Kyushu University Academic Staff Educational and Research Activities Database
List of Papers
Shinichiro Oda Last modified date:2021.10.22

Assistant Professor / Research Institute of Angiocardiology / Faculty of Medical Sciences

1. Kodama Y, Ishikawa Y, Kuraoka A, Nakamura M, Oda S, Nakano T, Kado H, Sakamoto I, Ohtani K, Ide T, Tsutsui H, Sagawa K, Systemic-to-pulmonary collateral flow correlates with clinical condition late after the Fontan procedure, Pediatr Cardiol, 41(8): 1800-1806, 2020., 2020.10.
2. Oda S, Nakano T, Kado H, Expansion of a huge compressive left atrial appendage aneurysm in a 29-day-old infant, Ann Thorac Surg, 110(6): e521-e523, 2020, 2020.04.
3. Shinichiro Oda, Toshihide Nakano, Satoshi Fujita, Shuhei Sakaguchi, Hideaki Kado, Long-Term Growth of the Neoaortic Root After Arterial Switch Operation, Annals of Thoracic Surgery, 10.1016/j.athoracsur.2018.09.025, 107, 4, 1203-1211, 2019.04, Background: The growth of the neoaortic root after the arterial switch operation for the transposition of the great arteries remains unclear. This study aimed to investigate the growth of the neoaortic root and identify risk factors for neoaortic root dilatation. Methods: Serial angiographic measurements of the neoaortic root for at least 10 years were evaluated in 145 patients. A total of 1,876 measurements of the sinuses of the Valsalva and the neoaortic annuli were obtained. A linear mixed effects model was used for z-score analysis, including evaluation of risk factors for neoaortic root dilatation. To assess changes in the time course of neoaortic root absolute diameters, a nonlinear mixed effects model with a growth curve model was used. Results: The growth curve revealed progressive growth of the neoaortic root during somatic growth and stabilization in adulthood without normalization. The growth rates of the sinus and annulus were 0.0046 and 0.029 z-score per year, respectively. The sinus and annulus were estimated to grow up to 47 ± 1 mm and 31 ± 1 mm, respectively. Major risk factors for neoaortic root dilatation were double-outlet right ventricle (parameter estimate [PE] = 2.1, 95% confidence interval [CI] = 1.5 to 2.7, p < 0.0001 for sinus; PE = 1.2; 95% CI = 0.7 to 1.6, p < 0.0001 for annulus) and presence of neoaortic valve insufficiency (PE = 0.9; 95% CI = 0.4 to 1.5; p < 0.001 for sinus; PE = 1.6, 95% CI = 1.2 to 2.0, p < 0.0001 for annulus). Conclusions: The risk for neoaortic root dilatation was common. Long-term surveillance is mandatory, particularly in patients with double-outlet right ventricle and neoaortic valve insufficiency..
4. Takuya Okamoto, Toshihide Nakano, Masami Goda, Shinichiro Oda, Hideaki Kado, Outcomes of mitral valve replacement with bileaflet mechanical prosthetic valve in children, General thoracic and cardiovascular surgery, 10.1007/s11748-019-01236-x, 2019.01, Objectives: We examined the outcomes following mitral valve replacement with bileaflet mechanical prosthetic valve in children and identified the predictors for mortality and reoperation. Methods: Medical records from 49 children who underwent mitral valve replacement between 1982 and 2015 were reviewed retrospectively. Median age and body weight at initial mitral valve replacement were 2.4 years and 9.7 kg, respectively. The median follow-up was 13 years. Surgical results and predictors for mortality and reoperation were investigated. Results: There was no operative mortality; eight late deaths occurred. The actuarial survival rates were 89.5%, 84.2%, and 80.7% at 5, 10, and 15 years, respectively, after initial mitral valve replacement. The actuarial freedom rates from related complications were 89.5%, 78.3%, and 70.7% at 5, 10, and 15 years, respectively. Nineteen patients required 1st re-mitral valve replacement at a median of 5.9 years; six of these 19 required 2nd re-mitral valve replacement at a median of 8.9 years after 1st re-MVR. The actuarial freedom rates from re-mitral valve replacement were 86.0%, 56.8%, and 44.2% at 5, 10, and 15 years, respectively. No predictor for death was determined; however, the predictor for re-mitral valve replacement was initial valve diameter less than 19 mm. Conclusions: Survival outcomes among children after mitral valve replacement with bileaflet mechanical prosthetic valve in biventricular heart were satisfactory. However, complications, including re-mitral valve replacement, were frequent and the predictor was of a small prosthesis size..
5. Takeaki Harada, Toshihide Nakano, Shinichiro Oda, Hideaki Kado, Surgical results of total anomalous pulmonary venous connection repair in 256 patients, Interactive cardiovascular and thoracic surgery, 10.1093/icvts/ivy267, 28, 3, 421-426, 2019.01, Objectives: This study was performed to analyse the surgical results of total anomalous pulmonary venous connection (TAPVC) repair at a single institution and to identify trends and variables associated with mortality and morbidity, particularly predictors of recurrent pulmonary venous obstruction (PVO). Methods: Our surgical database contained 256 patients with biventricular anatomy who underwent surgical repair for TAPVC from 1981 to 2016. The anatomic TAPVC subtypes in this study were as follows: 114 supracardiac (44.5%), 56 cardiac (21.9%), 64 infracardiac (25.0%) and 22 mixed (8.6%) types. The follow-up for the entire study ranged from 1.6 months to 28.2 years (median 10.4 years). Preoperative PVO was present in 128 patients (50.0%). All patients with TAPVC with single-ventricle anatomy were excluded from the analysis. Data were retrospectively reviewed. Results: Seven (2.7%) early deaths and 26 (10.1%) late deaths occurred. The actuarial survival rate at 20 years postoperatively was 85.3%. The preoperative predictors of operative mortality were younger age and the era of TAPVC repair (before 1998). In addition to these variables, associated cardiac anomalies were predictors of late mortality. Those for postoperative PVO were younger age, lower weight and being an emergency case. The actuarial survival rate at 20 years was 38.6% for patients with postoperative PVO and 92.2% for patients without postoperative PVO (P < 0.001). Conclusions: The long-term outcomes after TAPVC repair in patients with biventricular anatomy were satisfactory. Mortality was significantly associated with the rate of progression of postoperative PVO, and careful follow-up was required especially within 6 months after the primary operation..
6. Shuichi Shiraishi, Toshihide Nakano, Shinichiro Oda, Hideaki Kado, Impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after Fontan operation, Cardiology in the Young, 10.1017/S1047951118001543, 28, 12, 1436-1443, 2018.12, Backgrounds The aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection. Methods: We conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, <6 months (n=33), and older group, >6 months (n=67). Results: The proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm 2 /m 2 ; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044). Conclusions: Early bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome..
7. Satoshi Fujita, Toshihide Nakano, Shinichiro Oda, Hideaki Kado, Hisataka Yasui, Yasui Conversion for Repair After Left Ventricular Outflow Tract Obstruction, Annals of Thoracic Surgery, 10.1016/j.athoracsur.2017.06.030, 104, 5, e389-e391, 2017.11, We herein report two cases of progressive left ventricular outflow obstruction after primary repair of arch obstruction and ventricular septal defect that was successfully resolved with Yasui conversion. Patients who require surgical reintervention for progressive left ventricular outflow tract (LVOT) obstruction after primary biventricular repair of interruption of the aortic arch or coarctation of the aorta complex are occasionally experienced. The modified Konno procedure and Ross operation are well recognized as useful for these cases. However, in some patients, these procedures are difficult to perform because of anatomic restrictions or previous procedures. Although the indications are limited, the Yasui conversion is a safe, simple, and useful option for LVOT obstruction after primary biventricular repair..
8. Jun Muneuchi, Shinichiro Oda, Daisuke Shimizu, Rapidly progressive pulmonary veno-occlusive disease in an infant with Down syndrome, Cardiology in the Young, 10.1017/S1047951117000397, 27, 7, 1402-1405, 2017.09, A 4-month-old girl with Down syndrome showed unexpected deterioration of pulmonary hypertension. Despite aggressive pulmonary vasodilation therapy, the patient died at 5 months of age. Lung autopsy showed that the pulmonary veins were obliterated by intimal fibrous thickening, and the media of the veins was arterialised with an increase in elastic fibres. Pulmonary veno-occlusive disease should be considered in the management of individuals with Down syndrome..
9. Shinichiro Oda, Toshihide Nakano, Kazuhiro Hinokiyama, Hideaki Kado, An Unusual Double Connection in Mixed Type of Total Anomalous Pulmonary Venous Connection, Annals of Thoracic Surgery, 10.1016/j.athoracsur.2017.03.037, 104, 2, e193, 2017.08.
10. Toshihide Nakano, Hideaki Kado, Hideki Tatewaki, Kazuhiro Hinokiyama, Shinichiro Oda, Hiroya Ushinohama, Koichi Sagawa, Makoto Nakamura, Naoki Fusazaki, Shiro Ishikawa, Results of extracardiac conduit total cavopulmonary connection in 500 patients, European Journal of Cardio-thoracic Surgery, 10.1093/ejcts/ezv072, 48, 6, 825-832, 2015.01, OBJECTIVES: This single-institution study aimed to evaluate the early to mid-term outcomes of extracardiac conduit total cavopulmonary connection (EC-TCPC). METHODS: Between March 1994 and March 2014, 500 patients (median age, 3.4 years) underwent EC-TCPC at our hospital. One hundred and twenty-three patients (24.6%) showed heterotaxy, and fenestration was created in 6 patients (1.2%). The standard institutional treatment policy included postoperative anticoagulation and individualized cardiovascular medication. The mortality and morbidity rates, haemodynamic status, cardiopulmonary exercise capacity and liver examination results during the follow-up period (median, 6.7 years) were retrospectively reviewed. RESULTS: There were 2 early and 17 late deaths. The Kaplan-Meier estimated survival rate was 96.2% at 10 years and 92.8% at 15 years. Bradyarrhythmia and tachyarrhythmia occurred in 19 and 13 patients, respectively. Other late-occurring morbidities included proteinlosing enteropathy in 8, thromboembolism in 5, bleeding complications in 6 and liver cirrhosis in 1 patient. The rate of freedom from lateoccurring morbidities was 82.1% at 15 years. In the multivariate analysis, heterotaxy was found to be a predictor for mortality (P = 0.02), whereas age at operation was a predictor for new-onset arrhythmias (P = 0.048). In the cardiopulmonary exercise test (n = 312), the peak VO2 was 84.9 ± 17.3% of the predicted value, which tended to decrease with age (R2 = 0.32) and elapsed time since operation (R2 = 0.21). Postoperative cardiac catheterization (n = 468; time from surgery, 3.6 ± 4.3 years) showed central venous pressure of 9.9 ± 2.4 mmHg, ventricular end-diastolic pressure of 5.2 ± 3.3 mmHg, cardiac index of 3.4 ± 0.8 l/min/m2 and arterial oxygen saturation of 94.2 ± 4.8%. In 101 patients who were followed up for =10 years, amino-terminal type III procollagen peptide and collagen type IV levels exceeded the normal ranges in 52.9 and 75.2% of patients, respectively, and liver ultrasonography revealed hyper-echoic spots in 43.3% of patients. CONCLUSIONS: The early to mid-term outcomes of post-EC-TCPC patients managed with individualized pharmacotherapy were excellent, with low mortality and morbidity rates; however, development of late-occurring morbidities specific to Fontan physiology, including exercise intolerance and liver disease, must be carefully monitored during the long-term follow-up..
11. Junya Sugiura, Toshihide Nakano, Shinichiro Oda, Akihiko Usui, Yuichi Ueda, Hideaki Kado, Effects of tricuspid valve surgery on tricuspid regurgitation in patients with hypoplastic left heart syndrome
A non-randomized series comparing surgical and non-surgical cases, European Journal of Cardio-thoracic Surgery, 10.1093/ejcts/ezt613, 46, 1, 8-13, 2014.07, OBJECTIVES: Tricuspid regurgitation (TR) remains a significant risk factor affecting the survival of patients with hypoplastic left heart syndrome (HLHS). We performed this study to investigate differences in the clinical course based on the timing of the development of TR and the effects of tricuspid valve surgery (TVS). METHODS: One hundred and five patients of classic HLHS underwent staged operations from May 1991 to July 2010. Forty-four patients (41.9%) exhibited moderate or greater TR during the follow-up. We defined the early TR group (30 patients, around the first palliative surgery) and the late TR group (14 patients, the later period) based on the timing of the appearance of moderate or greater TR. We performed TVS when moderate or greater TR was detected in 28 patients. The follow-up period was 5.5 ± 5.1 (plus/minus values are means ± SD) years (range: 0.01-14.6 years) after the first palliative surgery and 4.9 ± 4.4 years (range: 0.01-13.3 years) after TVS. RESULTS: The early TR group exhibited poorer survival than the late TR group (42.9 vs 92.9% at 5 years, P = 0.003). However, in the early TR group, the TVS significantly improved survival compared with that observed in the non-TVS cases (52.1 vs 23.3% at 5 years, P = 0.046). The right ventricular ejection fraction (RVEF) significantly decreased (62.7 ± 11.4→57.2 ± 12.6% (plus/minus values are means ± SD), P = 0.040) and the right ventricular end-diastolic diameter (RVDd) became significantly enlarged (27.7 ± 7.6→36.7 ± 3.4 mm, P < 0.001) in association with deterioration of the TR degree. TVS significantly improved the degree of TR (2.5 ± 0.5→1.5 ± 0.9°, P < 0.001) and RVDd (37.7 ± 7.4→30.4 ± 5.0 mm, P = 0.007); however, the RVEF was not improved 1 month after surgery (54.4 ± 12.1→54.3 ± 12.4%, P = 0.931) or at the latest follow-up (53.7 ± 14.9%, P = 0.836). CONCLUSIONS: The survival of HLHS patients who develop moderate or greater TR around the time of the first palliative surgery is worse than that of HLHS patients who develop moderate or greater TR at a later time. In this study, TVS for early TR improved survival and decreased right ventricular dimensions during the 4.9-year follow-up period..
12. Shinichiro Oda, Toshihide Nakano, Hideki Tatewaki, Kazuhiro Hinokiyama, Daisuke Machida, Hideaki Kado, A 17-year experience with mitral valve repair with artificial chordae in infants and children, European Journal of Cardio-thoracic Surgery, 10.1093/ejcts/ezt183, 44, 1, e40-e45, 2013.07, OBJECTIVES: We sought to examine our long-term results of mitral valve (MV) repair with expanded polytetrafluoroethylene (ePTFE) sutures and to determine the predictors for the outcome of this procedure. METHODS: Between 1995 and 2011, MV repair with chordal reconstruction by artificial chordae was achieved in 78 patients (34 males and 44 females). Median age at repair was 1.5 years (range 3.6 months-13.4) and weight was 9.1 kg (2.5-31.4). The mean follow-up was 8.3 years. A Cox proportional hazards model was used to analyse the risk factors for a composite outcome of death, conversion to other MV repair techniques or MV replacement, reoperation on MV and recurrent mitral regurgitation (MR). RESULTS: According to Carpentier classification, 65 (83.3%) patients were Type 2 and 13 (16.7%) were Type 3. Mitral annuloplasty was performed in all cases, except 2. During MV repair, 8 (10.3%) patients were ineffective with artificial chordae and converted to other techniques. Six (7.7%) patients underwent MV reoperation (three repairs and three replacements). Freedom from MV reoperation was 92.5 and 90.4% at 5 and 10 years, respectively. There was 1 in-hospital death. At the latest follow-up, moderate or more MR was observed in 3 (3.8%) patients. Risks for the composite outcome were low body weight at operation and Carpentier classification Type 3. CONCLUSIONS: MV repair with artificial chordae in infants and children is safe and effective and associated with a low reoperation rate. Further investigation into the long-term durability and biological adaptation of ePTFE sutures after patient growth is mandatory..
13. Shigeki Morita, Takehisa Matsuda, Masataka Eto, Shinichiro Oda, Ryuji Tominaga, [Development of hemostatic sealant for arterial anastomosis; clinical application]., Kyobu geka. The Japanese journal of thoracic surgery, 66, 5, 395-400, 2013.05, For the purpose of examining the clinical applicability of a newly developed surgical sealant, animal experiments were performed, and clinical trial was followed. In animal experiments, several animal models, including carotid artery anastomosis model and coronary artery bypass grafting model were undertaken. In each model, complete hemostasis of the anastomoses using four simple interrupted sutures, was obtained. In addition, elastomeric property of the sealant prevented thinning of the arterial wall. The clinical trial performed in patients with thoracic aortic surgery showed significantly better hemostasis even under heparinized condition. Based on these excellent results, clinical usage of the sealant was approved..
14. Kiyomi Tsukimori, Yoichiro Hamasaki, Eiji Morihana, Naoki Fusazaki, Yasuyuki Fujita, Yasushi Takahata, Shinichiro Oda, Hideaki Kado, Aortic regurgitation associated with critical aortic stenosis in a fetus, Pediatric Cardiology, 10.1007/s00246-012-0344-2, 34, 4, 1020-1023, 2013.04, Aortic regurgitation in association with aortic stenosis is rare in the fetus. Findings have shown that severe aortic regurgitation is worsened by the increase in systemic vascular resistance after birth, resulting in low cardiac output, hypoxemia, and neonatal death. This report describes a unique case of aortic regurgitation with aortic stenosis, severe mitral regurgitation, retrograde flow in the aortic arch, and an enormous left atrium with a restrictive foramen ovale in a fetus. In this case, aortic regurgitation was diminished immediately after birth, indicating that spontaneous improvement in aortic regurgitation after birth should be taken into account when the final prognosis is predicted..
15. Kazuhiro Kurisu, Manabu Hisahara, Toshiro Iwai, Shinichiro Oda, Yuncong Wang, Yoshie Ochiai, Aortic valve replacement in a porcelain aorta using endo balloon occlusion, Journal of Cardiac Surgery, 10.1111/jocs.12017, 27, 6, 689-691, 2012.11, Aortic valve surgery carries increased risks in patients with an extensively calcified aorta. We describe a technique in which we maintain systemic perfusion via bilateral axillary artery perfusion in conjunction with endoaortic balloon occlusion, and limit the circulatory arrest time..
16. Shinichiro Oda, Toshihide Nakano, Junya Sugiura, Naoki Fusazaki, Shiro Ishikawa, Hideaki Kado, Twenty-eight years' experience of arterial switch operation for transposition of the great arteries in a single institution, European Journal of Cardio-thoracic Surgery, 10.1093/ejcts/ezs033, 42, 4, 674-679, 2012.10, Objectives: We reviewed our 28 years of experience of arterial switch operation (ASO) for transposition of the great arteries to investigate late sequelae of this procedure. Methods: 387 patients who underwent ASO from 1984 to 2010 were included in this retrospective study. The longitudinal data were estimated by the Kaplan-Meier method and compared using a log-rank test. Risk factors for late sequelae were analysed by the multivariable Cox proportional hazards model. Results: The mean follow-up time was 10.0 years. There were 13 early deaths and 17 late deaths. All late deaths were within 1year, except for three patients. Actuarial survival was 92.2 and 91.6% at 10 and 20 years, respectively. Sixty-six patients (17.1%) had developed pulmonary stenosis (PS) and 29 patients (7.5%) had developed moderate or more aortic insufficiency (AI) during follow-up. Selective coronary angiography was performed in 210 patients (54.3%) at 9.6± 5.1 years after ASO. Left main tract occlusion was found in 2 patients (2/210; 1.0%) and hypoplastic left coronary artery was found in 10 patients (10/210; 4.8%). Among these 12 patients, 8 patients were asymptomatic. Re-operation was performed in 76 patients (19.6%), pulmonary artery plasty for PS in 58 patients (15.0%), aortic valve replacement for AI including two Bentall operations in 9 patients (2.3%) and others. Freedom from re-operation was 78.2 and 62.8% at 10 and 20 years, respectively. The risk factor for PS was the use of equine pericardium for reconstruction (P< 0.0001). Factors associated with moderate or more AI was the presence of left ventricular outflow tract obstruction (P= 0.004). There were no risk factors for late coronary lesions. Three hundred and forty surviving patients (340/357; 95.2%) were in NYHA functional class I. Treadmill test, which was performed on 217 patients (56.1%) at 14.3 ± 5.4 years after ASO, revealed that the maximum heart rate was 97.5 ± 7.6% of normal and peak oxygen consumption was 105.2 ± 20.5% of normal. Conclusions: ASO was performed with satisfactory results in the overall survival and functional status. PS was the main reason for re-operation. Coronary lesions can appear late without any symptoms. Benefits of ASO can be achieved by long-term follow-ups of PS, AI and coronary lesions..
17. Kiyomi Tsukimori, Eiji Morihana, Naoki Fusazaki, Yasushi Takahata, Shinichiro Oda, Hideaki Kado, Critical ebstein anomaly in a fetus successfully managed by elective preterm delivery and surgical intervention without delay after birth, Pediatric Cardiology, 10.1007/s00246-011-0124-4, 33, 2, 343-346, 2012.02, This report describes a case of Ebstein anomaly in a fetus with cardiomegaly, severe tricuspid regurgitation, pulmonary regurgitation, and retrograde ductal flow that showed a marked increase in the size of the right atrium with advancing gestational age. Elective preterm delivery was performed at 35 weeks gestation. The prostaglandin E1 infusion resulted in more pronounced systemic hypotension and acidosis secondary to circular shunt across the patent ductus arteriosus as well as pulmonary regurgitation and tricuspid regurgitation. Emergency surgical intervention consisting of main pulmonary artery ligation, ductus arteriosus ligation, central shunt creation, and plication of the right atrium without cardiopulmonary bypass was performed 4 h after birth. At the age of 16 days, the Starnes procedure was performed. The infant's postoperative course was uneventful. A fetus that has Ebstein anomaly associated with pulmonary regurgitation is at risk for circular shunt across the patent ductus arteriosus after delivery. Planned delivery and surgical intervention without delay after birth are useful for the treatment of such cases..
18. Takahisa Sakurai, Hideaki Kado, Toshihide Nakano, Kazuhiro Hinokiyama, Shinichiro Oda, Junya Sugiura, Tomoki Ushijima, Yuichi Ueda, The impact of extracardiac conduit-total cavopulmonary connection on apicocaval juxtaposition, European Journal of Cardio-thoracic Surgery, 10.1016/j.ejcts.2010.02.032, 38, 4, 439-444, 2010.10, Objectives: Modifications of the Fontan procedure are applied to a wide range of complex congenital heart defects with single ventricle physiology. We examined the pathway and the clinical results of extracardiac conduit-total cavopulmonary connection (EC-TCPC) for a malpositioned heart with apicocaval juxtaposition. Methods: Of the 365 patients who underwent EC-TCPC since 1994, 56 patients with a malpositioned heart with apicocaval juxtaposition were included in this retrospective study (group 1). The pathway for the EC was selected after careful consideration of the results of preoperative angiography and computed tomography, as well as intra-operative findings. A concurrent group of 299 patients undergoing EC-TCPC without apicocaval juxtaposition was used as a control group (group 2). The mean follow-up periods for groups 1 and 2 were 5.5 years (range: 0-12 years) and 5.5 years (range: 0-14 years), respectively. Results: The mean age at operation was 4.2±3.2 years and the median size of the conduit was 18mm (range: 16-20mm). In 30 patients, the conduit was placed between the inferior venacava (IVC) and the opposite side of the pulmonary artery crossing the vertebra. In another 25 patients, the conduit was positioned behind the ventricle between the IVC and on the same side as the pulmonary artery (PA). There was one patient who had a Y-style conduit placed between the IVC and right and left PAs behind the ventricle. In group 1, there were no early deaths; three patients died in the intermediate term due to gastric bleeding in one, haemoptysis in another and sudden death in yet another. None of the patients developed conduit stenosis or pulmonary venous obstruction, and no patient required re-operation. Three patients developed late complications, including arrhythmias requiring medication in two and subdural haematoma in one. The incidence of death or late complications did not differ among the pathways of conduits. In group 2, there were eight late deaths, and 27 patients developed late complications. The Kaplan-Meier survival rate was 93.5% at 5 and 10 years in group 1, and 97.3% at 5 years and 96.1% at 10 years in group 2 (log-rank test, P=0.29). The haemodynamics in groups 1 and 2 during the intermediate term were identical with respect to IVC pressure (8.9±2.5 in group 1 and 9.6±2.6mmHg in group 2), left ventricular end-diastolic pressure (4.4 and 4.3mmHg, respectively), cardiac index (3.3 and 3.4lmin-1m-2, respectively) and arterial oxygen saturation (94 and 94.2%, respectively). No patient in either group had a pressure gradient >2mmHg between the IVC and central PA. Postoperative catheterisation data showed no significant differences in haemodynamics between the conduit pathways in group 1. Conclusions: EC-TCPC can be performed in children with apicocaval juxtaposition with excellent mid-term outcomes compared with other Fontan candidates. Based on individual cardiac anatomy, the pathway of the EC behind the ventricle or crossing the vertebra can be used without conduit stenosis or pulmonary venous obstruction..
19. Shinichiro Oda, Ryoji Nagahama, Kaku Nakano, Tetsuya Matoba, Mitsuki Kubo, Kenji Sunagawa, Ryuji Tominaga, Kensuke Egashira, Nanoparticle-mediated endothelial cell-selective delivery of pitavastatin induces functional collateral arteries (therapeutic arteriogenesis) in a rabbit model of chronic hind limb ischemia, Journal of Vascular Surgery, 10.1016/j.jvs.2010.03.020, 52, 2, 412-420, 2010.08, Objectives: We recently demonstrated in a murine model that nanoparticle-mediated delivery of pitavastatin into vascular endothelial cells effectively increased therapeutic neovascularization. For the development of a clinically applicable approach, further investigations are necessary to assess whether this novel system can induce the development of collateral arteries (arteriogenesis) in a chronic ischemia setting in larger animals. Methods: Chronic hind limb ischemia was induced in rabbits. They were administered single injections of nanoparticles loaded with pitavastatin (0.05, 0.15, and 0.5 mg/kg) into ischemic muscle. Results: Treatment with pitavastatin nanoparticles (0.5 mg/kg), but not other nanoparticles, induced angiographically visible arteriogenesis. The effects of intramuscular injections of phosphate-buffered saline, fluorescein isothiocyanate (FITC)-loaded nanoparticles, pitavastatin (0.5 mg/kg), or pitavastatin (0.5 mg/kg) nanoparticles were examined. FITC nanoparticles were detected mainly in endothelial cells of the ischemic muscles for up to 4 weeks. Treatment with pitavastatin nanoparticles, but not other treatments, induced therapeutic arteriogenesis and ameliorated exercise-induced ischemia, suggesting the development of functional collateral arteries. Pretreatment with nanoparticles loaded with vatalanib, a vascular endothelial growth factor receptor (VEGF) tyrosine kinase inhibitor, abrogated the therapeutic effects of pitavastatin nanoparticles. Separate experiments with mice deficient for VEGF receptor tyrosine kinase demonstrated a crucial role of VEGF receptor signals in the therapeutic angiogenic effects. Conclusions: The nanotechnology platform assessed in this study (nanoparticle-mediated endothelial cell-selective delivery of pitavastatin) may be developed as a clinically feasible and promising strategy for therapeutic arteriogenesis in patients..
20. Shinichiro Oda, Shigeki Morita, Yoshihisa Tanoue, Masataka Eto, Takehisa Matsuda, Ryuji Tominaga, Experimental use of an elastomeric surgical sealant for arterial hemostasis and its long-term tissue response, Interactive cardiovascular and thoracic surgery, 10.1510/icvts.2009.217620, 10, 2, 258-261, 2010.02, Objective: Reliable suture line hemostasis should improve the outcome of aortic surgery. We examined the hemostatic effect and the tissue response of a novel elastomeric surgical sealant. Methods: Using porcine internal carotid arteries, we performed 16 end-to-end anastomoses with four stitches of simple interrupted sutures under full heparinization. The anastomoses were divided into two groups (eight anastomoses per group). Either novel sealant or fibrin glue was applied. The amount of bleeding was measured during the 30 s period after removing the vascular clamp. In a separate experiment, we applied the novel sealant around the abdominal aorta of rabbits (n=6) to assess the effect of the elastomeric property of the sealant on arterial wall histology. For comparison, we applied cyanoacrylate, which has no elastomeric property (n=6). A histological study was performed three months after the operation. Results: The novel sealant prevented arterial bleeding. The amount of bleeding from the anastomoses applied with novel sealant and fibrin glue was 0.12±0.03 g vs. 91.8±16.5 g, respectively (P<0.001). Thinning of the rabbit aortic wall was observed in the cyanoacrylate-treated abdominal aorta, whereas no thinning was observed in the novel sealant group. Histological examination revealed neither cell death nor necrosis in the novel sealant group. Conclusions: The novel sealant effectively prevented arterial bleeding from the anastomosis under full heparinization. In addition, the elastomeric property of the sealant prevented thinning of the aortic wall. The novel sealant may be a promising hemostatic agent for arterial anastomosis..
21. Hironori Baba, Yoshihisa Tanoue, Taketoshi Maeda, Mariko Kobayashi, Shinichiro Oda, Ryuji Tominaga, Protective effects of cold spinoplegia with fasudil against ischemic spinal cord injury in rabbits, Journal of Vascular Surgery, 10.1016/j.jvs.2009.10.081, 51, 2, 445-452, 2010.02, Objective: Paraplegia remains a serious complication after surgical repair of thoracoabdominal aortic aneurysms. The aim of this study was to evaluate the neuroprotective efficacy of fasudil, a Rho kinase (ROCK) inhibitor, by reducing the number of infiltrating cells in the ventral horn and increasing the induction of eNOS against ischemic spinal cord injury in rabbits. Methods: Eighteen Japanese white rabbits were divided into three groups: saline (group 1, n = 7, 4°C) and fasudil (group 2, n = 6, 4°C) were immediately infused into the isolated segmental lumbar arteries over 30 seconds after aortic clamping. Group 3 (n = 5) was the sham-operated group. Hind limb function was evaluated 4 and 8 hours, and 1 and 2 days after 15 minutes of transient ischemia. Cell damage was analyzed by hematoxylin and eosin staining and temporal profiles of endothelial nitric oxide synthase immunoreactivity were performed. The number of intact motor neuron cells and infiltrating cells in the ventral horn were compared. Results: Two days after reperfusion, group 2 and group 3 showed better neurologic function, a greater number of intact motor neuron cells, and a smaller number of infiltrating cells in the ventral horn than group 1. The induction of endothelial nitric oxide synthase (eNOS) was prolonged up to 2 days after reperfusion in group 2. Conclusion: These results indicate that fasudil has neuroprotective effects against ischemic spinal cord injury in rabbits by reducing the number of infiltrating cells in the ventral horn and prolonging the expression of eNOS..
22. Yoshihisa Tanoue, Taketoshi Maeda, Shinichiro Oda, Hironori Baba, Yasuhisa Oishi, Shigehiko Tokunaga, Atsuhiro Nakashima, Ryuji Tominaga, Left ventricular performance in aortic valve replacement, Interactive cardiovascular and thoracic surgery, 10.1510/icvts.2009.202309, 9, 2, 255-259, 2009.08, We analyzed the mid-term left ventricular (LV) performance after aortic valve replacement (AVR). We measured LV contractility (endsystolic elastance: Ees), afterload (effective arterial elastance: Ea) and efficiency (ventriculoarterial coupling: Ea/Ees; ratio of stroke work and pressure-volume area: SW/PVA) based on transthoracic echocardiography data obtained before, after and approximately 1 year after isolated AVR in 263 patients with aortic stenosis (AS group; n=116), aortic regurgitation (AR group; n=93) or aortic stenosis and regurgitation (ASR group; n=54). The LV volume was calculated by the Teichholz M-mode method. Ees and Ea were approximated as follows: Eessmean blood pressure/minimal LV volume; Ea=systolic blood pressure/(maximal LV volume-minimal LV volume). Thereafter, Ea/Ees and SW/PVA were calculated. Arterial blood pressure was measured using manchette methods. Ees and Ea decreased after AVR inthe AS group, but increased in the AR group. Ea/Ees and SW/PVA worsened after AVR in the AR group, but improved during a 1-year period after AVR in all groups. Contrasting effects of AVR on LV contractility and afterload between AS and AR were clearly demonstrated. The mid-term LV contractility and efficiency after AVR were excellent and satisfactory. However, LV efficiency worsened early after AVR in AR patients..
23. Mitsuki Kubo, Kensuke Egashira, Takahiro Inoue, Jun Ichiro Koga, Shinichiro Oda, Ling Chen, Kaku Nakano, Tetsuya Matoba, Yoshiaki Kawashima, Kaori Hara, Hiroyuki Tsujimoto, Katsuo Sueishi, Ryuji Tominaga, Kenji Sunagawa, Therapeutic neovascularization by nanotechnology-mediated cell-selective delivery of pitavastatin into the vascular endothelium, Arteriosclerosis, thrombosis, and vascular biology, 10.1161/ATVBAHA.108.182584, 29, 6, 796-801, 2009.06, OBJECTIVE-: Recent clinical studies of therapeutic neovascularization using angiogenic growth factors demonstrated smaller therapeutic effects than those reported in animal experiments. We hypothesized that nanoparticle (NP)-mediated cell-selective delivery of statins to vascular endothelium would more effectively and integratively induce therapeutic neovascularization. METHODS AND RESULTS-: In a murine hindlimb ischemia model, intramuscular injection of biodegradable polymeric NP resulted in cell-selective delivery of NP into the capillary and arteriolar endothelium of ischemic muscles for up to 2 weeks postinjection. NP-mediated statin delivery significantly enhanced recovery of blood perfusion to the ischemic limb, increased angiogenesis and arteriogenesis, and promoted expression of the protein kinase Akt, endothelial nitric oxide synthase (eNOS), and angiogenic growth factors. These effects were blocked in mice administered a nitric oxide synthase inhibitor, or in eNOS-deficient mice. CONCLUSIONS-: NP-mediated cell-selective statin delivery may be a more effective and integrative strategy for therapeutic neovascularization in patients with severe organ ischemia..
24. Mariko Kobayashi, Yoshihisa Tanoue, Masataka Eto, Hironori Baba, Satoshi Kimura, Shinichiro Oda, Kenichiro Taniguchi, Ryuji Tominaga, A Rho-kinase inhibitor improves cardiac function after 24-hour heart preservation, Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2008.07.038, 136, 6, 1586-1592, 2008.12, Objective: The Rho-kinase signaling pathway is associated with coronary vasculopathy and myocardial dysfunction after cardiac transplantation. This study evaluated whether using a Rho-kinase inhibitor during allograft storage could limit early endothelial dysfunction and improve myocardial performance after reperfusion. Methods: This experiment was performed with an isolated working rabbit heart model and a support rabbit. Donor hearts (control group, n = 8) were arrested with an extracellular type of cardioplegia, preserved with University of Wisconsin solution, and then immersed in University of Wisconsin solution for 24 hours (1°C). The Rho-kinase inhibitor (Rho-kinase inhibitor group, n = 8) was administrated in the cardioplegic solution, the preservation University of Wisconsin solution, and the storage University of Wisconsin solution. Left ventricular performance was evaluated from the modified Frank-Starling curve in the working mode. Coronary blood flow and donor heart rate were measured in Langendorff mode. Effective evaluation of the Rho-kinase inhibitor was inferred from phosphorylated myosin light chain. The expression of endothelial nitric oxide synthase mRNA was analyzed to assess endothelial function. Results: The Frank-Starling curve showed a significant left and upward shift in the Rho-kinase inhibitor group compared with the control group (P < .05). The coronary blood flow and heart rate in the Rho-kinase inhibitor group at 120 minutes was significantly higher than in the control group (P < .05). Phosphorylated myosin light chain was significantly suppressed in the Rho-kinase inhibitor group (P < .05). Endothelial nitric oxide synthase mRNA levels in the Rho-kinase inhibitor group increased 4-fold relative to those seen in the control group. Conclusions: Treatment with Rho-kinase inhibitor during allograft harvest and storage enhanced coronary blood flow and ventricular recovery through nitric oxide-dependent endothelial protection after reperfusion. Rho-kinase inhibitor could help prevent early myocardial dysfunction after transplantation..