川原田　修義 (カワハラダ　ノブヨシ)

写真a

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医学部 心臓血管外科学講座

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  • 札幌医科大学   博士（医学）

  • 修士（医学）

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    日本心臓血管外科学会

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    Internaltional Society for Heart and Lung Transplantation

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    The Japanese Society for Cardiovascular Surgery

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    The Japanese Society for Artificial Organs

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    日本臨床外科学会

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  • 札幌医科大学 医学部   心臓血管外科   教授  

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  • 心臓血管外科

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  • Histomorphologic superiority of internal thoracic arteries over right gastroepiploic arteries for coronary bypass

    Tomohiro Nakajima, Kazutoshi Tachibana, Nobuyuki Takagi, Toshiro Ito, Nobuyoshi Kawaharada

    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY ( MOSBY-ELSEVIER )  151 ( 6 ) 1704 - 1708  2016年06月  [査読有り]

    　概要を見る

    Objective: In this study, we compared the histologic and morphometric properties of both internal thoracic arteries and the right gastroepiploic artery (GEA) in patients undergoing coronary artery bypass grafting (CABG). Methods: We microscopically examined transverse sections of segments of both internal thoracic arteries and the right GEA obtained from 83 consecutive patients who underwent CABG. Results: There were no significant differences between the internal thoracic arteries. Significant differences were found between the left and right internal thoracic arteries and GEA in the intimal width (21.8, 21.5, and 71.7 mm, respectively; P < .01), intima-to-media ratio (0.286, 0.256, and 0.749, respectively; P < .01), and media width (148.5, 157.5, and 164.8 mu m, respectively; P = .43). No atherosclerotic lesions, medial calcification, or intimal thickening were seen in the internal thoracic arteries; however, atherosclerotic lesions were seen in the GEA. The intima of the GEA was thicker than that of the internal thoracic arteries. Intimal thickening of the GEA, but not the internal thoracic arteries, was positively correlated with risk of arteriosclerosis. In patients with diabetes mellitus, dietary/drug therapy and insulin therapy were associated with GEA intimal thickness (P = .02 and .01, respectively). Conclusions: The internal thoracic arteries have equivalent histologic and morphometric properties that differ from those of the GEA only in intimal width. The former had no intimal thickening, and is thus preferable to the GEA for CABG.

    DOI PubMed

  • Risk factors for a persistent type 2 endoleak after endovascular aneurysm repair

    Toshiyuki Maeda, Toshiro Ito, Yoshihiko Kurimoto, Toshitaka Watanabe, Yohsuke Kuroda, Nobuyoshi Kawaharada, Tetsuya Higami

    SURGERY TODAY ( SPRINGER )  45 ( 11 ) 1373 - 1377  2015年11月  [査読有り]

    　概要を見る

    To investigate the natural course of type 2 endoleaks (T2Es) and to identify the risk factors associated with a persistent T2E after endovascular aneurysm repair (EVAR). The medical records of patients who underwent EVAR for the treatment of an atherosclerotic abdominal aortic aneurysm between October 2006 and December 2011 at our institute were reviewed. T2Es were diagnosed by contrast-enhanced computed tomography within 4 weeks of EVAR, and patients were followed up at 6 and 12 months. In cases where a T2E was detected, the blood vessels responsible for the T2E were identified and statistically analyzed for their association with a persistent T2E. We identified T2Es in 111 of 469 patients within 4 weeks of undergoing EVAR. During the follow-up, 41 patients (36.9 %) showed spontaneous resolution of their T2E. The percentage of patients with a T2E was 75.4, 69.2 and 58.0 % at 6, 12 and 24 months, respectively. T2E caused by defects in multiple vessels and T2E associated with the fourth lumbar artery were identified as risk factors associated with a persistent T2E in the univariate analysis. In the multivariate analysis, T2E caused by multiple vessels was identified as the only independent risk factor for a persistent T2E. We identified T2E caused by multiple vessel failure as an independent risk factor for persistent T2E.

    DOI PubMed

  • [Surgical Treatment for Mycotic Aortic Aneurysms].

    Osawa H, Muraki S, Sakurada T, Kawaharada N, Sasaki J, Araki E, Nakashima S, Yasoshima T

    Kyobu geka. The Japanese journal of thoracic surgery   68 ( 7 ) 483; discussion 488 - 90  2015年07月  [査読有り]

    PubMed

  • Prosthetic vascular graft infection through a median sternotomy: a multicentre review †.

    Oda T, Minatoya K, Kobayashi J, Okita Y, Akashi H, Tanaka H, Kawaharada N, Saiki Y, Kuniyoshi Y, Nishimura K

    Interactive cardiovascular and thoracic surgery ( OXFORD UNIV PRESS )  20 ( 6 ) 701 - 706  2015年06月  [査読有り]

    　概要を見る

    OBJECTIVES: The aim of this study is to analyse the treatment outcomes of thoracic prosthetic graft infection. METHODS: A retrospective chart review was conducted at six hospitals and included the records of 68 patients treated for postoperative prosthetic vascular graft infection (mean age: 62.3 +/- 15.1, male 51) from January 2000 to December 2013. The number of patients and the locations of the treated infections were as follows: 13 for aortic root, 16 for ascending aorta, 35 for aortic arch and 4 for aortic root to arch. In-hospital infection occurred in 43 patients and after discharge in 25. RESULTS: The mean follow-up time was 2.0 +/- 2.3 years. The follow-up rate was 94.1%. The most commonly isolated micro-organism was Staphylococcus aureus (72.1%). Rereplacement of infectious graft was performed in 18 patients (Dacron graft in 12, homograft in 4 and rifampicin-bonded Dacron graft in 2). The overall hospital mortality rate was 35.3% (24/68). The mortality rate among the patients with graft rereplacement was 33.3% (6/18), with pedicled muscle flaps or pedicled omental flaps to cover the graft 25.9% (7/27), with irrigation 55.0% (11/20) and on antibiotic therapy only 0% (0/3). Our multivariate analysis demonstrated that the risk factors of hospital death increased in the absence of pedicled flaps (muscle or omentum) to cover the graft (P = 0.001), age over 55 (P = 0.003), time from onset of initial operation < 1 week (P = 0.031) and period before 2008 (P = 0.001). The overall 1-year survival rate was 58.6%. CONCLUSIONS: The treatment outcomes of thoracic prosthetic vascular graft infection have not been satisfactory. However, the use of pedicled muscle or omental flaps to cover the graft could improve the outcomes.

    DOI PubMed

  • Evaluation of gastroepiploic arterial grafts to right coronary artery using transit-time flow measurement

    Mayuko Uehara, Satoshi Muraki, Nobuyuki Takagi, Yosuke Yanase, Masaki Tabuchi, Kazutoshi Tachibana, Yasuko Miyaki, Toshiro Ito, Nobuyoshi Kawaharada, Tetsuya Higami

    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY ( OXFORD UNIV PRESS INC )  47 ( 3 ) 459 - 463  2015年03月  [査読有り]

    　概要を見る

    OBJECTIVES: The objective of this study was to analyse the relationship between the intraoperative transit-time flow measurement (TTFM) parameter values and the postoperative angiographic results of gastroepiploic arterial (GEA) grafts to the right coronary artery (RCA). We investigated whether the intraoperative TTFM parameter values are reliable indicators of early patency in GEA grafts to the RCA. METHODS: Patients undergoing off-pump coronary artery bypass surgery with GEA grafts were included in this study. Eighty-three GEA grafts were individually anastomosed and examined by angiography 1 week after surgery. The quality of each graft was graded using FitzGibbon grading (Study 1) and graft-flow grading (Study 2). RESULTS: Study 1: Seventy-two grafts were determined as Grade A and 11 as Grades B or O. There were no significant differences in the average of mean graft flow (MGF), pulsatility index or diastolic filling percentage between Grade A and Grades B or O grafts. Study 2: Sixty-two grafts were graded as good-graft dominant, 16 as bidirectional and 5 as occlusion including string. The average of the MGF, pulsatility index and diastolic filling percentage in the grafts graded as bidirectional and occlusion including string were not significantly different from those of grafts graded as good-graft dominant. CONCLUSIONS: Previously reported cut-off values for intraoperative TTFM parameters could not be adapted for the early patency of GEA grafts to the RCA. However, the smoothness of the graft-flow curve may be a reliable predictor of postoperative graft patency.

    DOI PubMed

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  • Stroke in surgery of the arteriosclerotic descending thoracic aortic aneurysms: influence of cross-clamping technique of the aorta

    N Kawaharada, K Morishita, J Fukada, Y Hachiro, Y Fujisawa, T Saito, Y Kurimoto, T Abe

    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY ( ELSEVIER SCIENCE BV )  27 ( 4 ) 622 - 625  2005年04月

    　概要を見る

    Objective: The risk of stroke caused by dislodgment of loose atheromatous plaque or mural emboli is increased by cross-clamping of the aorta. Some patients undergo descending thoracic aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. The objective of this study was to determine the influence of proximal aortic cross-clamping in arteriosclerotic aneurysm or dissecting aneurysm repair. Methods: Between May 1984 and May 2003, 81 patients underwent elective surgery for distal arch or descending aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. To evaluate the influence of the proximal aortic cross-clamping, patients were divided into two groups: patients who had undergone arteriosclerotic aneurysm repair (group I, n=25) and patients who had undergone dissecting aneurysm repair (group II, n=56). Results: Eight (9.9%) of the 81 patients had a stroke. Six strokes occurred in operations for arteriosclerotic aneurysm repair group I and two strokes occurred in operations for dissecting aneurysm repair group II (24 vs 3.6%; p=0.009). In-hospital mortality rates were 12% in group I and 8.9% in group II (p=0.70). Major postoperative complications included renal failure requiring hemodialysis (in 4.2% of the patients in group I and in 8.3% of the patients in group II, p=0.99) and pulmonary complication (in 20% of the patients in group I and in 16% of the patients in group II, p=0.67). Conclusion: Cross-clamping between head vessels should be avoided if at all possible when operating on patients who have arteriosclerotic descending thoracic aneurysms. (c) 2004 Elsevier B.V. All rights reserved.

    DOI

  • Endovascular stent grafting for thoracic aneurysms in Jehovah's Witnesses: Report of three cases

    Y Hachiro, Y Kurimoto, K Morishita, J Fukada, Y Fujisawa, N Kawaharada, T Abe

    SURGERY TODAY ( SPRINGER )  35 ( 4 ) 317 - 319  2005年04月

    　概要を見る

    There are few published reports on endovascular stent grafting for thoracic aneurysms in Jehovahs Witnesses. Between 2001 and 2003, we performed endovascular stent grafting for a thoracic aneurysm in three patients of the Jehovahs Witness faith. Two patients had a thoracic aortic aneurysm and one had a chronic type-B dissection. The stent graft was constructed from a self-expanding Z-stent and thin-walled woven polyester fabric. None of the patients required perioperative blood transfusion, there was no postoperative endoleak, and all recovered uneventfully and were discharged from hospital. Thus, stent-graft repair of thoracic aneurysms in Jehovahs Witnesses is feasible and can be achieved without the need for blood transfusion.

    DOI PubMed CiNii

  • Descending thoracic aortic aneurysm repair with the aid of partial cardiopulmonary bypass: heparin-coated circuits versus nonheparin-coated circuits.

    Artif Organs   29   300 - 5  2005年

    DOI

  • Descending thoracic aortic rupture: Role of endovascular Stent-Grafting

    K Morishita, Y Kurimoto, N Kawaharada, J Fukada, Y Hachiro, Y Fujisawa, T Abe

    ANNALS OF THORACIC SURGERY ( ELSEVIER SCIENCE INC )  78 ( 5 ) 1630 - 1634  2004年11月

    　概要を見る

    Background. The mortality of patients with descending thoracic aortic rupture who are treated by conventional surgery is high. Our current strategy for the management of descending thoracic aortic rupture is to treat seriously ill patients with endovascular stent-grafting using handmade grafts, and to treat other patients with traditional open repair. The aim of this study was to assess the early results of our strategy. Methods. Twenty-nine consecutive patients with descending thoracic aortic rupture were referred to Sapporo Medical University Hospital from June 2001 to January 2004. Eighteen of these 29 patients were selected for enclovascular stent-grafting because of polytrauma (n = 7), comorbidities (n = 6), advanced age (n = 2), past history of left thoracotomy (n = 2), and patient's preference (n = 1). The remaining 11 patients underwent traditional graft replacement of the diseased aorta. Their outcomes and follow-up data were collected and analyzed retrospectively. Results. The in-hospital mortality rate was 14% (4/29). The mortality rate for surgical patients and stent-grafting patients was 9% (1/11) and 17% (3/18), respectively. The survival rate of patients at 2 years was 63% +/- 10%. In the follow-up period, 2 of the 18 patients who underwent endovascular stent-grafting required open repair, and 1 patient underwent a redo endovascular stent-grafting procedure because of stent failure. One of these 3 patients died of an intraoperative retrograde type A aortic dissection. Conclusions. The early results of endovascular stent-grafting for the treatment of high-risk patients with descending thoracic aortic rupture are promising. Early results of open repair can also be improved by the selection of stabilized patients. However, the requirement of reintervention indicates that detailed follow-up examinations in patients who have undergone endovascular stent-grafting with handmade stent-grafts should be performed. (C) 2004 by The Society of Thoracic Surgeons.

    DOI

  • Minilaparotomy abdominal aortic aneurysm repair versus the retroperitoneal approach and standard open surgery

    N Kawaharada, K Morishita, J Fukada, A Yamada, S Muraki, Y Hachiro, Y Fujisawa, T Saito, Y Kurimoto, T Abe

    SURGERY TODAY ( SPRINGER )  34 ( 10 ) 837 - 841  2004年10月

    　概要を見る

    Purpose. We evaluated the surgical results of mini-laparotomy abdominal aortic aneurysm (AAA) repair in comparison with those of standard open repair and retroperitoneal approach repair. Methods. Between February 2000 and January 2003, 30 patients with AAA underwent minimal incision laparotomy repair (MINI) through an abdominal incision 7-12 cm long. Their clinical characteristics and in-hospital outcome were then compared with those of patients who had undergone repair of AAA by a standard open technique (OPEN) or retroperitoneal approach technique (RETRO). Results. There were significant differences between the MINI, OPEN, and RETRO groups in the time until the patient was able to resume eating (2.4 +/- 1.0 vs 4.4 +/- 2.4* vs 2.8 +/- 1.9 postoperative days [PODs], respectively; *P < 0.05), the time until ambulation outside the room (2.1 &PLUSMN; 0.7 vs 3.5 &PLUSMN; 1.3* vs 2.5 &PLUSMN; 1.9 PODs, respectively; *P < 0.05), and the operation times (188 +/- 43* vs 256 +/- 77 vs 238 +/- 59 min, respectively; *P < 0.05). Conclusion. Minilaparotomy repair is a feasible technique, which combines the benefits of a small incision with those of conventional open repair. With the exception of patients with an iliac artery aneurysm extending to the external or internal iliac artery, MINI repair should be considered for the elective treatment of patients with aortic disease.

    DOI

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共同研究・競争的資金等の研究課題 【 表示 ／ 非表示 】

  • 胸腹部大動脈瘤の手術時における脊髄保護とくにMRAを用いた術前アダムキュービッツ動脈の同定

  • 小切開下腹部大動脈人工血管置換術法

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