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Biomedical subjects

S Takamoto

Publications and source records attributed to S Takamoto.

At least 109 records · Page 6Linked to original sources
PubMed1999

Retrograde cerebral perfusion for aortic arch surgery: analysis of risk factors.

BACKGROUND: Retrograde cerebral perfusion (RCP) has been widely adopted during aortic arch surgery under hypothermic circulatory arrest (HCA). However, the risks in terms of mortality and morbidity in aortic arch surgery using HCA with RCP have not yet been confirmed. METHODS: The present study is a retrospective review of 249 patients who underwent aortic arch surgery at three Japanese cardiovascular centers where RCP is a routine adjunct. The median age was 65 years, and 38 patients were more than 75 years old. The pathology in the aortic arch was atherosclerotic aneurysm in 133 patients and dissection in 116. Seventy patients had surgery on an emergency basis. Surgery was performed through a median sternotomy in 182 patients and through a left thoracotomy in 67. Using HCA with RCP, graft replacement of the total aortic arch was performed in 109, the distal arch in 63, and the ascending aorta and hemi-arch in 66; 11 patients had patch repair. RESULTS: The overall hospital mortality was 25/249 (10%), and 12/70 (17%) in emergent surgery. Stroke developed in 11 patients (4%). The median duration of RCP was 46 minutes (range, 5 to 95). Univariate analysis of risk factors revealed that an age of 75 years or more (p < 0.001), and urgency of surgery (p = 0.02) affected hospital mortality. Multivariate logistic analysis revealed that pump time (p = 0.0001), age (p = 0.0001) and RCP time (p = 0.05) are the most significant risk factors for mortality. The risk factors for mortality and neurological morbidity combined are pump time (p = 0.0001), age (p = 0.0002), and urgency of surgery (p = 0.07); RCP time is marginally significant (p = 0.15). CONCLUSIONS: The dominant risk factors for mortality and morbidity are pump time, urgency of the surgery, and age. RCP is a simple and useful adjunct for aortic arch surgery with up to 80 minutes of HCA, although prolonged RCP is a risk factor for mortality and morbidity.

Adult↗
PubMed1999

Right ventricular thrombosis early after bidirectional Glenn shunt.

Thrombosis in the right ventricle occurred early after bidirectional superior cavopulmonary shunt in 2 patients with pulmonary atresia with intact ventricular septum and major right ventricular coronary artery communication, and perioperative brain infarction occurred in 1 patient. Clinicians should be aware of the hazards of this potentially lethal complication, and transfusion of platelets and fresh plasma should be minimized. Although the hemodynamic state is good, echocardiography should be performed frequently and strict anticoagulation should be started as early as possible.

Coronary Vessel Anomalies↗
PubMed1999

Application of AdvaSeal for acute aortic dissection: experimental study.

BACKGROUND: In the surgical treatment of acute aortic dissection, intractable hemorrhage often occurs. We performed an animal study to test the hypothesis that a new sealant, AdvaSeal (Ethicon Inc, Johnson & Johnson Medical KK, Somerville, NJ), can close the false channel of aortic dissection. METHODS: Acute descending aortic dissection was created surgically in 12 mongrel dogs. In 7 of these (treated group), AdvaSeal was applied to the false cavity for reinforcing and fusing the dissected layers and also to the suture line. The other 5 dogs (control) were left untreated. Specimens were harvested 2 weeks after surgery. RESULTS: The sealant could be used in wet conditions. In the treated group, hemostasis was easily achieved during surgery. All false cavities were perfectly thrombosed, causing no deleterious effects related to the sealant. In the control group, all false lumina remained patent. CONCLUSIONS: The advantage of AdvaSeal was its effectiveness on wet tissue and its adhesiveness, allowing good hemostasis and closure of the false lumen. The sealant can be an easy and efficacious sealant in treatment for acute aortic dissection.

Acute Disease↗
PubMed1999

Is distal anastomosis only to the true channel in chronic type B aortic dissection justified?

BACKGROUND: We investigated long-term outcomes of the distal false lumen of the aorta and aortic branches after distal anastomosis of the graft only to the true lumen in chronic type B aortic dissection. METHODS: From November 1979 until June 1998, we treated 98 patients without Marfan syndrome who had chronic type B aortic dissection and underwent replacement of the descending aorta, 79 of whom had distal anastomosis to the true lumen only. The celiac artery originated from the false lumen in 11 patients, superior mesenteric artery in 5, right renal artery in 19, and left renal artery in 16. RESULTS: There were 12 (15.1%) early deaths. Spinal cord ischemia was detected in 5 patients. Postoperative follow-up was achieved in 67 patients, and 13 patients died. Postoperative survival at 10 years was 67.6% +/- 7.1%. Eight patients had complete occlusion of the distal false lumen, 54 patients had occlusion of the false lumen down to the celiac artery, and 5 patients had a patent false lumen. Four patients required further replacement of the thoracoabdominal aorta. CONCLUSIONS: In non-Marfan patients with chronic type B aortic dissection, the false lumen distal to the graft anastomosis was likely to be thrombosed when the graft was anastomosed to the true lumen only. Postoperative visceral circulation was not compromised, but spinal cord ischemia is a problem that remains to be solved.

Adult↗
PubMed1999

Surgical treatment for aortic regurgitation caused by non-specific aortitis.

Aortic regurgitation caused by non-specific aortitis is relatively rare, and prosthetic valve detachment after aortic valve replacement has been reported to be one of the most serious complications. The authors investigated the surgical results in patients with aortic regurgitation caused by non-specific aortitis. Between 1978 and 1997, 90 patients with aortic regurgitation secondary to non-specific aortitis underwent surgery. There were 28 males and 62 females. The age of these patients ranged from 19 years to 70 years (mean, 48 years). Sixty-five patients were diagnosed to have Takayasu's arteritis, 10 had Behçet's disease and 15 had aortitis of unknown etiology. The surgical procedures for aortic regurgitation were aortic valve replacement in 62 patients, Bentall-type operation in 27 and remodeling in one. Five patients (5.6%) died during the hospital stay. The follow-up duration ranged from 1 month to 224 months (mean, 98 months). Twenty-one patients died during the follow-up period, and the actuarial survival rate was 83% at 5 years and 68% at 10 years. Prosthetic valve detachment occurred in 12 patients (13.3%). Two patients required a re-aortic valve replacement, eight had a composite graft replacement and two patients underwent a homograft reconstruction. Absence of prosthetic valve detachment was noted in 83% of the patients at 5 years and in 75% at 10 years. The incidence of prosthetic valve detachment was 40% (4/10) in patients with Behçet's disease, 33% (5/15) in aortitis of unknown etiology, 4.6% (3/65) in Takayasu's arteritis and 29% (8/28) in male patients. Surgical techniques for treatment of this condition should be modified for further improvement of the surgical outcome in these patients with Behçet's disease and aortitis of unknown etiology.

Adult↗
PubMed1999

Early and long-term results of surgery for aneurysms of the thoracic aorta in septuagenarians and octogenarians.

OBJECTIVE: The purpose of this study was to demonstrate early and long-term results of surgery for thoracic aortic aneurysm in patients over 70 years of age compared with those of patients under 70 years and to clarify the clinical problems peculiar to this subset of patients. PATIENTS AND METHODS: Of 1157 patients who underwent surgery for thoracic aortic aneurysm from 1978 to December 1997, 261 who were 70 years or older were selected for analysis. Mean age at the time of surgery was 74.4 +/- 3.5 years. Aneurysms were atherosclerotic in 177 patients and aortic dissection in 84. Acute aortic dissection was found in 25 patients and ruptured aneurysm in 44. The control group consisted of 896 patients under 70 years. Preoperative complications such as AAA, peripheral arterial disease, emphysema, and old cerebral infraction were more common in the older group. Operative procedures consisted of replacement of the ascending aorta or hemiarch in 51 patients, total arch replacement in 75, distal arch replacement in 35, descending aorta replacement in 75, replacement of the thoracoabdominal aorta in 28, and extra-anatomical repair and others in 15. The technique of extracorporeal circulation was selective cerebral perfusion in 69 patients, deep hypothermic circulatory arrest in 90, femoro-femoral bypass in 39, left heart bypass in 12, and temporary aorto-arterial bypass in 30, and others in 21. RESULT: Early mortality was 21% (54 patients), which was greater than that of the control group (113 patients, 13%, P < 0.01). The incidence of postoperative stroke, transient brain dysfunction, and respiratory problems was higher in the study group (P < 0.01 in all). Mean duration in ICU among survivors was 9.3 +/- 20.2 days and that of the control group was 5.9 +/- 2.8 days (P < 0.01). In a recent series (from 1991 to 1997) postoperative mortality improved to 15.6% (30/192 patients) in the study group however this result was still inferior to that of the control group (8.6%, 39/452, P = 0.03) however mortality of emergency surgery during the same periods was still high (31%, 11/35 patients). Logistic regression analysis revealed that significant risk factors for postoperative hospital death were surgery before 1991, age over 70 years, preoperative cardiac problems, aneurysm rupture, postoperative stroke, low output syndrome, bleeding, and acute renal failure. Postoperative follow-up was obtained in 408 patients/year and the longest period was 10.2 years. Late deaths were documented in 31 patients. Five-year and 10-year survival were 61.2 +/- 5.7% and 31.3 +/- 16.4%, respectively. In the control group the 5-year and 10-year survival were 78.0 +/- 2.1% and 62.5 +/- 4.0%, respectively (P = 0.03). However, survival of the early survivors in the study group was similar with that of the age-matched normal population. Aortic reoperation was performed in 13 patients. Freedom from aortic reoperation was 86.7 +/- 4.2% at 5 years and 80.5 +/- 7.1% at 10 years in the study group and 83.4 +/- 1.8% at 5 years and 64.1 +/- 13.3% at 10 years in the control group (P = 0.27). CONCLUSION: Although recent advances have been achieved, early and long-term results of surgery for thoracic aortic aneurysm in patients older than 70 years were less satisfactory compared with those of patients under 70 years of age, especially in patients who required emergency surgery. Preoperative disorder of the vital organ systems was considered to be the main causative factor for high mortality, however, pertinent surgical strategies are necessary to improve the outcome of elderly patients.

Age Factors↗
PubMed1999

Effect of ursodeoxycholic acid on autoimmune-associated chronic hepatitis C.

BACKGROUND: Hypergammaglobulinaemia and various auto-antibodies which are commonly seen in autoimmune hepatitis are also found in patients with chronic hepatitis C. We recently reported that ursodeoxycholic acid (UDCA) improved liver function tests and immunoserological markers in patients with type I autoimmune hepatitis. The aim of this study was to prospectively evaluate the efficacy of UDCA on autoimmune-associated chronic hepatitis C. METHODS: Immunoglobulin G (IgG), anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) were determined in 95 patients with chronic hepatitis C. All patients were positive for hepatitis C virus RNA. Autoimmune-associated chronic hepatitis C (C-AIH) was defined by elevated serum IgG level (> or = 2.0 g/dL) and high titres of ANA and/or ASMA (> or = 1 : 160). Nine (9%) of 95 patients were diagnosed as C-AIH. All the C-AIH patients and 30 of the remaining 86 chronic hepatitis C patients without autoimmune features (CHC) were treated with UDCA (600 mg/day) for 1 year. RESULTS: Autoimmune-associated chronic hepatitis C patients included one man and eight women and their AIH scores, as defined by the International Autoimmune Hepatitis Group, were significantly higher than the CHC patients. Before UDCA therapy, there were no significant differences in aspartate aminotransferase (AST), alanine aminotransferase (ALT) and y-glutamyl transpeptidase (gamma-GTP) levels between C-AIH and CHC patients. However, after 1 year UDCA therapy, AST, ALT and gamma-GTP were significantly lower in C-AIH patients (P< 0.05) than in CHC patients. In C-AIH, ANA titres in seven of nine patients and ASMA titres in five of seven patients were reduced after 1 year UDCA treatment. CONCLUSIONS: These results suggest that UDCA is a useful therapeutic agent for autoimmune-associated chronic hepatitis C.

Alanine Transaminase↗
PubMed1999

Extracardiac conduit replacement with autologous tissue only, via a left anterior small thoracotomy.

A 13-year-old boy, who had undergone a Rastelli procedure 8 years before, developed severe extracardiac conduit stenosis and infectious endocarditis. Sternal re-entry appeared to be dangerous and to require extensive adhesiolysis. Through a left anterior small thoracotomy, however, good exposure was obtained and the operation was performed safely and much less invasively. The main pulmonary artery was reconstructed with autologous tissues only, i.e. fibrous tissue bed and broadly based pericardial pedicle. There was no residual stenosis. The patient convalesced rapidly.

Adolescent↗
PubMed1999

Coronary artery bypass grafting in a patient with human immunodeficiency virus: role of perioperative active anti-retroviral therapy.

In a patient with severe ischemic heart disease and advanced human immunodeficiency virus (HIV) infection, vigorous perioperative treatment with anti-retroviral agents was given and coronary artery bypass surgery using cardiopulmonary bypass was successfully performed. This strategy could become the standard for patients with cardiovascular disease and advanced HIV infection. The following aspects of this case require further investigation: (1) lack of a reactive increase in the neutrophil count, (2) transient extreme reduction of lymphocytes, and (3) a relative decrease in the CD8+ cell ratio.

Acquired Immunodeficiency Syndrome↗
PubMed1999

A case of intestinal obstruction following stent graft placement for an abdominal aortic aneurysm.

A 76-year-old male was admitted to hospital complaining of severe abdominal pain, constipation, nausea and vomiting. The patient had undergone stent graft placement of an abdominal aortic aneurysm (AAA) at another hospital 13 months prior to admission. An X-ray, computed tomography scan and barium-enema examination revealed partial obstruction of the duodenum. Stent graft placement has been reported to be a useful procedure for AAA. However, as mass effects associated with AAA cannot be excluded, several symptoms may remain postoperatively.

Aged↗
PubMed1999

[Atherosclerotic and dissecting aortic aneurysms].

Atherosclerotic aortic aneurysm frequently contains organized thrombus on its luminal surface. Macroemboli or microemboli derived from fragile thrombus may cause occlusion of peripheral arteries. Although this ischemic symptom is seen preoperatively, it occurs more frequently as a complication caused by intraoperative manipulation. Of late, aortic dissection with clotted false lumen has been recognized as having unique characters with good prognosis. There is, however, no definite diagnostic criteria or treatment strategy for this entity. Disseminated intravascular coagulation is a rare consequence of massive thrombus formation in giant atherosclerotic or dissecting aortic aneurysm. In this chapter, we will describe clinical signs relevant to the thrombus formation in these aortic aneurysms, and refer to key points of surgical treatment.

Aortic Dissection↗
PubMed1999

Estimation of functional liver reserve in patients before cardiac surgery using antipyrine plasma clearance test.

BACKGROUND: Hyperbilirubinemia is not uncommon and is sometimes fatal after valvular surgery. One important cause of it is a poor functional liver reserve, however, conventional tests reflect hepatic blood flow and do not offer precise evaluation of the pure functional liver reserve. Antipyrine has particular pharmacological properties, and its plasma clearance represents quantitatively the functional capacity of the liver. In this study, we measured antipyrine plasma clearance in cardiac surgical patients and evaluated the feasibility of using this parameter as a predictor of the risk of postoperative hyperbilirubinemia. METHODS: The plasma clearance of antipyrine was measured preoperatively in 40 cardiac patients undergoing mitral and/or tricuspid valvular surgery and its relations with hemodynamics or postoperative course were studied. RESULTS: Antipyrine clearance in preoperative patients was 0.365+/-0.175 (mean +/- SD) ml/min/kg, lower than the normal range (0.405+/-0.04 ml/min/kg), and showed no correlation with cardiac index, while the plasma disappearance rate of indocyanine green depended on the cardiac index. The maximum postoperative total bilirubin level showed significant correlation with antipyrine clearance (r=-0.699); this correlation coefficient was greater than that with indocyanine green (-0.477). The correlation was more prominent in patients with cardiac dysfunction. Furthermore, antipyrine clearance showed significant predictability of the duration of ICU stay. CONCLUSIONS: Antipyrine clearance provides a precise estimate of functional liver reserve which is independent of hemodynamics and predicts the risk of postoperative hyperbilirubinemia in preoperative cardiac patients.

Adult↗
PubMed1998

Surgery for Three-Channeled Aortic Dissection.

Among aortic dissections, three-channeled aortic dissection, in which two parallel false lumens are present, is relatively rare. We surgically treated 26 patients with this type of dissection, they accounted for 7.4% of all 349 patients with aortic dissection surgically treated between 1978 and May 1997. Their ages ranged from 24 to 77 years (mean 45 years). The male/female ratio was 1:1. Marfan's syndrome was present in 15 patients and Bentall's-type operation had been performed in 12 patients. Pain at different times was observed in 19 patients. For preoperative diagnosis, computed tomography (CT) and magnetic resonance imaging (MRI) were useful. The morphology of the 1st and 2nd false lumens was Stanford type A + type B in 11 patients, type B + type B in 12, type A + type A in 2, and localized abdominal dissection in 1. Reentry of the second false lumen was observed in only 3 patients. Descending aortic replacement was performed in 13 patients, thoracoabdominal aortic replacement in 6, ascending aortic replacement in 3, and others in 4. Seven patients died in the hospital. There were 4 late deaths during follow-up for 10-158 months (mean, 58 months). When pain recurred in patients with aortic dissection, three-channeled dissection should be suspected. The incidence of this dissection is high in patients with Marfan's syndrome.

Journal Article↗