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Suzuki, Yasuyuki ; Daitoku, Kazuyuki ; Minakawa, Masahito ; Fukui, Kozo ; Fukuda, Ikuo
概要:
We have proved that Sivelestat preserved lung function after cardiopulmonary bypass（ CPB） in the rabbit model. We now r
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eport the therapeutic efficacy of Sivelestat in the clinical case. From July 2005, 16 patients who underwent aortic arch replacements were enrolled in this study. Diagnosis included dissected aortic aneurysm in 6 patients, true aortic arch aneurysm in 8, and traumatic aortic arch aneurysm in 1 patient. We randomly divided these patients into two groups. In the Pre-Group（ Pre:n=8）, infusion of Sivelestat（ 0.2mg/kg/hr） was started before the operation; in the Post-Group（ Post:n=8）, it was started after the operation. Serum elastase activity, interleukin-8（ IL-8） levels were measured before the operation, before cessation of CPB and at the end of operation. Blood gas analyses were measured before the operation, at one and three hours after the CPB and the next morning. Because the preoperative P/F ratio（ arterial PO2/FiO2） varies with each case, the value of the P/F ratio at one hour after the CPB was calculated for 100%. Elastase activity of both groups were increased at the end of CPB（ Pre:8.9±10.6, Post:4.6± 3.5）, then returned to baseline level at end of operation（ NS）. IL-8 of both groups were increased at end of CPB, then in the Pre-Group decreased to 59.3± 25.0 pg/ml, but in the Post-Group increased to 97.9±45.7 pg/ml（ p=0.09）. The P/F ratio in the Pre- Group was well maintained from post CPB to next morning, but in the Post-Group was decreased three hours after the CPB （p<0.05）. In conclusion, these fi ndings showed that Sivelestat reduced the infl ammatory reaction associated with cardiopulmonary bypass, and prevented the pulmonary dysfunction caused by infl ammatory reaction.
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| 2.
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Yokoyama, Hiroaki ; Saito, Shin ; Higuma, Takumi ; Hanada, Hiroyuki ; Osanai, Tomohiro ; Daitoku, Kazuyuki ; Fukuda, Ikuo ; Okumura, Ken
概要:
Adipose tissue secretes various bioactive molecules （adipokines）, and apelin is one kind of adipokines.Recently, it was
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shown that plasma apelin level is decreased in patients with chronic heart failure, and apelin mightplay an important role in the pathogenesis of cardiovascular disease. However, plasma apelin level in coronary arterydisease（ CAD） or other heart disease such as valvular heart disease（ VHD） has not been elucidated. We enrolled 31patients with CAD and 14 patients with VHD who underwent elective cardiac surgery. We also examined plasmaapelin level in 20 healthy subjects （Control）. Blood samples were obtained before the surgery. Paired samples ofvisceral and subcutaneous adipose tissues were harvested during surgery. Plasma apelin level was lower in both CADand VHD than in Control. When compared between CAD and VHD, it was lower in CAD than in VHD, and was notaff ected by treatment with HMG-CoA reductase inhibitors （statins） which was shown to increase adiponectin level.Left ventricular ejection fraction（ LVEF） was lower in CAD than in VHD. There was no correlation between plasmaapelin level and LVEF. Gene expression of apelin in visceral adipose tissue was higher than that in subcutaneousadipose tissue, but it was similar between two groups. These suggest that plasma apelin level was decreased inpatients with cardiac diseases, especially in those with CAD. Its role in the pathophysiology of CAD remains to beelucidated.
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| 3.
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Fukuda, Wakako ; Chiyoya, Mari ; Saito, Yoshiaki ; Taniguchi, Satoshi ; Daitoku, Kazuyuki ; Fukuda, Ikuo
概要:
Background: Retrievable inferior vena cava （IVC） filter devices have been developed to overcome thelong-term complicatio
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ns of permanent filters. It is of interest to evaluate the retrievability of retrievable IVC filtersand how safely the IVC filters indwelled for a long period of time can be retrieved. We reviewed a group of 44patients, who were selected for ALN retrievable filter implantation and reviewed the indications, efficacy as well ascomplications.Material and Methods: 300 venous thromboembolism （VTE） patients were treated in our institution between2003 and 2014. IVC filters were inserted in 84 cases （28%） and 44 of 84 patients received ALN retrievable filterimplantation. We retrospectively reviewed the indications, efficacy and complications of 44 patients with ALN filters.Results: All 44 patients had deep vein thrombosis（ DVT） and 39 patients（ 88.6%） also had pulmonary embolism（ PE）.The most frequent associated risk factor for DVT was cancer（ n=19）. The filter was implanted for a median durationof 708.8 days（ range 68-1717）. While the filter was in place, at least one venous thromboembolic event occurred in 4.5%（2 of 44 patients）. Filter retrieval was attempted in 8 patients（ 18.2%） after a median period of 271.9 days（ range 79- 559）. Filter retrievals were successful in all cases.Conclusion: This study showed the efficacy of ALN filter. It also demonstrated the safety of retrieval after a longterm placement.
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shimizu, mayumi ; Nishizawa, Toshiko ; Aizu, Keiko ; Tsuchiya, Ryoko ; Daitoku, Kazuyuki
概要:
The aim of this study was to elucidate the differences in the causes of incidents at each stage of drugadministration be
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tween nurses with different numbers of years of experience and current nursing unit tenure.We evaluated 510 reports involving medications taken after meals where medication charts were utilized. Thesereports were selected from 1,173 incident reports involving drug administration by hospital ward nurses in advancedtreatment hospitals with 640 bed capacities in the northeastern area of Japan between fiscal 2012 and 2014.Approximately 40% of these were related to the drug preparation stage. There was no difference in the frequency ofincidents between nurses with less than 2 years and those with 11 or more years of experience. As per the resultsof our correspondence analysis of the relation between the nursing unit tenure and the causal factors for each stage,“insufficient checking” at all stages was the most common factor. At the drug preparation and distribution stages,11 or more years of experience were related to physical conditions. At all stages, nursing unit tenure of less than 2years was related to psychological conditions. The findings indicated that nurse training and organized approach are required to minimize human factors involved in medical incidents.
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| 5.
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Aoki, Chikashi ; Kondo, Norihiro ; Saito, Yoshiaki ; Taniguchi, Satoshi ; Fukuda, Wakako ; Daitoku, Kazuyuki ; Fukuda, Ikuo
概要:
Objective: Endovascular repair has become the treatment of choice for ruptured abdominal aortic aneurysms (RAAAs). To improve surgical outcomes, preoperative management is important. In 2011, we introduced integrated management, which
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involves endovascular aneurysm repair, stabilization of hemodynamics by endovascular clamping, and open abdominal decompression to address abdominal compartment syndrome (ACS). Methods: To evaluate the efficacy of this management strategy, 62 patients who had undergone emergency surgery for an RAAA were analyzed retrospectively: group A (n=39), where an old strategy was used, and group B (n=23), where integrated management was introduced. Patient characteristics and 30-day mortality rates were compared between the two groups. Results: The average patient age was 67.7 years and 74.7 years for groups A and B, respectively (P=0.032). Group B patients required more frequent use of vasopressors (P=0.035). Other patient characteristics did not differ between the two groups. The duration of surgery was significantly shorter in group B than in group A (P=0.001). The total amount of transfused blood did not differ between the two groups. No patients showed symptoms of ACS. Early mortality rates were 12.8% and 8.7% in groups A and B, respectively. The number of wound infections was significantly fewer in group B than in group A. Conclusion: Although group B patients were significantly older and had a higher rate of vasopressor use, early mortality was improved in both groups. Morbidity was significantly better in group B with respect to the duration of surgery and number of wound infections than in group A.
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| 6.
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Fukuda, Ikuo ; Daitoku, Kazuyuki
概要:
Acute pulmonary thromboembolism is a catastrophic event, especially for hospitalized patients. The prognosis of pulmonary thromboembolism depends on the degree of pulmonary arterial occlusion. The mortality of massive pulmonary
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embolism is reportedly as high as 25% without cardiopulmonary arrest and 65% with cardiopulmonary arrest. In patients with unstable hemodynamics due to pulmonary thromboembolism, surgical pulmonary embolectomy is indicated for patients with a contraindication to thrombolysis, failed catheter therapy, or failed thrombolysis. Thrombolytic therapy adds an additional burden on patients who are at risk of potential hemorrhagic complications. It is also indicated if patients are already on a veno-arterial extra-corporate membrane oxygenator for circulatory collapse or cardiopulmonary arrest. The outcome for patients who require cardiopulmonary resuscitation for longer than 30 minutes is poor. Therefore, early triage for massive and sub-massive pulmonary embolism is crucial. A team approach including a cardiovascular surgeon may be effective to save critically ill patients. Prompt removal of emboli reduces the right ventricular load with quick recovery of cardiopulmonary function in the early postoperative period. A recent series reported excellent results, with in-hospital mortality of less than 10%. Surgical pulmonary embolectomy is an effective, safe, and easy procedure to save critical patients due to pulmonary thromboembolism.
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| 7.
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Fukuda, Wakako ; Taniguchi, Satoshi ; Fukuda, Ikuo ; Chiyoya, Mari ; Aoki, Chikashi ; Kondo, Norihiro ; Hattori, Kaoru ; Daitoku, Kazuyuki ; Kowatari, Ryosuke ; Minakawa, Masahito ; Suzuki, Yasuyuki
概要:
Background: The incidence of pulmonary thromboembolism has been considered rare in Japan. However, its occurrence has been increasing because of westernized lifestyle and diet, increased diagnostic technique, and recognition of this
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disease. Method: Between January 2003 and September 2014, 179 patients were treated for pulmonary thromboembolism. We classified these patients into 3 groups; Massive (n=35), Sub-massive (n=29) and Nonmassive (n=115) and retrospectively reviewed the treatment options and the outcome. Results: Percutaneous cardiopulmonary support (PCPS) was applied for patients with hemodynamic instability and IVC filter was inserted if there was proximal DVT. In non-massive group (n=115), 95.7% of the patient underwent anticoagulant therapy and 47.0% of the patients received IVC filter. In submassive group (n=29), 48.3% of the patient received thrombolytic therapy and 93.1% of the patient underwent IVC filter insertion. Surgical pulmonary embolectomy was performed in 3 patients who had high risk of thrombolytic therapy in submassive group. There was no death in this group. In massive group, 4 patients who had cardiogenic shock died in acute phase. PCPS was applied in 5 patients, pulmonary embolectomy was performed in 13 patients, thrombolytic therapy was performed in 4 patients and 13 patients underwent anticoagulant therapy alone. There were 7 deaths (20.0%) in this group. Conclusions: In submassive group, treatment should be decided depending on the bleeding risk. In massive group, pulmonary embolectomy was effective.
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| 8.
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Yu, Zaiqiang ; Fukuda, Ikuo ; Kondo, Norihiro ; Minakawa, Masahito ; Daitoku, Kazuyuki
概要:
A high percentage of patients with a unicuspid aortic valve require cardiac surgery, because it always induces aortic s
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tenosis or regurgitation. It is sometimes difficult to discriminate it from a bicuspid valve. Here, we report a case of a young patient with severe aortic regurgitation and aortic root enlargement caused by the unicommissural form of unicuspid aortic valve. An aortic valve-sparing operation could not be performed because of his special morphology, and it was thought that sufficient durability could not be obtained postoperatively. The Bentall operation was successfully performed with a mechanical prosthetic valve. His postoperative course was uneventful.
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| 9.
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Yu, Zaiqiang ; Daitoku, Kazuyuki ; Yang, Wei ; Kondo, Norihiro ; Minakawa, Masahito ; Fukuda, Ikuo
概要:
Background: Combined aortic valve replacement（ AVR） and coronary artery bypass grafting（ABG）is mostly performed for pati
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ents with aortic stenosis（ AS） and coronary artery disease（ AD）.Objectives: We aim to clarify that combined operation of AVR and CABG with adequate perioperative ardiac protection does not increase operative and postoperative risk.Methods: A total of 217 patients who underwent AVR for aortic stenosis alone or combined AVR and CABG from 1/2002 to 12/2015 were recruited. The aortic valve alone group （group A） had 164 patients, with an average age of 71.6± 8.1 years. The combined operation group （group C） consisted of 54 patients, with an average age of 73.5±8.5 years. Aortic valve area and pressure gradient showed no significant differences between the two groups. In group C, an average of 2±0.8 vessels had CAD. Cold crystalloid cardioplegia according to left ventricular mass ± a terminal hot shot was used for all patients. Distal graft anastomosis was done after cardiac arrest and cardioplegia （1.5-fold normal） was injected additionally from the graft with severe proximal obstruction of the right coronary artery.Results: Group C included more patients with diabetes mellitus （DM, 43.4% vs. 26.8%） and low left ventricular ejection fraction（ LVEF<50%, 33.96% vs. 16.46%） than group A. On the other hand, the incidence of atrial fibrillation（ AF, .77% vs. 13.41%） was significantly less in group C than in group A. Although cardiac arrest time was longer in group C,postoperative CPK-MB was not significantly elevated, except in 4 patients. Postoperative data showed no significant differences between the two groups.Conclusions: In our department, satisfactory clinical outcomes were obtained with combined operation AVR and CABG. Sufficient myocardial protection had an important effect on clinical outcomes.
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| 10.
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Kawamura, Tomonori ; Minakawa, Masahito ; Kondo, Norihiro ; Daitoku, Kazuyuki ; Fukuda, Ikuo
概要:
Objectives: The study aimed to evaluate the outcomes of total arch repair in patients with type I aortic dissection.Meth
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ods: A total of 117 patients who underwent total arch repair over a period of 27 years were enrolled and divided into two groups: 75 patients who underwent total arch replacement （TAR） and 42 who underwent total arch repair using the frozen elephant trunk（ FET） technique. Univariate and multivariate analyses of outcomes were performed between the two groups.Results: There was no significant difference in permanent cerebral dysfunction （5.3% vs. 9.5%） and temporary cerebral dysfunction （4.0% vs. 2.4%） between the TAR group and FET group. The 30-day and in-hospital mortality of TAR group vs. FET group were 6.7% vs. 0% （P=0.158） and 10.7% vs. 0% （P=0.049）, respectively. The overall survival was significantly higher in the FET group（ log rank P=0.034）. The long-term survival and aortic event free survival rates were not significantly different between the two groups. The independent risk factors for hospital mortality were age（ P=0.046）, preoperative hemodialysis（ P=0.003）, malperfusion of the carotid artery（ P=0.032）, and mediastinitis（ P=0.017）.Conclusions: Total arch repair in patients with type I aortic dissection using FET was beneficial by educing the inhospital inhospital mortality and improving long-term survival rate.
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