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en: An evaluation of the long-term patency of the aortocoronary bypass graft anastomosed to a vascular prosthesis.

en: In the simultaneous surgery for CAD and thoracic aortic aneurysm, CABG design from vascular prosthesis to coronary artery should be avoided if possible, although further studies are warranted.

ja: During 45.9 ± 39.7 months follow-up, significantly worse patency of the grafts in group P was revealed when compared with those in group N (100% vs 77.6% in 12 months, 100% vs 52.7% in 36 months and 100% vs 31.6% in 57 months, log rank P < 0.001). The poor patency of the grafts was confirmed in each target lesions (left anterior descending artery: P = 0.050, right coronary artery: P = 0.045, left circumflex artery: P = 0.051) and regardless of the severities of the target coronary vessels (severe stenosis: P = 0.013, mild-to-moderate stenosis: P = 0.029). Furthermore, an analysis of graft occlusion risk factors using the univariate Cox proportional hazards model revealed that the proximal anastomosis site on the vascular prosthesis was the sole risk factor for graft occlusion (P < 0.001).

en: European Journal of Cardio-Thoracic Surgery


en: Recovery From Exhaustion of the Frank-Starling Mechanism by Mechanical Unloading With a Continuous-Flow Ventricular Assist Device.

en: The LVAD speed ramp and volume loading test facilitates the precise evaluation of native heart function during continuous-flow LVAD support.

ja: We describe our original left ventricular assist device (LVAD) speed ramp and volume loading test designed to evaluate native heart function under continuous-flow LVAD support.Methods and Results:LVAD speed was decreased in 4 stages from the patient's optimal speed to the minimum setting for each device. Under minimal LVAD support, patients were subjected to saline loading (body weight [kg]×10 mL in 15 min). Echocardiographic and hemodynamic data were obtained at each stage of the LVAD speed ramp and every 3 min during saline loading. Patients were divided into Recovery (with successful LVAD removal; n=8) and Non-recovery (others; n=31) groups. During testing, increased pulmonary capillary wedge pressure caused by volume loading was milder in the Recovery than Non-recovery group (repeated measures analysis of variance; group effect, P=0.0069; time effect, P<0.0001; interaction effect, P=0.0173). Increased cardiac output from volume loading was significantly higher in the Recovery than Non-recovery group (group effect, P=0.0124; time effect, P<0.0001; interaction effect, P=0.0091). Therefore, the Frank-Starling curve of the Recovery group was located upward and to the left of that of the Non-recovery group.

en: Circulation Journal

ja: Circulation Journal


en: Restrictive mitral annuloplasty with or without coronary artery bypass grafting in ischemic mitral regurgitation.

en: RMA can be performed with an acceptable operative mortality, irrespective of indications for CABG. Patients with ischaemic MR for whom CABG is indicated with RMA are more likely to show better long-term and event-free survival and greater improvements in LV systolic function. The optimal revascularization strategy should be discussed with a heart team whenever indicated in patients with ischaemic MR; otherwise, they may miss the opportunity to benefit from concomitant CABG during subsequent RMA.

ja: This study included 309 patients with chronic MR and ischaemic cardiomyopathy for whom concomitant CABG was indicated (n = 225) or not indicated (n = 84) with RMA. The primary endpoint was all cause mortality during the follow-up, and the secondary endpoint was defined as the composite of mortality and re-admission for heart failure. Linear mixed model was used to analyse serial echocardiographic changes in LV function. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent RMA with and those who underwent it without CABG, we established weighted Cox proportional-hazards regression models with inverse-probability-of-treatment weighting. Pre-operatively, there were no intergroup differences in age (RMA with CABG, 67 ± 9 vs. RMA without CABG, 68 ± 11, P = 0.409) and logistic EuroSCORE II (16 ± 14 vs. 15 ± 15%, P = 0.496). The 30-day mortalities were 2.7% and 3.6%, respectively (P = 0.67). During follow-up with a mean duration of 72 ± 37 months (range, 5.6-179), there were 157 deaths and 105 re-admissions for heart failure. Overall 1-year and 5-year survival rates were 83 ± 2% and 58 ± 3%, respectively. Patients who did not receive CABG with RMA had a significantly lower 5-year survival rate (45% vs. 63%, P = 0.049) and freedom from adverse events defined as mortality and/or admission for heart failure (19% vs. 43%, P < 0.001) than those who did. After adjustments for clinical covariates with inverse-probability-of-treatment weighting, concomitant CABG was identified as an independent protective factor for adverse events (hazard ratio: 0.53; 95% confidence interval: 0.44-0.64; P < 0.001). Along with significant MR reduction, LV function parameters changed over time after surgery in both groups, with greater improvements in patients who underwent RMA with CABG (time effect, P < 0.001; and interaction effect, P = 0.002).

en: ESC Heart Failure

ja: ESC Heart Failure


en: Intraoperative hemoglobin level and primary graft dysfunction in adult heart transplantation.

en: Low recipient serum hemoglobin levels at the time of donor heart reperfusion was independently associated with primary graft dysfunction after heart transplantation. Intraoperative management of recipient hemoglobin using red blood cell transfusion may prevent post-heart transplantation primary graft dysfunction.

ja: We assessed 69 patients, and 12 showed primary graft dysfunction. The mean hemoglobin levels at reperfusion in the low, middle, and high hemoglobin quantiles were 7.6 ± 0.9, 9.2 ± 0.3, and 10.4 ± 0.6 mg/dL, respectively. There were no significant between-group differences in pre-heart transplantation serum hemoglobin levels (p = 0.53). The odds ratio for primary graft dysfunction was significantly higher in the low hemoglobin quantile (5.80; 95% confidence interval, 2.32-14.5; p < 0.001) than in the middle (1.14; 95% confidence interval, 0.40-3.23) and high (reference) hemoglobin quantiles. The odds ratios for primary graft dysfunction in the three quantiles based on pre-heart transplantation hemoglobin levels did not differ significantly.

en: General Thoracic and Cardiovascular Surgery


en: Orthotopic heart transplantation with reconstruction of persistent left superior vena cava.

en: Reconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.

ja: A 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient's postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications.

en: Surgical Case Reports

ja: Surgical Case Reports


en: Impact of turbulent blood flow in the aortic root on de novo aortic insufficiency during continuous-flow left ventricular-assist device support.

en: , P = .0495, respectively). No significant difference in wall shear stress on the aortic valve was observed between the groups. Patients with AI had a perpendicular anastomosis at the distal ascending aorta and the simulation in the modified anastomosis model of patients with AI showed that the retrograde blood flow pattern depended on the angle and position of anastomosis. Computational fluid dynamics revealed strong retrograde blood flow in the ascending aorta and aortic root in patients with AI after LVAD implantation. The angle and position of LVAD outflow anastomosis might impact retrograde blood flow and de novo AI after LVAD implantation.

en: Artificial Organs

ja: Artificial Organs


en: A case of tacrolimus-induced reversible cerebral vasoconstriction syndrome after heart transplantation.

en: Reversible cerebral vasoconstriction syndrome (RCVS) after heart transplantation is a rare, but serious complication, because of a high risk for permanent neurological deficits or allograft rejection. A 48-year-old female who underwent orthotropic heart transplantation presented with a sudden severe headache 10 days after transplantation. Although magnetic resonance angiography (MRA) findings at initial symptom onset were normal, MRA finding at the next day revealed multifocal vasoconstriction of cerebral arteries. Tacrolimus-induced RCVS was strongly suspected, and tacrolimus was immediately discontinued and basiliximab was added as an alternative immunosuppressant. Notably, neurological symptoms occurred at the time of sharp increase in serum tacrolimus levels and resolved when it decreased to low levels. Follow-up MRA showed complete remission and she recovered without any neurological symptom or allograft rejection. Our case suggests that prompt diagnosis with repeated MRA and immediate discontinuation of tacrolimus are essential to avoid severe neurological sequelae of RCVS.

ja: General Thoracic and Cardiovascular Surgery


en: Left Ventricular Stroke Work Index Associated With Outcome After Mitral Valve Surgery for Functional Regurgitation in Nonischemic Dilated Cardiomyopathy.

en: The indications for mitral valve surgery in patients with advanced nonischemic dilated cardiomyopathy and functional mitral regurgitation are still unclear. We reviewed our experience of mitral valve surgery in such patients and explored factors that were predictive of outcomes. Fifty-three consecutive patients with nonischemic dilated cardiomyopathy and an ejection fraction <35% who underwent mitral valve surgery were reviewed. Thirty five patients (66%) suffered all-cause death or underwent admission for heart failure or left ventricular assist device implantation after mitral valve surgery during follow-up (37 ± 27 months); freedom from these events at 3 years was 45%. Mitral valve surgery significantly reduced left ventricular volume (P < 0.01) and pulmonary vascular resistance (P < 0.01) in survivors. New York Heart Association functional class also improved significantly (P < 0.01) at 1 year after surgery. By multivariate analysis, preoperative left ventricular stroke work index (P < 0.04) was the sole significant predictor of composite outcomes including all-cause mortality, admission for heart failure or left ventricular assist device implantation after mitral valve surgery, with a cut-off value of 25.9 g-m/m

ja: /beat. A higher tethering height (≥11 mm, P < 0.01) was a significant predictive factor for mitral regurgitation recurrence (P = 0.02). Mitral valve surgery for significant functional mitral regurgitation associated with nonischemic cardiomyopathy is still challenging. However, thorough hemodynamic investigations prior to surgery could provide useful indications regarding mitral valve surgery in these patients, contributing to an improvement in their clinical outcomes.

en: Seminars in Thoracic and Cardiovascular Surgery


en: Jarvik 2000 with postauricular cable as destination therapy: first clinical case in Japan.

en: Currently in Japan, a left ventricular assist device powered by an abdominal driveline is the only type of left ventricular assist device available. The driveline is vulnerable to infection secondary to inappropriate fixation and the traditional Japanese custom of bathing is prohibited in patients with an abdominal driveline. The Jarvik 2000 with postauricular cable is a left ventricular assist device in which the driveline exits the body behind the ear (postauricular) instead of exiting through an abdominal site. This case report is the first to describe the implantation of Jarvik 2000 with postauricular cable as destination therapy in a Japanese patient. This device enables patients to take a bath and may reduce the incidence of driveline infection.

en: Journal of Artificial Organs

ja: Journal of Artificial Organs