記述言語：日本語   出版者・発行元：日本外科系連合学会  

researchmap

記述言語：日本語   出版者・発行元：日本外科系連合学会  

researchmap

記述言語：日本語   出版者・発行元：日本外科系連合学会  

researchmap

記述言語：日本語   出版者・発行元：日本外科系連合学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent developments in surgical devices, including left atrial appendage closure, have enabled surgeons to perform aggressive operations for atrial fibrillation (AF). However, the outcomes of AF surgery in emergent cases have not been extensively studied. OBJECTIVE AND METHODS: The present study aimed to investigate the effectiveness of AF surgery in emergency surgery cases associated with cardiovascular events. We enrolled 18 patients who underwent various types of AF surgery due to emergencies, including acute aortic dissection (n = 6), acute myocardial infarction (n = 5), bleeding due to perforation from radiofrequency catheter ablation (n = 4), acute mitral regurgitation (n = 2), and cardiac tumor (n = 1). Four and ten patients underwent the full maze procedure and pulmonary vein isolation, respectively. Ganglionated plexi ablation was also performed in three patients as part of a combined procedure. The left atrial appendage was solely closed in four patients. RESULTS: There was no surgical mortality or major adverse cardiac and cerebrovascular events in our patient series. The rates of freedom of recurrence of AF or atrial tachycardia at 1 and 3 years were 92.9% and 82.5%, respectively. After a mean follow-up period of 46.7 ± 25.8 months, no thromboembolism events were observed in the patients. Furthermore, no cardiovascular death was recorded. CONCLUSION: The surgical procedures for AF are safe and effective in cases requiring emergency surgery.

DOI： 10.1007/s11748-024-02027-9

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

researchmap

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は86歳,女性。外出中に屋外で倒れこみ,通行人によって救急要請,意識障害を主訴として当院救命センターに搬入された。バイタルサインは保たれていたが,腹部エコーで腹腔内出血と腹部大動脈瘤を認めたため,造影CTを施行し,腹部大動脈瘤破裂の診断となった。初療室へ帰室直後に心肺停止となり開胸心臓マッサージおよび下行大動脈を遮断した後,ただちに初療室内で心臓血管外科による緊急人工血管置換術が施行された。術後合併症の残存はあったものの,リハビリテーションを目的に転院に至った。高齢者の心肺停止を伴う破裂性腹部大動脈瘤症例に対して救急救命医と心臓血管外科医のすみやかな連携で救命の可能性がもたらされることが示唆された。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although surgical approaches for infected or failing cardiac implantable electronic device (CIED) leads are more invasive than transvenous approaches, they are still required for patients considered unsuitable for transvenous procedures. In this study, surgical management with transvenous equipment for CIED complications was examined in patients unsuitable for transvenous lead extraction.Methods and Results: We retrospectively examined 152 consecutive patients who underwent CIED extraction between April 2009 and December 2021 at the Department of Cardiovascular Surgery, Nippon Medical School. Nine patients (5.9%; mean [±SD] age 61.7±16.7 years) who underwent open heart surgery were identified as unsuitable for the isolated transvenous approach. CIED types included 5 pacemakers and 4 implantable cardioverter-defibrillators; the mean [±SD] lead age was 19.5±7.0 years. Indications for surgical management according to Heart Rhythm Society guidelines included failed prior to transvenous CIED extraction (n=6), intracardiac vegetation (n=2), and severe lead adhesion (n=1). Transvenous CIED extraction tools were used in all patients during or before surgery. Additional surgical procedures with CIED extraction included epicardial lead implantation (n=4) and tricuspid valve repair (n=3). All patients were discharged; during the follow-up period (mean 5.7±3.7 years), only 1 patient died (non-cardiac cause). CONCLUSIONS: Surgical procedures and transvenous extraction tools were combined in the removal strategy for efficacious surgical management of CIED leads. Intensive surgical procedures were safely performed in patients unsuitable for transvenous extraction.

DOI： 10.1253/circj.CJ-22-0456

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To determine pulmonary functional changes that predict early clinical outcomes in valve surgery requiring long cardiopulmonary bypass (CPB). METHODS: This retrospective study included 225 consecutive non-emergency valve surgeries with fast-track cardiac anesthesia between January 2014 and March 2020. Blood gas analyses before and 0, 2, 4, 8, and 14 h after CPB were investigated. RESULTS: Median age and EuroSCORE II were 71.0 years (25-75 percentile: 59.5-77.0) and 2.46 (1.44-5.01). Patients underwent 96 aortic, 106 mitral, and 23 combined valve surgeries. The median CPB time was 151 min (122-193). PaO2/FiO2 and AaDO2/PaO2 significantly deteriorated two hours, but not immediately, after CPB (both p < 0.0001). Decreased PaO2/FiO2 and AaDO2/PaO2 were correlated with ventilation time (r2 = 0.318 and 0.435) and intensive care unit (ICU) (r2 = 0.172 and 0.267) and hospital stays (r2 = 0.164 and 0.209). Early and delayed extubations (<6 and >24 h) were predicted by PaO2/FiO2 (377.2 and 213.1) and AaDO2/PaO2 (0.683 and 1.680), measured two hours after CPB with acceptable sensitivity and specificity (0.700-0.911 and 0.677-0.859). CONCLUSIONS: PaO2/FiO2 and AaDO2/PaO2 two hours after CPB were correlated with ventilation time and lengths of ICU and hospital stays. These parameters suitably predicted early and delayed extubations.

DOI： 10.3390/jcm10153262

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early extubation (EEx) after cardiac surgery has been essentially studied in patients with short cardiopulmonary bypass (CPB). Whether preoperative spirometry can predict EEx remains controversial. OBJECTIVES: To investigate whether EEx can be a goal and predicted by preoperative spirometry in valve surgery requiring long CPB. METHODS: Nonemergent consecutive 210 patients who underwent valve surgery from January 2014 to August 2019 were investigated retrospectively. RESULTS: EEx (<8 h) was achieved in 93 (44.3%) patients without increasing adverse events. Patients with EEx had shorter ICU and hospital stays than those without EEx. Multivariate analysis showed that higher estimated glomerular filtration rate and mitral valve repair were significant protective factors for EEx. Conversely, moderate and severe chronic obstructive pulmonary disease defined by spirometry, longer operation, CPB, and aortic cross-clamp time were significant risk factors. CONCLUSIONS: EEx should be the goal in current valve surgery. Preoperative spirometry is a significant predictor.

DOI： 10.1016/j.hrtlng.2020.07.013

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications Ltd  

Background: Cerebrovascular disease (CVD) with brain hypoperfusion is a strong risk factor for stroke. However, how this pathology influences long-term outcomes after coronary artery bypass graft (CABG) surgery is not known. Methods: Magnetic resonance imaging/angiography (MRI/A) of the neck and brain was performed in 318 out of 575 consecutive CABG patients between May 2005 and April 2018. Critical CVD with chronic hypoperfusion was defined as multiple severe stenoses (⩾70%) and/or occlusion in the carotid and/or vertebral systems associated with reduced collateral flow due to severe contralateral and/or circle of Willis lesion. Fifty patients were identified to have this pathology (early results were previously reported). The entire cohort was followed up for 83.6 ± 53.7 months. Carotid endarterectomy was considered for symptomatic patients. Propensity matching was performed to compare long-term outcomes between patients with and without critical CVD. Results: Patients with critical CVD at follow-up displayed significantly higher incidences of stroke than those without critical CVD (p=0.007), with an extremely high final incidence (approximately 40% at 8 years). However, survival (p=0.623) and incidences of major adverse cardiac events (MACE: myocardial infarction, coronary revascularization and all causes of death) (p=0.881) were similar. The Cox hazard model revealed that critical CVD was the strongest risk factor for stroke (p=0.000
hazard ratio 6.572
95% confidence interval 2.657–16.258) while not affecting survival and MACE. Conclusion: Critical CVD was the strongest risk factor for long-term stroke after CABG. However, survival and MACE-free rates were equivalent in patients with critical CVD and those without critical CVD.

DOI： 10.1177/0267659118813042

Scopus

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

researchmap