Biomedical subjects

Daijirou Kishi

Publications and source records attributed to Daijirou Kishi.

4 recordsLinked to original sources

PubMed2004

Technical considerations using a composite graft for aortic root replacement.

We performed modified aortic root replacement using a composite graft in seven patients over a 7-year-period. Six patients underwent emergency surgery for acute aortic dissection and one patient underwent elective surgery for an aortic aneurysm. To make the composite graft, we chose an artificial valve that was 1 mm larger than the graft, and when performing the proximal anastomosis, we sutured only the graft edge using the horizontal mattress suture technique, applying an additional running suture for reinforcement. The button technique was routinely used for coronary reattachment. To assess hemostasis of the aortic proximal and coronary suture line, cardioplegia was injected via the left atrial vent, which enabled us to confirm hemostasis before performing the distal anastomosis. Blood loss and the need for blood transfusion were minimized by this modified technique. None of the six survivors has required reoperation during 7-year period. Our technique of aortic root replacement based on a composite graft with some operative modifications seems to be safe and reliable, resulting in a satisfactory outcome.

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PubMed2004

Double primary left ventricular and aortic valve papillary fibroelastoma.

Papillary fibroelastomas of the heart are relatively rare benign tumors and although they can be symptom free, symptoms such as cerebral ischemia and cardiac infarction can be lethal. It is important to diagnose this tumor using echocardiography, because lethal embolisms can be prevented by surgical resection. Recurrence of this tumor has not been reported and multiple tumors are rare. The present report is a case of double primary aortic valve fibroelastoma with aortic regurgitation diagnosed 4 years after surgery for a left ventricular fibroelastoma with mitral valvular disease.

Aortic Valve↗

PubMed2003

Clinical study of biocompatibility between open and closed heparin-coated cardiopulmonary bypass circuits.

The objective of this study was to investigate the difference between the closed circuit system and the open circuit system in clinical heparin-coated cardiopulmonary bypass (CPB) circuits with a centrifugal pump. We evaluated the coagulation, fibrinolysis, and inflammatory response in valvular heart surgery. Nineteen patients were assigned at random to a group for the closed circuit system or the open circuit system. This is the first report on the effect of a closed circuit in valvular surgery. We measured the platelet count, white blood cell count, plasma fibrinogen concentration, thrombin-antithrombin III complex, plasmin-Alpha2 plasmin inhibitor complex, D-dimer, interleukin-6, polymorphic neutrophil-elastase, and the plasma free hemoglobin. Blood samples were collected before the start of perfusion, 15 and 60 min after the start of perfusion, 60 min after the administration of protamine, and 1 day after the operation. During the perfusion, coagulation, fibrinolysis, and inflammatory responses were activated; however, no significant differences between the two groups were noted. In this clinical investigation with suction and the cell saving system, the closed circuit was not found to be superior to the open circuit with regard to biocompatibility.

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PubMed2002

The left internal thoracic artery and radial artery composite graft in off-pump coronary artery bypass grafting.

Arterial multivessel bypass grafting without extra corporeal circulation and manipulation of the ascending aorta should be a good surgical option for the treatment of coronary artery disease. An internal thoracic artery (ITA)-radial artery (RA) composite graft was used for this purpose. Between July 2000 and October 2001, we employed the LITA-RA composite graft for off-pump coronary artery bypass in 15 cases. Mean patient age was 71.3 +/- 5.8 years old. Left main trunk disease was present in six patients and triple-vessel disease in four patients. Preoperative concomitant disease was renal dysfunction in three cases, cerebrovascular disease in four and diabetes mellitus in five cases. Two patients had a so-called bad aorta. Twelve elective operations and three urgent operations were carried out for unstable angina. Two to four (mean 2.6 +/- 0.7) anastomoses were performed per patient. Complete revascularization was achieved in 12 out of 15 patients. Mean operating time was 335 +/- 53 min. Mean intraoperative blood loss was 595 +/- 375 ml and nine patients underwent the operation without blood transfusion. There was no PMI, no brain disorder, and no death. Postoperative coronary angiography in all patients documented a good patency rate (LITA 15/15, RA 21/21, right gastroepiploic artery (RGEA) 2/2, and saphenous vein graft (SVG) 0/2). LITA-RA composite grafting in off-pump coronary artery bypass enables arterial multivessel revascularization using an aortic no touch technique. This can be done with minimum postoperative complications and without risk of cerebral infarction even in patients at high risk for extracorporeal circulation (ECC).

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