des Centres de Lutte Contre Le Cancer system (FNCLCC) is not adopted for angiosarcoma, we experimentally established a modified version of FNCLCC. Immunohistochemical staining for ERG, CD31, CD34, D2-40, HHV-8, p16, C-MYC, and p53 was performed. Fluorescence in situ hybridization (FISH) was performed for 31 cases to assay c-MYC gene amplification. Multivariate analysis revealed that age (> 70 years old) (p = 0.0011), non-cutaneous angiosarcoma (p = 0.0265), metastasis on diagnosis (p < 0.0001), size ≥ 5 cm (p = 0.0388), no taxane chemotherapy (p = 0.0388), strong nuclear atypia (p = 0.0087), and the presence of luminal structure in ≥ 50% of the tumor volume (p = 0.0009) were independent poor prognostic factors. Among angiosarcomas with luminal formation, mFNCLCC scores were significantly correlated with a poorer prognosis. The overexpression of p16 was associated with less luminal formation (p = 0.0192). Immunohistochemical analysis of C-MYC showed a moderate level of concordance with FISH (Kappa value = 0.45). This study suggested that luminal formation and nuclear atypia may be poor histological prognostic factors of angiosarcoma and that mFNCLCC would be useful for predicting the prognosis of angiosarcoma with luminal formation.

DOI： 10.1007/s00428-023-03572-z

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Language：English   Publisher：(一社)日本循環器学会  

durable左室補助人工心臓(LVAD)植え込み後の臨床転帰を予測する新たなリスクスコアを構築し、他の従来型リスクスコアとの比較によりその有用性を検証した。当該LVAD植え込みが行われ、日本における補助人工心臓に関連した市販後のデータ収集事業(J-MACS)に登録された患者1287例から494例(男性394例、女性100例、年齢中央値46歳)を導出コホート、487例を検証コホートとして無作為に抽出した。生存時間解析に従い、年齢、心臓手術歴、血清クレアチニン値、0.71を超える中心静脈圧と肺動脈楔入圧比から構成されるJ-MACSリスクスコアを新たに構築して導出コホートで3年全死因死亡率を予測し、その有用性を検証コホートで評価した。LVAD植え込み後の経過観察期間中(中央値1095日)に57例が死亡した。J-MACSリスクスコアは、HeartMate IIリスクスコアやHeartMate 3リスクスコアなど他の従来のスコアと比較して検証コホートにおける3年全死因死亡率の予測可能性が最も高かった。

Language：Japanese   Publisher：JAPANESE SOCIETY FOR ARTIFICIAL ORGANS  

DOI： 10.11392/jsao.52.85

CiNii Research

Language：English   Publisher：Jtcvs Techniques  

DOI： 10.1016/j.xjtc.2023.03.002

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Language：English  

DOI： 10.1016/j.atssr.2023.02.018

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Language：English   Publisher：Annals of Thoracic Surgery  

A 37-year-old man with repaired transposition of the great arteries had extensive infective endocarditis, and a multidisciplinary therapeutic strategy was planned based on surgical indications, invasiveness, and future prospects. After adequate antibiotic treatment, simultaneous replacement of quadruple valve and aortic root using mechanical valves was performed to intervene in the healed valvular disease and the concurrent anatomic and functional abnormalities. We believe that this extensive one-stage surgery contributed to maximizing the quality of life and minimizing the number of future reoperations. Our approach can provide suggestions for the management of adult patients with repaired congenital heart disease.

DOI： 10.1016/j.athoracsur.2022.05.031

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Language：English   Publisher：European Heart Journal  

DOI： 10.1093/eurheartj/ehad008

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Language：English   Publisher：ASAIO Journal  

There is controversy regarding appropriate surgical ablation procedures concomitant with nonmitral valve surgery. We retrospectively investigated the impact of surgical ablation for atrial fibrillation during aortic valve replacement between 2010 and 2015 in 16 institutions registered through the Japanese Society for Arrhythmia Surgery. Clinical data of 171 patients with paroxysmal and nonparoxysmal atrial fibrillation undergoing aortic valve replacement were collected and classified into full maze operation (n = 79), pulmonary vein isolation (PVI) (n = 56), and no surgical ablation (n = 36) groups. All patients were followed up and electrocardiograms were recorded in 68% at 2 years. The myocardial ischemia time was significantly longer in the maze group than the others during isolated aortic valve replacement (p ≤ 0.01), but there were no significant differences in 30-day or 2-year mortality rates between groups. The ratios of sinus rhythm at 2 years in paroxysmal and nonparoxysmal atrial fibrillation in the maze group versus PVI group were 87% versus 97%, respectively (p = 0.24) and 53% versus 42%, respectively (p = 0.47). No patients with nonparoxysmal atrial fibrillation in the no surgical ablation group maintained sinus rhythm at 2 years. In conclusion, both maze and PVI during aortic valve replacement are valuable strategies to restore sinus rhythm at 2 years and result in favorable early and midterm survival rates.

DOI： 10.1097/MAT.0000000000001882

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Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> The Impella^®percutaneous left ventricular assist device has been available in Japan since 2017. This is the first large-scale registry study to analyze the efficacy and safety of Impella in Japanese patients with acute myocardial infarction with cardiogenic shock (AMICS).</p><p><b><i>Methods and Results:</i></b> The Japanese registry for Percutaneous Ventricular Assist Device (J-PVAD) has registered all consecutive Japanese patients treated with Impella. We extracted data for 593 AMICS patients from J-PVAD and analyzed 30-day survival and safety profiles. Overall 30-day survival was 63.1%. The 30-day survival of the Impella alone and Impella plus venoarterial extracorporeal membrane oxygenation (ECPELLA) groups was 80.9% and 45.7%, respectively. The Impella alone group was older and had a lower rate of cardiac arrest, milder consciousness disturbance, less inotrope use, lower serum lactate concentrations, higher B-type natriuretic peptide concentrations, and higher left ventricular ejection fraction (LVEF) than the ECPELLA group. Cox regression analysis revealed that older age and comorbid renal disturbance were common risk factors affecting 30-day mortality in both groups. Major adverse events were hemolysis (10.8%), hemorrhage/hematoma (7.6%), peripheral ischemia (4.4%), stroke (1.3%), and thrombosis (0.7%). LVEF improved in both groups during support.</p><p><b><i>Conclusions:</i></b> AMICS treatment with Impella showed favorable 30-day survival and safety profiles. The survival rate of patients treated with Impella alone was particularly high. Further studies are needed to improve outcomes of patients with ECPELLA support.</p>

DOI： 10.1253/circj.cj-22-0476

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CiNii Research

Language：English   Publisher：(一社)日本循環器学会  

急性心筋梗塞のため心原性ショックを発症した(AMIwCS)日本人患者を対象に、Impellaの有効性と安全性を解析した。J-PVADレジストリが2017年10月より連続登録しているImpella治療日本人症例から2020年1月までのAMIwCS症例を抽出し、Impella単独治療の293名(男性222名、年齢中央値72歳)(単独群)と、静脈-動脈体外式膜型人工肺も併用された300名(男性247名、年齢中央値68歳)(併用群)に分類した。30日生存率は、全集団で63.1%、単独群では80.9%、併用群では45.7%となった。併用群に比べて単独群では、高年齢で、心停止率が低く、意識障害は軽症で、変力物質の使用が少なく、血清乳酸濃度が低く、B型ナトリウム利尿ペプチド濃度は高く、左室駆出分画(LVEF)も高かった。Cox回帰分析の結果、両群で共通して30日死亡率に影響している危険因子として、高齢と、腎障害の併存が同定された。主要有害事象は、溶血(10.8%)、出血/血腫(7.6%)、末梢虚血(4.4%)、脳卒中(1.3%)、血栓症(0.7%)であった。どちらの群でも補助療法中にはLVEFが改善していた。AMIwCSへのImpella治療の30日生存率と安全性プロファイルは良好で、中でもImpella単独治療例の生存率は特に高かった。

DOI： 10.14503/THIJ-22-7891

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Language：English   Publisher：シュプリンガー・ジャパン(株)  

補助人工心臓、Impellaポンプで治療した日本人心不全患者823人(2017年10月～2020年1月)の日本レジストリー(J-PVAD)を用いて、その安全性と有効性について最初の中間解析を行った。患者の44.8%は心原性ショックを伴う急性心筋梗塞で、主要評価項目は安全性と累積30日生存率とした。Impellaポンプは患者4人には適用できなかった。Impella 2.5、CP、5.0型ポンプはそれぞれ患者の72.4、6.2、16.6%に使用され、その平均支援期間は8.1±10.2日であった。Impellaと静-動脈体外式膜型人工肺(VA-ECMO)の併用患者は387人(47.3%)で、ポンプ停止は患者22人(2.7%)に認められた。主要有害事象は、溶血(11.2)、出血/血腫(6.1)、末梢虚血(1.6)、脳卒中(1.6%)で、全体の30日生存率は62.2%であった。Impella支援患者の生存率は上記の併用患者より有意に高かった(81.1%対49.6%)。併用患者では血圧は低く、左室駆出率は低く、変力サポートの程度は高かった。

Language：English   Publisher：Journal of Artificial Organs  

Catheter-based micro-axial ventricular assist device Impella® (Abiomed, Danvers, MA) has been used in Japanese patients with drug-refractory acute heart failure (AHF) since 2017. This is the first interim analysis of the ongoing Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) to investigate the safety and efficacy of Impella support. Between October 2017 and January 2020, 823 Japanese patients, who were treated with the Impella 2.5, CP, or 5.0 pump, were enrolled. The primary endpoints were safety profiles and cumulative 30-day survival. Among them, 44.8% of patients were acute myocardial infarction with cardiogenic shock. The Impella pumps were unable to implant in 4 patients. The Impella 2.5, CP, and 5.0 pumps were used in 72.4%, 6.2%, and 16.6%, respectively, and mean support duration was 8.1 ± 10.2 days. Combination use of Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was applied for 387 patients (47.3%). Pump stop occurred 22 patients (2.7%). Major adverse events included hemolysis (11.2%), hemorrhage/hematoma (6.1%), peripheral ischemia (1.6%), and stroke (1.6%). The overall 30-day survival was 62.2%. Survival of patients with single Impella support was significantly higher than patients with Impella combined with VA-ECMO support (81.1% vs 49.6%; p < 0.01), who had lower blood pressure, lower left ventricular ejection fraction, and higher degree of inotropic support. Results suggest that short-term outcome of Impella support for Japanese patients was favorable with acceptable safety profiles.

DOI： 10.1007/s10047-022-01328-1

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Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-22-0497

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CiNii Research

Language：English   Publisher：Journal of Infection and Chemotherapy  

An 81-year-old man was admitted to our hospital because of fever and malaise that had persisted for 3 months. The patient had undergone two aortic valve replacements, 10 and 5 years previously, because of aortic valve regurgitation and infectious endocarditis. He also had had asymptomatic Mycobacterium abscessus complex (MABC) pulmonary disease for the two previous years. Contrast-enhanced computed tomography showed a mediastinal abscess and an ascending aortic aneurysm. Mycobacterium abscessus subsp. massiliense was cultured from his blood, suggesting the aortic aneurysm was secondary to infection of an implanted device. After enlargement over only a few days, a leakage of contrast medium to the mediastinal abscess was found on computed tomography. The patient was diagnosed with rupture of an infectious aortic aneurysm, and emergency aortic replacement and drainage of the mediastinal abscess were successful. The patient was treated with several antibiotics, including meropenem, amikacin, and clarithromycin, and his general condition improved. Cultures from both the mediastinal abscess and a pericardial patch that was placed at the time of surgery 5 years previously revealed MABC. In our case, the infected aortic aneurysm most likely resulted from MABC pulmonary disease rather than from previous intraoperative contamination. This route of infection is rare. Physicians should be aware of the possibility of dissemination and subsequent infection of implants related to MABC pulmonary disease.

DOI： 10.1016/j.jiac.2022.09.017

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Language：English   Publisher：エルゼビア・ジャパン(株)  

症例は81歳男性で、発熱と倦怠感を主訴に当院紹介となった。患者は10年前に大動脈弁逆流症による大動脈弁置換術、5年前に感染性心内膜炎による2回目の大動脈弁置換術を受け、同時に胃癌と診断され幽門側胃切除術を受けていた。2年前に肺NTM症と診断されていた。入院時の全身の外観はわずかに不良で肩と膝の関節痛を訴えていた。表在リンパ節は触診できなかった。血清アルブミン値の減少とCRP値の軽度上昇がみられた。9ヵ月前の胃癌フォローアップ造影CT検査で大動脈弁近傍の液体貯留が示されたが、無症状のため精密検査は実施されなかった。入院5日後に実施された造影CTで前縦隔内のリング状増強低密度領域、低密度領域近くの上行大動脈の偽動脈瘤、両側胸膜液が示された。右側胸膜液の穿刺により漏出性胸水が認められたが培養でNTMは検出されなかった。感染性大動脈瘤と縦隔膿瘍が示唆されたためバンコマイシンとメロペネムを投与した。血液培養で分離された抗酸菌は迅速発育菌であったためメロペネム/アミカシン/クラリスロマイシンに切り替えた。感染性動脈瘤破裂が認められ、緊急の大動脈置換術と縦隔膿瘍ドレナージを実施した。縦隔膿瘍と心膜パッチからMycobacterium abscessus subsp. massilienseが分離された。3剤治療により術後CRP値は低下し血液培養は陰性となり、2ヵ月後リハビリ病院へ転院した。

Language：Japanese   Publisher：The Japan Society for Transplantation  

<p>【背景】当院は2020年5月に大阪以西で唯一の小児心臓移植実施施設に認定された。それ以前は九州・山口地区で心移植を希望する小児重症心不全患者は遠方の医療施設に頼らなければならず、治療の選択が狭められることもあった。当院の小児心臓移植を中心とした重症心不全診療の現状と課題を考察する。【現状】機械的循環補助や心移植を考慮する症例は、毎年5例程度の診療依頼がある。うち2020年以降に新たに心臓移植登録したのは拡張型心筋症４例、先天性心疾患１例で、4例が登録時11歳未満であった。人口およそ1400万人の九州・山口地区で年1-2例の小児心臓移植適応患者が発生することとなる。3例が補助人工心臓を装着して待機し、2022年9月に11歳未満の小児第１例目の心臓移植を実施した。【課題】小児ドナー不足はコロナ禍で拍車がかかり、当院の移植待機患者は最長で4年目となった。待機が長期化するほど感染や血栓など合併症のリスクは増加し、患者や家族の精神的負担も大きな問題となる。また長期入院は病棟運営にも少なからず影響する。【解決に向けて】ドナーを増やす努力が解決への鍵となるが、年々移植医療に対する医療者および市民の意識は高まってきている。また九州・山口地区は地域間の繋がりも強く、情報を共有し地区全体で重症児を支える意識を持てば、より良い小児重症心不全診療に繋がる。</p>

DOI： 10.11386/jst.58.supplement_s196_2

CiNii Research

Language：Japanese   Publisher：Japanese Society for Medical and Biological Engineering  

<p>九州大学大学院医学研究院循環器外科塩瀬　明これまでの植込型補助人工心臓(VAD)治療は、心臓移植を目指す治療の一貫（BTT, Bridge to Transplant）として行われてきたが、2021年4月より心臓移植までの橋渡しを目的としない植込型VAD治療が始まった。海外で「Destination Therapy（DT）」と呼ばれるこの治療は、日本語で「長期在宅補助人工心臓治療」と称されている。DTでは、心臓移植に到達することが第一の目標であるBTTと異なり、患者・家族のQuality of Lifeの維持が重視される。すなわち、心不全を治療するという医学的要素に加え、医療機器であるVADと共に生きるという姿勢が、DTではより重要となってくる。VADは、治療効果とともに安全性を向上させながら大きく進歩してきた。一方で、デバイスに起因するトラブルやヒューマンエラーも含めて種々の合併症が、いまだ生じうるのも事実である。理想的な在宅管理の実現には、医学的進歩だけでなく機器面での性能向上も不可欠であり、これは患者に”やさしい”医療につながるものである。VAD治療は成熟期に入っているものの、現在進行形で発展を続けている医療である。医学・生体医工学のさらなるコラボレーションにより、これまで以上の発展を遂げることを期待している。</p>

DOI： 10.11239/jsmbe.annual61.84_2

CiNii Research

Language：Japanese   Publisher：The Japan Society for Transplantation  

<p>心臓移植レシピエント候補の中でもpanel reactive antibody (PRA)高値の症例は、ドナー特異的抗HLA抗体（DSA）を生じやすく、移植後の拒絶反応リスクが高いことが想定される。</p><p>当院では、心臓移植を施行した61例のうち、4例（男性1例、女性3例）に周術期の脱感作療法を施行した。いずれもhigh PRAかつpreformed DSA陽性の症例であった。プロトコールとして、全例で移植術直前に血漿交換と免疫グロブリン投与を併用した。移植後の経過として、1例で急性期にgrade 1R/2の細胞性拒絶反応を認めたが、抗体関連拒絶反応を発症した症例はなく、心機能低下を来した症例もなかった。</p><p>当院でのhigh PRA症例に対する周術期脱感作療法は安全に施行でき、術後に問題となる拒絶反応も見られなかった。注意して長期経過を観察する必要がある。また、本邦では血漿交換や免疫グロブリン療法、さらにはリツキシマブといった治療は心臓移植における脱感作療法に対しては保険適応外であり、治療の有効性・必要性について今後も検証が必要である。</p>

DOI： 10.11386/jst.58.supplement_s197_1

CiNii Research

Language：Japanese   Publisher：Japanese Society of Sonographers  

DOI： 10.11272/jssabst.48.0_s158

CiNii Research

Language：Japanese   Publisher：Japanese Society of Sonographers  

DOI： 10.11272/jssabst.48.0_s127

CiNii Research

Language：Japanese   Publisher：The Japan Society for Transplantation  

<p>【背景】移植心に対する心臓再手術は、海外では一定数行われているが、国内ではごくわずかである。今回我々は、心臓移植後10年目の心臓再手術を経験した。【症例】症例は30歳女性。2012年に他院で心臓移植を施行され、2020年より当院で管理されている。移植後5年目より心機能の低下・有意な三尖弁逆流と僧帽弁逆流が指摘され始めた。移植後9年目、徐脈性不整脈を契機に心肺停止となり、心肺蘇生およびECMO管理を要したが、後遺症なく回復した。移植後10年目、心不全は内科的治療抵抗性となり、重度の三尖弁逆流と僧帽弁逆流に対して手術介入する方針とし、生体弁による三尖弁置換術と僧帽弁形成術を行った。また、三尖弁人工弁機能の長期維持と安定したペースメーカー作動の実現のために、経静脈的右室リードを人工弁外を通過させる工夫を行った。弁逆流が制御されたことで血行動態・自覚症状ともに大きく改善した。現在再手術後8か月が経過し、QOLの改善した日常生活を取り戻している。【結語】心臓移植後の再心臓移植が事実上難しい国内では、移植心に起こる心機能障害に対しては、難治化する前に内科的/外科的に介入していくことが現実的な治療方針である。移植心の心機能低下は複合的要因により起こりうるが、制御可能な段階での治療介入が肝要である。また、心筋生検や拒絶反応などの移植心特有の事情を考慮しての手術戦略をもつことが心臓移植の長期成績の向上に寄与すると考える。</p>

DOI： 10.11386/jst.58.supplement_s136_1

CiNii Research

Language：Japanese   Publisher：The Japan Society for Transplantation  

<p>別紙</p>

DOI： 10.11386/jst.58.supplement_s153_1

CiNii Research

Language：English   Publisher：European Heart Journal Case Reports  

DOI： 10.1093/ehjcr/ytad025

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Language：English  

DOI： 10.1186/s44215-022-00016-z

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PubMed

DOI： 10.1253/circj.CJ-21-1056

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Language：English   Publisher：Jtcvs Techniques  

DOI： 10.1016/j.xjtc.2022.09.004

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Language：English   Publisher：BioMed Central  

症例は56歳女性。Fallot四徴症の既往があり、5歳時にBTシャント術を受けた。29歳時に根治手術を受け、mono-cusp patchを用いた右室流出路再建術が施行された。48歳時に心房細動と中等度の僧帽弁閉鎖不全症が出現し、左室駆出率は32.4%に低下した。55歳時に経胸壁心エコー検査で僧帽弁逆流の進行を認め、腹部超音波検査で肝脾腫を認めた。経食道心エコー検査で右室流出路再建術後の肺動脈弁逆流を認めた。また三尖弁輪拡大に伴う高度三尖弁逆流を認め、三尖弁輪径指数は40.7mm/m2であった。さらに中等度の僧帽弁逆流と軽度の大動脈弁逆流を認めた。心臓MRIで測定した右室拡張末期容積係数は129.2mL/m2、肺動脈弁逆流分画は52.0%であった。CTで上行大動脈径は55.0mmに拡大していた。脾機能亢進症による血小板減少症を有しているため、腹腔鏡下脾臓摘出術を先行し、血小板数の改善を待って1ヵ月後に肺動脈弁置換術、三尖弁輪縫縮術、僧帽弁形成術、上行大動脈置換術を施行した。手術時間は764分であった。7日後に人工呼吸器から離脱し、55日後にリハビリテーションのため転院となった。

DOI： 10.1253/circj.CJ-21-1056

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Publisher：Circulation Journal  

Background: The objective of this study is to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with continuous-flow left ventricular assist device (LVAD) by using data from a national database. Methods and Results: The 545 study patients who underwent primary HeartMateII implantation between 2013 and 2019 were divided into 2 groups according to their diabetes mellitus (DM) status; patients with DM (n=116) and patients without DM (n=429). First, the on-device survival and incidence of adverse events were evaluated. Second, after adjusting for patients’ backgrounds, the change of laboratory data in the 2 groups were compared. Overall, on-device survival at 1, 2, and 3 years was almost equivalent between the 2 groups; it was 95%, 94%, and 91% in patients without DM, and 93%, 91%m and 91% in patients with DM (P=0.468) The incidence of adverse events was similar between 2 groups of patients, except for driveline exit site infection in the adjusted cohort. Cox proportional hazards regression analysis revealed younger age (HR: 0.98 (95% confidence interval (CI): 0.97–0.99, P=0.001) and presence of DM (HR: 1.83 (95% CI: 1.14–2.88), P=0.016) as significant predictors of driveline infection. Laboratory findings revealed no differences between groups throughout the periods. Conclusions: The clinical results after LVAD implantation in DM patients were comparable with those in non-DM patients, except for the driveline exit site infection.

DOI： 10.1253/circj.CJ-21-1056

Scopus

Language：English  

DOI： 10.1253/circj.CJ-21-1056

PubMed

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> The objective of this study is to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with continuous-flow left ventricular assist device (LVAD) by using data from a national database.</p><p><b><i>Methods and Results:</i></b> The 545 study patients who underwent primary HeartMateII implantation between 2013 and 2019 were divided into 2 groups according to their diabetes mellitus (DM) status; patients with DM (n=116) and patients without DM (n=429). First, the on-device survival and incidence of adverse events were evaluated. Second, after adjusting for patients’ backgrounds, the change of laboratory data in the 2 groups were compared. Overall, on-device survival at 1, 2, and 3 years was almost equivalent between the 2 groups; it was 95%, 94%, and 91% in patients without DM, and 93%, 91%m and 91% in patients with DM (P=0.468) The incidence of adverse events was similar between 2 groups of patients, except for driveline exit site infection in the adjusted cohort. Cox proportional hazards regression analysis revealed younger age (HR: 0.98 (95% confidence interval (CI): 0.97–0.99, P=0.001) and presence of DM (HR: 1.83 (95% CI: 1.14–2.88), P=0.016) as significant predictors of driveline infection. Laboratory findings revealed no differences between groups throughout the periods.</p><p><b><i>Conclusions:</i></b> The clinical results after LVAD implantation in DM patients were comparable with those in non-DM patients, except for the driveline exit site infection.</p>

DOI： 10.1253/circj.cj-21-1056

PubMed

CiNii Research

Publisher：医歯薬出版  

DOI： 10.32118/ayu28308806

CiNii Research

Language：Japanese   Publisher：The Japanese Society for Cardiovascular Surgery  

DOI： 10.4326/jjcvs.51.m6

CiNii Research

Language：English   Publisher：(一社)日本循環器学会  

日本の全国規模のデータベース(J-MACS)を用いて、定常流型補助人工心臓HeartMateIIを装着した患者における全死亡および主要な術後合併症に対する糖尿病の影響について検討した。2013年から2019年にHeartMateII植込み術を行った545例を糖尿病の有無により、糖尿病群(男性96名、女性20名、年齢中央値54歳)、非糖尿病群429例(男性317名、女性112名、年齢中央値44歳)へ層別化した。糖尿病群の1/2/3年生存率は93%/91%/91%、非糖尿病群では95%/94%/91%であり、有意な群間差はなかった。両群の有害事象発現率は、ドライブライン皮膚貫通部感染症を除いて同等であった。Cox比例ハザード回帰分析の結果、若齢、糖尿病がドライブライン感染症の有意な予測因子であった。糖尿病患者における補助人工心臓植込み術後の臨床経過は、ドライブライン皮膚貫通部感染症以外、非糖尿病患者と同等であった。

Language：English   Publisher：ASAIO Journal  

A 32-year-old man, who had developed fulminant myocarditis leading to asystole, underwent implantation of an EVAHEART 2 left ventricular assist system with a double-cuff tipless inflow cannula and a concurrent Fontan operation. Approximately 2 years after the simultaneous EVAHEART 2 implantation and the Fontan operation, the patient underwent heart transplantation. There was no device-related thromboembolism or pump malfunction under adequate antithrombotic management during the postoperative support period. Computed tomography showed no malposition of the inflow cannula irrespective of the left ventricular chamber size. Macroscopically, the left ventricular cavity of the excised heart revealed a smooth inflow ostium with appropriate intimal proliferation and without pannus or wedge thrombus formation. These findings suggest the utility of the double-cuff tipless inflow cannula for long-term clinical applications, which may lead to favorable outcomes during long-term patient management. The double-cuff tipless inflow cannula, which does not protrude into the left ventricular cavity, potentially contributes to the prevention of suction events and the collision of the inflow cannula with the interventricular septum and left ventricular free wall. Further investigation is required to confirm the role of the unique EVAHEART 2 inflow cannula in reducing thromboembolic events.

DOI： 10.1097/MAT.0000000000001672

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Language：English   Publisher：International Heart Journal Association  

<p>Sleep-disordered breathing is one of the complications commonly seen in patients with adult congenital heart disease (ACHD) due to multiple causes including complex underlying cardiac defects, cardiomegaly, previous thoracotomies, obesity, scoliosis, and paralysis of the diaphragm. It is often hard to determine its main cause and predict the efficacy of each treatment in its management. We herein report a 30-year-old woman after biventricular repair of pulmonary atresia with intact ventricular septum diagnosed as sleep-related hypoventilation disorder. Simultaneous treatment targeting obesity, paralysis of the diaphragm, and cardiomegaly followed by respiratory muscle reinforcement through non-invasive ventilation resolved her sleep-related hypoventilation disorder. Such management for each factor responsible for the hypoventilation is expected to provide synergetic therapeutic efficacy and increase daily activity in a patient with ACHD.</p>

DOI： 10.1536/ihj.22-073

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Publisher：南江堂  

DOI： 10.15106/j_kyobu75_819

CiNii Research

Language：Japanese  

PubMed

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

症例は30歳女性。心室中隔欠損を伴わない肺動脈閉鎖症の既往があり、生後2ヵ月でBlalock-Taussigシャント手術を受けた。1歳時にパッチ拡大術による二心室修復術が施行され、4歳時には左肺動脈形成術が施行された。術後に横隔膜麻痺が出現した。労作時呼吸困難と日中の過度の眠気を自覚し、近医を受診したところ、日本語版Epworth Sleepiness Scale(JESS)で20/24点の高値のため、紹介となった。受診時血圧は103/74mmHg、心拍数は64bpm、BMIは35.1kg/m2であった。拡張期雑音を胸骨右縁に聴取した。胸部X線検査で心拡大、横隔膜麻痺、脊椎側彎症を認めた。右室拡張末期容量係数(RVEDVi)は235.6mL/m2、左室駆出率は29%であった。重度の肺動脈弁逆流症を認めた。終夜睡眠ポリグラフ検査で睡眠関連低換気障害と診断された。非侵襲的陽圧換気を開始した。肺動脈弁逆流症に対して肺動脈弁置換術、三尖弁輪形成術、横隔膜縫縮術を施行した。肥満に対して食事制限と運動療法を開始した。6ヵ月後にRVEDViは131.2mL/m2、左室駆出率は63%に改善した。労作時呼吸困難は消失し、日中の眠気は改善した。

Language：English   Publisher：Esc Heart Failure  

A 69-year-old man was hospitalized for heart failure 7 days after coronavirus disease 2019 (COVID-19) mRNA vaccination. Electrocardiography showed ST-segment elevation and echocardiography demonstrated severe left ventricular dysfunction. Venoarterial extracorporeal membrane oxygenation and Impella 5.0 were instituted because of cardiogenic shock and ventricular fibrillation. Endomyocardial biopsy demonstrated necrotizing eosinophilic myocarditis (NEM). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) PCR test was negative. He had no infection or history of new drug exposure. NEM was likely related to COVID-19 vaccination. He was administered 10 mg/kg of prednisolone following methylprednisolone pulse treatment (1000 mg/day for 3 days). Left ventricular function recovered and he was weaned from mechanical circulatory support (MCS). Follow-up endomyocardial biopsy showed no inflammatory cell infiltration. This is the first report of biopsy-proven NEM after COVID-19 vaccination survived with MCS and immunosuppression therapy. It is a rare condition but early, accurate diagnosis and early aggressive intervention can rescue patients.

DOI： 10.1002/ehf2.13962

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Language：English   Publisher：Annals of Thoracic Surgery  

An incidental finding of right coronary artery compression between the dilated aortic root and the sternum was detected on follow-up cardiac catheterization after Fontan completion for tricuspid atresia with transposition of the great arteries. Although this 31-year-old man had no subjective symptoms, an exercise stress test and perfusion scan revealed ischemic changes in the inferior region. Valve-sparing aortic root replacement using the reimplantation technique proved to be an effective approach for this condition. The possibility of coronary artery compression associated with aortic root dilatation should be considered in adult patients with congenital heart disease.

DOI： 10.1016/j.athoracsur.2021.10.041

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Publisher：南江堂  

DOI： 10.15106/j_kyobu75_484

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Publisher：南江堂  

DOI： 10.15106/j_kyobu75_524

CiNii Research

Language：Japanese  

PubMed

Publisher：Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery  

A 76-year-old male patient had undergone aortic valve replacement with a 19-mm Carpentier–Edwards Perimount valve 12 years prior and underwent laryngopharyngo-esophagectomy for hypopharyngeal carcinoma followed by permanent tracheostomy and tracheoesophageal shunt creation 2 years later. Echocardiography showed exacerbated structural valve deterioration of the bioprosthesis, necessitating redo surgery. A permanent tracheostoma, located just above the upper edge of the sternum, seemed to be at high risk of serious infections when median resternotomy was performed. To minimize the risk of infection, we performed implantation of a Perceval prosthesis via the right anterior minithoracotomy after sufficient anatomical assessments. There was no evidence of mediastinitis or wound infection during the follow-up period. This report highlights that the less invasive Perceval implantation strategically allowed reduction in the resternotomy-associated infection risks in this patient.

DOI： 10.1177/15569845221106758

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Language：English   Publisher：Indian Journal of Thoracic and Cardiovascular Surgery  

For patients who have previously undergone total laryngectomy and a permanent tracheostomy, median full sternotomy is not the ideal surgical approach because of the substantially increased risk of sternal wound complications and tracheal injuries. We present a case in which conventional coronary artery bypass grafting using bilateral internal thoracic arteries was performed safely via a manubrium-sparing sternotomy in a patient who had undergone total laryngectomy and a permanent tracheostoma. We also discuss the appropriate surgical approach for patients with total laryngectomy and a permanent tracheostoma.

DOI： 10.1007/s12055-021-01309-8

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Publisher：南江堂  

DOI： 10.15106/j_kyobu75_448

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Language：English   Publisher：Annals of Thoracic Surgery  

Few reports have described the implantation and management of an implantable ventricular assist device in patients with functional univentricular anatomy. We herein report a case of a patient who underwent Heartware ventricular assist device (Medtronic, Minneapolis, MN) implantation due to severe cardiac dysfunction and Fontan failure in the remote period after total cavopulmonary connection. Double valve replacement was subsequently required 1 year later due to repeated Fontan failure caused by the progression of aortic and atrioventricular regurgitation. The low-profile and saddle-shaped sewing cuff design of the MITRIS mitral valve (Edwards Lifesciences, Irvine, CA) were beneficial for avoiding the Heartware ventricular assist device inflow and atrioventricular valve interference in the less-dilated ventricle.

DOI： 10.1016/j.athoracsur.2021.08.050

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Language：English   Publisher：Frontiers in Cardiovascular Medicine  

A 31-year-old woman was referred to our hospital for evaluation of a cardiac mass in the right atrium. Cardiac magnetic resonance imaging indicated a cystic mass filled with fluid accumulation in the right atrium. The mass was identified as a cardiac cyst and was surgically removed. Pathological examination revealed an extremely rare bronchogenic cyst. Bronchogenic cysts are benign congenital abnormalities of primitive foregut origins that form in the mediastinum during embryonic development. There is unusual clinical dilemmas surrounding the treatment plan for cardiac surgery or biopsy of cardiac masses, especially in patients with rare cardiac cysts. The anatomical location of the cyst can be related to various clinical symptoms and complications. In cases of indeterminate cardiac cysts, direct cyst removal without prior biopsy is of utmost importance.

DOI： 10.3389/fcvm.2022.915876

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Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-21-0880

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Language：Japanese   Publisher：The Japanese Society for Cardiovascular Surgery  

DOI： 10.4326/jjcvs.51.194

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Language：English   Publisher：Virchows Archiv  

Intimal sarcoma is one of the most common and well-known primary malignant neoplasms of the aorta and heart. The authors reviewed cases of intimal sarcoma from histological, immunohistochemical and genetic perspectives. Twenty cases of intimal sarcoma were retrieved. Immunohistochemistry and FISH of MDM2 and PDGFRA genes were performed. All 20 tumours were composed of spindle-shaped, stellate, oval or polygonal tumour cells with irregular hyperchromatic nuclei arranged in a haphazard pattern, accompanied by nuclear pleomorphism and frequent mitotic figures. Other histological findings were as follows: abnormal mitosis in 10 cases (50%), necrosis in 15 cases (75%), myxoid stroma in 12 cases (60%), cartilaginous formation in 1 case (5%), haemorrhage in 12 cases (60%) and fibrinous deposition in 14 cases (70%). The tumours were positive for MDM2 in 16 cases (80%), ERG in 4 cases (20%), alpha-smooth muscle actin in 6 cases (30%), desmin in 5 cases (25%) and AE1/AE3 in 4 cases (20%). Immunohistochemical positivity was focal in each case. Loss of H3K27me3 expression was noted in 2 cases (10%). MDM2 and PDGFRA gene amplifications were detected in 11 cases (55%) and 1 case (5%), respectively. Fisher’s exact test revealed a significant correlation between MDM2 gene amplification and myxoid stroma (p = 0.0194). No parameters showed any association with the anatomical location of the tumours. It was suggested that myxoid histology of intimal sarcoma may be associated with MDM2 gene amplification and that intimal sarcoma may be divided into myxoid and non-myxoid types.

DOI： 10.1007/s00428-022-03293-9

Web of Science

Scopus

PubMed

Language：English   Publisher：Annals of Thoracic Surgery  

We report an implantation of a novel bovine pericardial bioprosthesis in the mitral position. An 80-year-old woman underwent double valve replacement with the novel bioprosthesis, the MITRIS RESILIA mitral valve, in the mitral position and the INSPIRIS RESILIA aortic valve in the aortic position. The MITRIS valve is attached to the RESILIA tissue, which is treated using a special integrity preservation technology, which possibly increases its durability. The structural features of this bioprosthesis could facilitate easier and safer implantability during double valve replacement. This bioprosthesis can be considered advantageous theoretically in patients undergoing double valve replacement.

DOI： 10.1016/j.athoracsur.2021.05.065

Web of Science

Scopus

PubMed

Language：English   Publisher：European Journal of Cardio Thoracic Surgery  

We report a case with a retrosternal gastric tube after oesophagectomy, who required left atrial myxoma resection, pulmonary vein isolation and left atrial appendage closure. A right mini-thoracotomy approach was adopted to avoid neo-oesophagus injury, and nitric oxide inhalation was useful to facilitate one-lung ventilation while dissecting the pleural adhesion.

DOI： 10.1093/ejcts/ezab461

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Neurosurgery Case Lessons  

BACKGROUND Cerebrovascular events and infection are among the most common complications of left ventricular assist device (LVAD) therapy. The authors reported on a patient with an infectious intracranial aneurysm (IIA) associated with LVAD infection that was successfully occluded by endovascular therapy. OBSERVATIONS A 37-year-old man with severe heart failure received an implantable LVAD. He was diagnosed with candidemia due to driveline infection 44 months after LVAD implantation, and empirical antibiotic therapy was started. After 4 days of antibiotic treatment, the patient experienced sudden dizziness. Computed tomography (CT) revealed subarachnoid hemorrhage in the right frontal lobe, and CT angiography revealed multiple aneurysms in the peripheral lesion of the anterior cerebral artery (ACA) and middle cerebral artery. Two weeks and 4 days after the first bleeding, aneurysms on the ACA reruptured. Each aneurysm was treated with endovascular embolization using n-butyl cyanoacrylate. Subsequently, the patient had no rebleeding of IIAs. The LVAD was replaced, and bloodstream infection was controlled. He received a heart transplant and was independent 2 years after the heart transplant. LESSONS LVAD-associated IIAs have high mortality and an increased risk of surgical complications. However, endovascular obliteration may be safe and thus improve prognosis.

DOI： 10.3171/CASE21559

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Microbial Genomics  

Serratia marcescens is an important nosocomial pathogen causing various opportunistic infections, such as urinary tract infec-tions, bacteremia and sometimes even hospital outbreaks. The recent emergence and spread of multidrug-resistant (MDR) strains further pose serious threats to global public health. This bacterium is also ubiquitously found in natural environments, but the genomic differences between clinical and environmental isolates are not clear, including those between S. marcescens and its close relatives. In this study, we performed a large-scale genome analysis of S. marcescens and closely related species (referred to as the ‘S. marcescens complex’), including more than 200 clinical and environmental strains newly sequenced here. Our analysis revealed their phylogenetic relationships and complex global population structure, comprising 14 clades, which were defined based on whole-genome average nucleotide identity. Clades 10, 11, 12 and 13 corresponded to S. nematodiphila, S. marcescens sensu stricto, S. ureilytica and S. surfactantfaciens, respectively. Several clades exhibited distinct genome sizes and GC contents and a negative correlation of these genomic parameters was observed in each clade, which was associated with the acquisition of mobile genetic elements (MGEs), but different types of MGEs, plasmids or prophages (and other inte-grative elements), were found to contribute to the generation of these genomic variations. Importantly, clades 1 and 2 mostly comprised clinical or hospital environment isolates and accumulated a wide range of antimicrobial resistance genes, including various extended-spectrum β-lactamase and carbapenemase genes, and fluoroquinolone target site mutations, leading to a high proportion of MDR strains. This finding suggests that clades 1 and 2 represent hospital-adapted lineages in the S. marc-escens complex although their potential virulence is currently unknown. These data provide an important genomic basis for reconsidering the classification of this group of bacteria and reveal novel insights into their evolution, biology and differential importance in clinical settings.

DOI： 10.1099/mgen.0.000793

Web of Science

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_kyobu75_12

CiNii Research

Language：Japanese  

PubMed

Language：Japanese   Publisher：(一社)日本外科学会  

心臓血管外科領域における長時間労働の関連因子を明らかにすることを目的にアンケート調査を行い、607名の心臓血管外科医より回答を得た。その結果、週60時間以上勤務(超過勤務に換算して960時間以上)している心臓血管外科医は458名(75.5%)であった。また、長時間労働に影響を与えている因子として、「年齢」「オンコール(月20回以上)」「カテコラミン管理」「手術関連の承諾書作成」「心臓血管外科医によるICUでの術後管理」が明らかになった。

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Background: The high surgical risk in redo cardiac surgery is largely attributed to adhesions around the epicardium and the great vessels. BAX602 is an adhesion prevention reagent composed of two synthetic polyethylene glycols. Spraying BAX602 over the epicardium and the great vessels reportedly contributes to adhesion prevention after pediatric cardiac surgery. The present study aims to evaluate the safety and effectiveness of BAX602 spray in patients undergoing extracorporeal ventricular assist device implantation surgery to treat refractory congestive heart failure. Methods and Design: This investigator-initiated, multicenter, pivotal, two-arm, open-label, randomized trial will include a total of 30 patients. The primary outcome measure is the severity of adhesions, which will be evaluated during re-sternotomy surgery performed 2–12 weeks after the primary extracorporeal ventricular assist device implantation surgery. The adhesion severity will be evaluated at five predefined sites using a four-grade adhesion evaluation score (0 = no adhesion; 1 = filmy and avascular adhesion; 2 = dense/vascular adhesion; 3 = cohesive adhesion). This measure will be summarized in two ways to evaluate the effect of BAX602: (1) the total score of the severity of adhesions at all five sites (ranging from 0 to 15), and (2) the total number of sites with dense/vascular or cohesive adhesions (ranging from 0 to 5). Ethics and Dissemination: The study findings will be disseminated at regional, national, and international conferences and through peer-reviewed scientific journals. Trial Registration: The trial was registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000038998) on 6 January 2020.

DOI： 10.1007/s10557-020-06990-2

Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Book type：Scholarly book

Language：Japanese   Book type：Scholarly book

Language：Japanese   Book type：Scholarly book

Language：Japanese   Book type：Scholarly book

Responsible for pages：「成人心臓・大動脈外科手術書：一流外科医が教える基本・コツ・勘所」、小坂眞一編集、医学書院（東京）pp.224-227, 2018   Language：Japanese   Book type：Scholarly book

Responsible for pages：「今日の治療指針　2018年版─私はこう治療している」、医学書院（東京）pp.393-395、2018   Language：Japanese   Book type：Scholarly book

Responsible for pages：Heart Nursing 30（2）：50-57、2017   Language：Japanese   Book type：General book, introductory book for general audience

Responsible for pages：日本臨床（増刊号）「動脈・静脈の疾患（上）－最新の診断・治療動向─」、日本臨床社（東京）、pp.428-430、2017   Language：Japanese   Book type：Scholarly book

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Event date： 2023.11

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Venue：ハイブリッド開催   Country：Japan  

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Venue：InterContinental Seoul COEX   Country：Korea, Republic of  

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Venue：InterContinental Seoul COEX   Country：Korea, Republic of  

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Venue：InterContinental Seoul COEX   Country：Korea, Republic of  

Event date： 2017.11

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：小倉   Country：Japan  

Event date： 2017.11

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：小倉   Country：Japan  

Event date： 2017.11

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：香港  

Event date： 2017.11

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：岡山   Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：横浜   Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：福岡   Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：福岡   Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：秋田   Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：札幌   Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：札幌   Country：Japan  

Event date： 2017.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：札幌   Country：Japan  

Event date： 2017.9

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：札幌   Country：Japan  

Event date： 2017.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：札幌   Country：Japan  

Event date： 2017.9

Language：English   Presentation type：Oral presentation (invited, special)  

Venue：東京   Country：Japan  

Event date： 2017.9

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：東京   Country：Japan  

Event date： 2017.8

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：長崎   Country：Japan  

Event date： 2017.8

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：福岡   Country：Japan  

Event date： 2017.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2017.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2017.7

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan