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Biomedical subjects

K Eishi

Publications and source records attributed to K Eishi.

At least 55 records · Page 3Linked to original sources
PubMed1996

Risks and benefits of combined maze procedure for atrial fibrillation associated with organic heart disease.

OBJECTIVES: This study sought to identify the risks and benefits of adding the maze procedure in patients with atrial fibrillation (AF) undergoing operation for underlying organic cardiac disorders. BACKGROUND: Persistent AF often leaves patients symptomatic even after otherwise successful cardiac surgery. METHODS: Fifty-one patients undergoing valvular operation and the maze procedure (n = 43) or repair of congenital anomalies (n = 8) combined with the maze procedure were compared with 51 patients (control group) matched for underlying diseases and procedures except for the maze operation. Each group, including 31 patients with a concomitant tricuspid annuloplasty and 12 undergoing reoperation, were similar in age, duration of arrhythmia, degree of cardiomegaly and New York Heart Association functional class. RESULTS: Patients undergoing the maze procedure had longer cardiopulmonary bypass time (213 vs. 144 min, p < 0.0001), longer cardiac arrest (134 vs. 93 min, p < 0.0001) and greater blood loss with longer respiratory care (39 vs. 18 h p = 0.021) and intensive care unit stay but no mortality. No significant differences were found in catecholamine or transfusion requirements immediately after operation. Sustained AF was much less frequent in the maze group (12% at 1 year) than the control group (86%, p < 0.0001), with an average follow-up period of 32 months (range 25 to 42). Atrial contraction was documented in 41 (80%) and 40 (78%) patients for right and left ventricular filling, respectively, after the maze procedure, resulting in a significantly smaller cardiac size and improved functional capacity. Medication was discontinued in seven patients in the maze group compared with two in the control group. CONCLUSIONS: Improved restoration of atrial rhythm and contraction with combined maze operation appeared to justify the increased operative time and complexity and postoperative care.

Atrial Fibrillation↗
PubMed1996

Surgical stratification of patients with atrial fibrillation secondary to organic cardiac lesions.

BACKGROUND: While the maze procedure does not always eliminate atrial fibrillation (AF) secondary to organic cardiac lesions, concomitant performance of the procedure is associated with increased surgical complexity and potential risks. METHODS: To stratify the surgical approach for patients with AF secondary to underlying cardiac lesions, we analyzed 24 preoperative and perioperative variables in 115 consecutive patients with AF undergoing a modified maze procedure combined with valvular intervention (101), repair of congenital anomalies (13) and coronary revascularization (1). RESULTS: Patients who remained in AF (18) compared to patients with restored atrial rhythm (97), had a higher incidence of giant left atrium (56% vs 10%, P < 0.0001), larger cardiothoracic ratio (70 +/- 13 vs 62 +/- 8%, P = 0.001) and left atrial dimension (64 +/- 12 vs 55 +/- 12 mm, P = 0.004), a longer history of AF (13.7 +/- 6.8 vs 8.3 +/- 6.9 years, P = 0.003) and lower f-wave voltage (0.10 vs 0.15 mV, P = 0.004). Multivariate logistic regression analysis of 24 preoperative and perioperative variables identified the presence of giant left atrium, cardiothoracic ratio and age at operation as the significant risk factors predisposing patients to persistent postoperative AF. Retrospective estimation identified 73 (63.5%) patients with a high probability of atrial defibrillation (97.3%) and 42 (36.5%) patients with a high risk of failure (38.1%). Regardless of the preoperative risk analysis or the performance of left atrial plication, every patient with a postoperative left atrial dimension less than 40 mm or cardiothoracic ratio below 55% was successfully defibrillated. CONCLUSION: The results suggest performing the maze procedure before "risk factors" develop for patients with predicted maze-amenable AF. While omitting the maze procedure may be prudent for patients with suspected maze-refractory AF, the simultaneous reduction of left atrial size may offset the increased risk from preoperative size factors. A prospective study seems warranted to examine the effects of left atrial plication on postoperative rhythm.

Adult↗
PubMed1996

[Valvular surgery in the patients more than 70 years old].

One hundred twenty-eight valvular surgeries in patients over 70-year-old were reviewed (AVR:58, MVR:38, AVR and MVR: 11, mitral valvuloplasty (MVP): 11, AVR + MVP:11, mitral valvuloplasty (MVP): 11, AVR + MVP: 8, others: 2). Concomitant CABG was performed in 7, Maze in 6, TVR in 5 and Bentall in 3 cases. Early deaths occurred in 17 patients (13%). The early mortality was 5% in AVR, 21% MVR, 18% in AVR and MVR, 0% in MVP and 38% in AVR and MVP. Late death occurred in 16 patients. Forty-three percent of the late deaths were cardiac death. The actuarial survival at 10 years was around 50% in all groups. In the aortic position, a mechanical valve was implanted in 47 cases and a bioprosthetic valve was implanted in 33 cases. In the mitral position, the mechanical valve was implanted in 37 cases and the bioprosthetic valve was implanted in 12 cases. The event free rate after AVR at 10 years was 37% in patients with the mechanical valve (3 cerebral hemorrhage, 2 PVE, 1 thromboembolism and 1 sudden death) and 46% in patients with the bioprosthetic valve (2 PVE and 1 primary tissue failure). The event free rate after MVR at 10 years was 84% in patients with mechanical valves (1 perivalvular leak, 1 PVE and 1 sudden death) and 75% in patients with bioprosthetic valves (1 PVE and 1 sudden death). Between mechanical valve group and bioprosthesis group, no statistically significance was found in the event free curve after AVR nor MVR. There was no valve related event after MVP. Considering the better durability of bioprostheses in the aortic position than in the mitral position, the presence of atrial fibrillation and necessity of warfarin anticoagulation, we conclude that a choice of a bioprosthetic valve could be acceptable in the aortic position, but may not be recommended in the mitral position.

Aged↗
PubMed1996

Valve replacement with the CarboMedics bileaflet mechanical prosthesis: clinical results at midterm.

OBJECTIVE: We study the clinical midterm results of the valve replacement with the CarboMedics bileaflet mechanical prosthesis. EXPERIMENTAL DESIGN AND SETTING: Retrospective study. Institutional practice (National Cardiovascular Center, Osaka, Japan). PATIENTS AND INTERVENTIONS: 167 CarboMedics prostheses were implanted in 144 patients from April, 1990 and December, 1993. Of these, 77 patients underwent isolated aortic valve replacement (AVR), 45 patients underwent isolated mitral valve replacement (MVR), 21 patients underwent double (aortic and mitral) valve replacement (DVR), and one patient underwent triple (aortic, mitral and tricuspid) valve replacement (TVR). MEASURES: Events were defined in accordance with the guidelines for reporting morbidity and mortality after cardiac valve operations of the Society of Thoracic Surgeons/American Association for Thoracic Surgery.

Aortic Valve↗
PubMed1996

[Anticoagulant related hemorrhage and thromboembolism after valvular surgery].

We reviewed anticoagulant related hemorrhage (ACRH) and thromboembolism (TE) in 84 patients after valvular surgery. There were 45 females and 39 males with a mean age of 51.8 years (range 30.5-71.2 years), who underwent valvuloplasty in 14, bioprosthetic valve replacements in 17, mechanical valve replacements in 13. A mean period from the operation to the event were 2.7 years (range 0.01-12.3 years). There were 25 ACRH events after one valvuloplasty, 4 bioprosthetic valve replacements, 20 mechanical valve replacements. About half of them, the prothrombin time were less than 25%, which was considered the effect of warfarin is high, and 8% of them had infective endocarditis (IE) previously. There were 59 TE events after 13 valvuloplasties, 13 bioprosthetic valve replacements, 33 mechanical valve replacements. In the patients with atrial fibrillation, TE occurred irrespective of operative procedures. And in the patients with mechanical valve, severely impaired left ventricular function and past history of IE, thrombi of left ventricule were caused of TE. It was suggested that past history of IE was a risk factor ACRH and TE, and severely depressed left ventricular function and atrial fibrillation were for TE.

Adult↗
PubMed1996

Aortic and mitral valve replacement with the Carpentier-Edwards pericardial bioprosthesis: 10-year results.

BACKGROUND AND AIM OF THE STUDY: This report reviews our experience with single aortic and mitral valve replacement using the Carpentier-Edwards pericardial valve in a population younger than those of other reports. METHODS: Between 1984 and 1993, 106 patients underwent single aortic or mitral valve replacement using a Carpentier-Edwards pericardial valve. There were 49 aortic and 57 mitral implants. The mean age was 56.7 +/- 14.3 years. The follow up was 100% complete; total follow up being 273.3 patient-years in the aortic (AVR) and 348.0 patient-years in the mitral valve replacement (MVR) group, with a mean of 5.6 and 6.1 years, respectively. RESULTS: The rates of thromboembolic complications for AVR and MVR were 0.37% and 0.58% per patient year respectively. There were no cases of non-structural dysfunction or anticoagulant-related hemorrhage. The incidences of prosthetic valve endocarditis for AVR and MVR were 0% and 0.86% per patient year respectively. Structural deterioration (calcification and sclerosis) occurred in one patient after AVR and in six patients after MVR, all younger than 60 years of age. Freedom from structural deterioration at five years and 10 years was 100% and 92.9% +/- 6.9% for AVR, and 100% and 76.9% +/- 8.6% for MVR. CONCLUSIONS: In conclusion, the Carpentier-Edwards aortic valve has a low incidence of valve-related complications at 10 years. Although late results of this valve in the mitral position were excellent in the elderly, leaflet degeneration is still a problem in patients under the age of 60 years.

Adult↗
PubMed1996

Calcific degeneration of bioprosthetic aortic valves in patients receiving steroid therapy.

BACKGROUND AND AIMS OF THE STUDY: Calcification of glutaraldehyde-preserved bioprosthetic valves is a frequent long-term complication of valve replacement, although the mechanism responsible for such degeneration is not clearly understood. In the current study, we investigated the calcific degeneration of bioprosthetic aortic valves in patients who had been given steroid treatment for aortitis in order to evaluate the immune response to glutaraldehyde-preserved bioprostheses. METHODS: Ten patients who had undergone aortic valve replacement with bioprosthetic valves were studied. Their mean age was 48.4 years (range: 27 to 64 years). Aortitis was due to Takayasu disease in eight patients and to Behcet aortitis in two. The bioprosthetic valves used included bovine pericardial xenografts (n = 8) and porcine aortic valves (n = 2). The mean daily dosage of prednisone was 10.1 mg (range: 2.5 to 60 mg); mean duration of therapy was 8.0 years. The mean patient follow up, using echocardiography, was 11.5 years (range: 8.5 to 16 years). The total follow up period was 115 patient-years. RESULTS: During follow up, three reoperations were required because of valve detachment, aortic insufficiency due to perforation of the aortic cusp, and aortic insufficiency with coronary orifice stenosis, respectively. No reoperations were required for stenotic degeneration of the bioprosthetic valves. Seven bioprosthetic valves were still functioning between 8.5 and 16 years after implantation. Calcific degeneration in two of three bovine pericardial valves that required replacing was surprisingly minimal; separation of collagen fibers in the valves by infiltration with plasma proteins was also minimal. CONCLUSIONS: These results suggest that the calcific degeneration of bioprosthetic valves may be decreased by concomitant steroid therapy for aortitis, though further research will be required to confirm this effect and to determine the mechanism(s) involved.

Adult↗
PubMed1996

[Clinical study of re-do surgery after Bentall-type operation].

Among patients who underwent reconstruction of the aortic root by Bentall-type procedure using a composite graft, we investigated patients who underwent reoperation for complications related to composite graft. We employed composite graft reconstruction of the aortic root in 155 patients for 16 years prior to December 1994. Annulo-aortic ectasia was observed in 112 patients, aortic dissection in 34, and aortitis without aneurysm formation in 9. The original Bentall procedure was performed in 36, the Cabrol method in 8, the interposition method in 26, and the Carrel patch method in 85 patients. Thirteen (8.4%) of these patients required reoperation for complications related to the composite graft. Three of 4 patients with graft infection early after surgery underwent reconstruction with composite graft, but died in the hospital. The remaining patient survived after combined treatment that included the graft washing with Iodine (Isozin) solution and omentopexy. Four patients developed pseudoaneurysm formation due to sutural insufficiency and 7 has prosthetic valve failure as late complications. Three of the 4 patients with pseudoaneurysm underwent reconstruction with a second composite graft by the interposition method, while one patient with aortitis required another reoperation. In the remaining one patient, the leak was directly close along with second aortic valve replacement. All prosthetic valves used in 7 patients with prosthetic valve failure were Ionescu-Shiley biological valves. Primary tissue failure was observed in 6 and prosthetic valve endocarditis in one patient. Second cardiac valve replacement using a mechanical valve was possible. All the patients who underwent late reoperation showed favorable results. Infection of the composite graft showed the poor prognosis, and prevention of infection is important. Sutural insufficiency at the anastomosed site can be prevented by appropriate surgical procedures such as reinforcing suture, but further countermeasures for sutural insufficiency were considered necessary for aortitis in conditions, such as Behcet's diseases.

Adult↗
PubMed1995

Modified maze procedure for patients with atrial fibrillation undergoing simultaneous open heart surgery.

BACKGROUND: Persistent atrial fibrillation (AF) leaves patients symptomatic and at increased risk of thromboembolism even after otherwise successful cardiac surgery. METHODS AND RESULTS: To treat AF secondary to cardiac lesions requiring surgery, we combined a modified maze procedure in 101 patients simultaneously undergoing valvular procedures (87), repair of congenital anomalies (12), and other procedures (2), including 24 repeat operations. Duration of AF varied from 0.1 to 30 years (average +/- SD, 8.8 +/- 7.0 years); the f-wave voltage ranged from 0 to 0.45 mV (0.15 +/- 0.09 mV); and cardiothoracic ratio varied from 40% to 99% (63 +/- 9%). Aortic cross-clamp time varied from 75 to 229 minutes (138 +/- 31 minutes), with bypass time ranging from 119 to 326 minutes (217 +/- 42 minutes). There were two early deaths (2%), no late deaths, and one episode of transient neurological ischemic attack in follow-up ranging from 1.0 to 3.1 years, for a total of 190 patient-years. Postoperative rhythms were sinus in 83 patients (82%), junctional in 4 (4%), and persistent AF in 14 (14%), each of whom had mitral valve disease. Patients with other underlying pathology had complete recovery of atrial rhythm. A normal-sized A wave was detected in 88% for transtricuspid flow and in 73% for transmitral flow, suggesting concomitant recovery of atrial contraction. Among 36 patients without mechanical valves, 30 (83%) with atrial rhythm and contraction have been taken off anticoagulation therapy, including 10 who are free of all medication. CONCLUSIONS: The results suggest that the combined approach is safe, effective, and indicated in patients who are judged capable of tolerating the procedure and likely to regain atrial rhythm.

Aged↗
PubMed1995

Cell viability of aortic allografts after long-term cryopreservation and clinical application to aortic root replacement in a patient with aortitis.

A key point in the establishment of a tissue cryopreservation system is to maintain cell viability for an extended period. The viability of the tissue cells in the authors' cryopreservation system was examined, and the first clinical application reported. The tissue culture method demonstrated 95% of rat aortas (21 of 22 specimens) and 88% of human cardiac valves (seven of eight) to be viable after 6.4 months and 5.8 months of cryopreservation, respectively. The first clinical case, a 54-year-old man with aortic valve replacement and complications of aortitis, underwent successful aortic root replacement. Whereas the use of allografts in aortitis cases is controversial, such an approach was assumed reasonable because the mechanical stress between the native aortic annulus and the inserted valve could be reduced by aortic root replacement with the allograft.

Adult↗
PubMed1995

Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan.

To establish guidelines for the surgical treatment of patients with infective endocarditis who have cerebrovascular complications, we conducted a detailed retrospective study of 181 of 244 patients with cerebral complications among 2523 surgical cases of infective endocarditis of the Japanese Association of Thoracic Surgery. The results showed that 9.7% of all patients with infective endocarditis had associated cerebral complications: 108 (44.3%) had active native valve endocarditis, 96 (39.3%) had healed native valve endocarditis, and 40 (16.4%) had prosthetic valve endocarditis. The hospital mortality of the patients with cerebral complications was 11.0% in the group as a whole: 13.9% in active native valve endocarditis, 3.1% in healed native valve endocarditis, and 37.5% in prosthetic valve endocarditis. Diseased valves included the following aortic valve in 55.5%, mitral valve 49.8%, tricuspid valve in 1.3%, and pulmonary valve in 1.3%. In 181 patients with cerebral complications, organisms were detected as follows: gram-positive cocci in 133 (73.5% [Streptococcus in 85, Staphylococcus in 32]), gram-negative in 18 (9.9%), fungus in 11 (6.1%), and unknown in 64.6%, cerebral bleeding in 31.5%, cerebral abscess in 2.8%, and meningitis in 1.1%. Hospital mortality rate and an exacerbation rate of cerebral complications, including related death, according to the interval from onset of cerebral infarction to cardiac surgery, were as follows: 66.3% and 45.5% within 24 hours, 31.3% and 43.8% between 2 and 7 days, 16.7% and 16.7% between 8 and 14 days, 10.0% and 10.0% between 15 and 21 days, 26.3% and 10.5% between 22 and 28 days, and 7.0% and 2.3% over 4 weeks later, respectively. A significant correlation existed between the interval and the exacerbation of cerebral complications (tied p = 0.008). Preoperative risk factors affecting exacerbation of cerebral complications were as follows: (1) severity of cerebral complications (p = 0.006), (2) intervals (p = 0.012), and (3) uncontrolled congestive heart failure as indications for cardiac surgery (p = 0.014). One patient underwent a cardiac operation within 24 hours of the onset of cerebral hemorrhage and died of cerebral damage. No exacerbations occurred in 10 patients who underwent their operation between 2 and 28 days. Nevertheless, exacerbations occurred in 19.0% of patients whose operation was done more than 4 weeks later. These data suggest that cardiac operations can be done safely 4 weeks after cerebral infarction, and if the delay is more than 2 weeks, the exacerbation rate will be around 10%. The risk of progression of cerebral damage is still significant 15 days and even 4 weeks after cerebral hemorrhage.

Adult↗
PubMed1995

[Surgical treatment and long-term results of cardiac myxoma in 38 patients].

Long-term results of thirty-eight patients with cardiac myxoma, who underwent resection at National Cardiovascular Center between May, 1978 and December, 1993, were reviewed focussing on embolism, cerebral complication, tumor recurrence and metastasis. The mean age was 49.6 years (range 0 to 74) in 20 female and 18 male. Overall follow-up were known for 35 of 38 patients (92.1%), and an average of follow-up period was 6.7 years (range 0.5 to 15.9 years). 15 of 38 patients (34.2%) had embolism (brain 10, peripheral artery 4, coronary 1) preoperatively. All patients survived operation and the hospital mortality rate was 0%. Long-term results were almost satisfactory (myxoma related-death in one patients). However, distant metastasis occurred in two patients, and tumor recurrence in one patient irrespective of a presence of preoperative embolism. Cerebral embolism occurred in one patient and cerebral arterial lesins were noticed in five patients postoperatively. Cardiac myxoma has a malignant potentiality and a close follow-up is necessary about recurrence, metastasis and cerebral artery disease.

Adolescent↗
PubMed1995

[Reconstructive techniques for complete mitral valve repair for mitral valve insufficiency].

Reconstruction of mitral valve, which was performed completely, provides better postoperative ventricular function and less morbidity compared with prosthetic replacement. In this article, reconstructive techniques as a radical mitral valve repair are demonstrated from a viewpoint of long-term performance. Since January, pure mitral regurgitation due to prolapse were repaired with freedom from reoperation of 89% at 5 years and 81% at 10 years. The incidence rate of thromboembolism was 0.8% and no endocarditis or hemorrhagic complications were noted. The technique of leaflet resection-suture is most useful and reliable for the mural leaflet prolapse, and replacement of chordae tendineae is appropriate for the diffuse anterior leaflet prolapse. Prosthetic ring implantation increase leaflet coaptation, reinforce sutures and prevent further annular dilatation.

Adolescent↗
PubMed1995

[A case of successful surgical treatment of recrudescent stanford type A aortic dissection after early thrombogenic closure and reduction of dissecting lumen].

A 51-year-old woman was admitted with acute chest and back pain. A CT scan (2 hours after onset) was demonstrated acute type A aortic dissection. The dissecting lumen was already closed with thrombus. A DSA was performed. It showed no intimal tear and a normal aortic figure. Repeat CT (5 hours after onset) was performed. It showed reduction of dissecting lumen compared with previous CT. Although medical treatment was continued, she recomplained intermittent slight chest and back pain. On the sixteenth day after her admission, repeat CT revealed recrudescent dissection and opened dissecting lumen of ascending aorta. Graft replacement was successfully performed using circulatory arrest and retrograde cerebral perfusion. She was discharged in good health.

Acute Disease↗
PubMed1995

[Results of coronary artery bypass grafting in dialysis patients].

To determine the short- and medium-term results of coronary artery bypass grafting (CABG) in dialysis patients, we analyzed a group of 14 patients with chronic renal failure who underwent CABG between May 1990 and October 1994. Two patients had concomitant valve repair for mitral regurgitation. Hospital mortality was 14% (2 out of 14). These two patients died of ileus due to ischemic colitis and agranulocytosis respectively. There was one late death from stroke. The four significant postoperative complications (morbidity 29%) were composed of two sternal dehiscence, one cardiac tamponade because of bleeding, and one perioperative myocardial infarction. Graft patency rate was 97% (34 out of 35 in 13 patients) within one month. Actuarial survival was 86% at one 1 to 3 years, and 43% at 3 and a half years. This rate is not significantly different from all dialysis patients, but night be better than dialysis patients with coronary artery disease who had not undergone CABG in the previous reports. Left ventricular size is larger in patients who died or who had significant complications in hospital than in patients with uneventful postoperative course. Cardiac arrest time, cardiopulmonary bypass time, chest tube output, and the amount of transfusion might be also related to mortality and morbidity though statistically not significant.

Aged↗