記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To evaluate the long-term surgical outcomes of advanced renal cell carcinoma with a thrombus extending into the inferior vena cava (IVC). METHODS: From 2008 to 2023, 29 patients underwent radical nephrectomy with IVC reconstruction. Surgical procedures were stratified by the cephalad extension of the IVC thrombus: from the renal vein into the infrahepatic segment (level I, n = 2), below the hepatic vein (level II, n = 20), and into the suprahepatic segment (level > III, n = 7; including 1 level IV). RESULTS: IVC reconstruction was performed by direct suturing in 18 patients (62.1%), patch repair in 8 (27.6%), and graft replacement in 3 (10.3%). Operative outcomes for levels I, II, and >III were associated with the rate of thoraco-laparotomy (0%, 5.0%, and 43.9%, respectively) and use of cardiopulmonary bypass (0%, 5.0%, and 85.7%, respectively). Although 1 level III patient (3.4%) died due to acute pulmonary embolism during surgery, there was no significant difference in the incidence of postoperative complications according to the level of tumor thrombus extension. The 5-year overall survival and cause-specific survival were 53.8% and 65.7%, respectively. CONCLUSION: Although tumor thrombus extension can influence surgical invasiveness, our strategy did not impact perioperative outcomes and may enhance advanced renal cell carcinoma prognosis.

DOI： 10.1016/j.avsg.2025.07.037

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Thrombus formation in atrial fibrillation is caused by blood flow stagnation within the left atrial appendage (LAA). It is believed that blood flow tends to stagnate within the LAA even in patients with sinus rhythm and high risk of stroke. This study evaluated blood flow within the LAA using four-dimensional flow magnetic resonance imaging among patients stratified by the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, vascular disease, age, sex category (CHA2DS2-VASc) score. METHODS: Ninety-eight participants with sinus rhythm (70 patients, 28 controls) underwent non-contrast four-dimensional flow magnetic resonance imaging. Participants were divided into low- and high-risk groups (CHA2DS2-VASc scores 0-2 and 3-9, respectively. Blood flow parameters, including the blood flow volume in the basal, middle, and top segments of the LAA, were analyzed and compared between groups. RESULTS: The blood flow volume was significantly reduced in the top segment of the LAA in the high-risk group (low-risk: 3.13 ± 1.07 mL/cm2 vs. high-risk: 2.54 ± 0.96 mL/cm2, p = 0.006). However, the blood flow volume in the basal and middle segments did not differ significantly between the two groups (basal segment, p = 0.14; middle segment, p = 0.44). In addition, larger LAA volumes (EDV, ESV, and mean volume) were associated with reduced top-segment flow, but correlations with intra-LAA flow were not statistically significant. CONCLUSIONS: In patients with high CHA2DS2-VASc scores, blood flow stagnation can occur in the LAA top segment even in the presence of sinus rhythm. Establishing blood flow-based criteria may enhance the potential applications of LAA closure to prevent stroke.

DOI： 10.1007/s11748-025-02216-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 73-year-old female patient was diagnosed with unresectable locally advanced pancreatic cancer at 72 years of age and underwent chemotherapy. Due to a successful response to chemotherapy, she was scheduled for a pancreaticoduodenectomy and common hepatic artery resection by the gastrointestinal surgery department. As the common hepatic artery was to be resected, our cardiovascular surgery department was consulted for vascular reconstruction to ensure hepatic blood flow. During the surgery, our team intervened prior to tumor resection. The pancreaticoduodenal artery was infiltrated by the tumor and required resection. Although the common hepatic artery proximal to its branches had to be resected, we determined that a direct end-to-end anastomosis between the remaining common hepatic artery and the proper hepatic artery was feasible. To maintain a wide anastomotic opening, both ends were trimmed obliquely. An end-to-end anastomosis was performed using 6-0 PROLENE® Polypropylene Suture (Ethicon, Johnson & Johnson, Somerville, NJ, USA). Blood flow was confirmed to be adequate using a flow meter. Subsequently, the gastrointestinal surgery department proceeded with tumor resection. The patient had an uneventful postoperative course and was discharged on postoperative day 22. This case highlights that prompt, direct hepatic arterial reconstruction can safely preserve hepatic inflow without the need for interposition grafting.

DOI： 10.7759/cureus.94956

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Randomised clinical trials have demonstrated superiority of the Eluvia stent over Zilver PTX for femoropopliteal artery disease in terms of one and two year clinical outcomes, but comparative real world data beyond two years are not available. This study aimed to compare Zilver PTX and Eluvia stents and to report three year primary patency, patient outcomes, and safety results from the REALDES study. METHODS: The REALDES study was a prospective, multicentre, observational study that enrolled adult patients with symptomatic femoropopliteal disease scheduled for treatment with either Zilver PTX or Eluvia. The study included patients with native femoropopliteal artery disease treated with Zilver PTX (n = 96 limbs) or Eluvia (n = 104 limbs). The primary outcome was three year primary patency, and secondary outcomes included freedom from clinically driven target lesion revascularisation (TLR) and Tosaka classification. RESULTS: The baseline characteristics were comparable between the Zilver PTX and Eluvia groups, apart for greater lesion lengths in the Zilver PTX group. At three years, the primary patency rates were 70.0% for Zilver PTX and 65.2% for Eluvia, with no statistically significant difference (p = .74). Furthermore, there were no statistically significant differences between the two stents at one and two years. Freedom from TLR rates were 79.4% for Zilver PTX and 76.3% for Eluvia, with no statistically significant difference (p = .27). The incidence of Tosaka class III was 7.3% in the Zilver PTX group and 14.4% in the Eluvia group at three years (p = .10). Among patients with re-stenosis, the incidence of in stent occlusion was statistically significantly higher with Eluvia (57.7%) than with Zilver PTX (29.2%) (p = .041). No baseline characteristics were associated with the three year re-stenosis risk. CONCLUSION: The Zilver PTX and Eluvia stents demonstrated comparable primary patency and freedom from clinically driven TLR after three years in real world femoropopliteal artery interventions. In routine clinical practice, Eluvia should be used judiciously in backgrounds with a high risk of re-stenosis.

DOI： 10.1016/j.ejvs.2025.03.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This report describes the case of a 69-year-old female patient. At the age of 68, she was diagnosed with cecum cancer, and infiltration of the right external iliac artery was detected. Owing to arterial infiltration, surgical resection was considered inappropriate, and a future risk of intestinal obstruction in the cecum region was anticipated. Therefore, a laparoscopic ileum-transverse colon bypass was performed. Subsequently, chemotherapy with the FOLFOXIRI (folinic acid, fluorouracil, oxaliplatin and irinotecan) regimen plus bevacizumab was administered for five months. Contrast-enhanced computed tomography revealed reduced infiltration of the right external iliac artery, prompting plans for ileocecal resection with combined resection of the right external iliac artery and iliopsoas muscle. After resection of the intestine, preserving the bypass site and tissue mobilization except the right external iliac artery infiltration site, systemic heparinization was performed. An 8 mm artificial vessel was then interposed to reconstruct the right external iliac artery using an end-to-end anastomosis technique. Lower extremity blood flow was unremarkable, and the postoperative course was uneventful. The patient was discharged on postoperative day 10 without complications.

DOI： 10.7759/cureus.84916

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Prognostic models for cardiovascular death, but not all-cause death, after transcatheter aortic valve implantation (TAVI) have not been established yet. METHODS AND RESULTS: In 252 patients with aortic stenosis (AS) who underwent TAVI (men/women 83/169; mean age 85 years), we explored predictive models by machine learning for cardiovascular death using 62 candidates. During the follow-up period (mean 1,135 days), 13 (5.2%) patients died of cardiovascular disease. The least absolute shrinkage and selection operator (LASSO) feature selection identified 8 features as important candidates, including old myocardial infarction, triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio, Society of Thoracic Surgeons predicted risk of mortality score (STS-PROM), pulse rate, left atrium volume index, stroke volume index, estimated glomerular filtration rate, and albumin. Cox regression analyses with adjustment for age and sex showed that old myocardial infarction, high levels of TG/HDL-C, STS-PROM, and pulse rate, as well as low levels of glomerular filtration rate and albumin, were independent risk factors for cardiovascular death. Models of logistic regression (LR) and random survival forest (RSF) using the LASSO-selected features, except for STS-PROM, significantly improved predictive abilities for cardiovascular death compared with LR analysis using STS-PROM alone. CONCLUSIONS: Machine learning models of prediction for cardiovascular death of LR and RSF using the LASSO-selected features are superior to a LR model using STS-PROM alone in patients with severe AS who underwent TAVI.

DOI： 10.1253/circrep.CR-24-0182

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This multicenter, prospective, observational study aimed to compare Zilver PTX and Eluvia stents in real-world settings for treating femoropopliteal lesions as the differences in the 1-year outcomes of these stents have not been elucidated. MATERIALS AND METHODS: Overall, 200 limbs with native femoropopliteal artery disease were treated with Zilver PTX (96 limbs) or Eluvia (104 limbs) at 8 Japanese hospitals between February 2019 and September 2020. The primary outcome measure of this study was primary patency at 12 months, defined as a peak systolic velocity ratio of ≤2.4, without clinically-driven target lesion revascularization (TLR) or stenosis ≤50% based on angiographic findings. RESULTS: The baseline clinical and lesion characteristics of Zilver PTX and Eluvia groups were roughly comparable (of all limbs analyzed, approximately 30% presented with critical limb-threatening ischemia, approximately 60% presented with Trans-Atlantic Inter-Society Consensus II C-D, and approximately half had total occlusion), except for the longer lesion lengths in the Zilver PTX group (185.7±92.0 mm vs 160.0±98.5 mm, p=0.030). The Kaplan-Meier estimates of primary patency at 12 months were 84.9% and 88.1% for Zilver PTX and Eluvia, respectively (log-rank p=0.417). Freedom from clinically-driven TLR rates were 88.8% and 90.9% for Zilver PTX and Eluvia, respectively (log-rank p=0.812). CONCLUSIONS: The results of the Zilver PTX and Eluvia stents were not different regarding primary patency and freedom from clinically-driven TLR at 12 months after treating patients with femoropopliteal peripheral artery disease in real-world settings.Clinical ImpactThis is the first study to reveal that the Zilver PTX and Eluvia have similar results in real-world practice when the proper vessel preparation is performed. However, the type of restenosis in the Eluvia stent may differ from that in the Zilver PTX stent. Therefore, the results of this study may influence the selection of DES for femoropopliteal lesions in routine clinical practice.

DOI： 10.1177/15266028231179861

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chronic inflammation is involved in the development of abdominal aortic aneurysm (AAA). A tertiary lymphoid structure (TLS) within vascular lesions has recently been focused on for its role in modulation of inflammation in local tissues. We aimed to elucidate the relationships between TLS and pathophysiology of AAA. METHODS: Abdominal aortic samples obtained from 37 patients with AAA (men/women: 34/3, age: 72.8±9.9 years) and 15 autopsied patients who died from non-aortic events (men/women: 11/4, age: 65.5±9.8 years) were investigated. RESULTS: TLSs in AAA lesions were confirmed by focal infiltration of CD3-positive cells surrounding germinal center-like structures containing CD20-positive cells between the tunica adventitia and tunica media layers. The formation of a TLS was significantly more prevalent in AAA patients than in autopsied patients. The number of TLSs in AAA lesions was positively correlated with sac diameter (r=0.357, P=0.035) and the amount of intraluminal thrombosis (r=0.466, P=0.005). T cells and B cells were predominant cellular populations among CD45+ cells in AAA lesions. There was a significantly positive correlation between the proportions of interfollicular T follicular helper (CD3+CD4+CD45RA-CXCR5+PD-1+) cells and double negative B (CD3-CD19+IgD-CD27-) cells, and they were positively correlated with sac diameter, intraluminal thrombosis, and serum lipids. Deposited single-cell RNA-sequencing data for AAA showed that T follicular helper cells and double negative B cells were associated with lipid metabolism, T cell activation/proliferation and inflammation. CONCLUSIONS: The formation of a TLS in AAA lesions is associated with sac diameter and intraluminal thrombosis in connection with interfollicular T follicular helper cells and double negative B cells, which may contribute to the pathophysiology of AAA and might be novel therapeutic targets for the development of AAA.

DOI： 10.1161/JAHA.124.040279

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 33-year-old man was brought to the emergency department after sustaining multiple traumas. The interventional radiology team performed vascular embolization via a 6 Fr sheath inserted into the right common femoral artery due to suspected bleeding from the duodenum. The man underwent multidisciplinary management. On day 3 after injury, contrast-enhanced computed tomography (CT) revealed a pseudoaneurysm in the right common femoral artery, the radiology team opted for thrombin injection therapy, and the patient was monitored. No swelling was initially observed. However, repeat contrast-enhanced CT demonstrated a pseudoaneurysm on postinjury day 9, indicating that thrombin treatment had failed. Vascular surgery was considered, and emergency surgical intervention was performed on the same day. A pseudoaneurysm and a 6 Fr sheath puncture site were identified through a right inguinal incision, and hemostasis was achieved. The postoperative course was uneventful, and the patient was transferred for rehabilitation on postoperative day 19 following pseudoaneurysm repair. This case involved the development of a femoral artery pseudoaneurysm following endovascular treatment for multiple traumas. Although the interventional radiology team performed a local thrombin injection, the treatment ultimately failed, necessitating vascular surgery intervention. The patient underwent open surgical repair without complications. With the increasing use of local thrombin injection for pseudoaneurysms, careful post-treatment monitoring is essential, and surgical intervention should be considered at an appropriate time if necessary.

DOI： 10.7759/cureus.80640

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To report the initial outcomes of physician-modified inner branched endovascular repair (PMiBEVAR) for pararenal aneurysms (PRAs), thoracoabdominal aortic aneurysms (TAAAs), and aortic arch aneurysms in high-surgical-risk patients. MATERIALS AND METHODS: A total of 10 patients (6 men; median age, 83.0 years) treated using PMiBEVAR were enrolled in this retrospective, single-center study. All patients were at high surgical risk because of severe comorbidities (American Society of Anesthesiologists physical status score≥3 or emergency repair). End points were defined as technical success per patient and per vessel (successful deployment), clinical success (no endoleaks postoperatively), in-hospital death, and major adverse events. RESULTS: There were 3 PRAs, 4 TAAAs, and 3 aortic arch aneurysms with 12 renal-mesenteric arteries and 3 left subclavian arteries incorporated by inner branches. The technical success rate was 90.0% (9/10) per patient and 93.3% (14/15) per vessel. The clinical success rate was 90% (9/10). There were 2 in-hospital deaths, unrelated to aneurysms. Paraplegia and shower emboli occurred separately in 2 patients. Three patients experienced prolonged ventilation for 3 days after surgery. Aneurysm sac shrinkage occurred in 4 patients, and aneurysm size stabilized in 1 patient during follow-up, more than 6 months later. None of the patients required intervention. CONCLUSION: PMiBEVAR is a feasible approach for treating complex aneurysms in high-surgical-risk patients. This technology may complement the existing technology in terms of improved anatomical adaptability, no time delay and practicability in many countries. However, long-term durability remains undetermined. Further large-scale and long-term studies are needed. CLINICAL IMPACT: This is the first clinical study to investigate outcomes of physician-modified inner branched endovascular repair (PMiBEVAR). PMiBEVAR for treating pararenal aneurysm, thoracoabdominal aortic aneurysm, or aortic arch aneurysm is a feasible procedure. This technology is likely to complement existing technology in terms of improved anatomical adaptability (compared to off-the-shelf devices), no time delay (compared to custom-made devices), and the potential to be performed in many countries. On the other hand, surgery time varied greatly depending on the case, suggesting a learning curve and the need for technological innovation to perform more consistent surgeries.

DOI： 10.1177/15266028231169183

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An 85-year-old man underwent abdominal aortic aneurysm (AAA) repair with a synthetic graft at age 48. Sac enlargement, likely due to an endoleak, was observed during follow-up, and covered stents were placed in the graft limbs at age 80. Despite this, the sac continued to enlarge, leading to a referral to our institution. Imaging revealed an endoleak from an uncovered graft section. An EXCLUDER® stent graft (W. L. Gore & Associates, Inc., Flagstaff, AZ) was placed to cover the graft entirely, resolving the endoleak. The patient was discharged on postoperative day 5. This case highlights the rare failure of a synthetic graft after 37 years.

DOI： 10.7759/cureus.77408

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) is widely used in thoracic aortic surgery. However, for various reasons some patients require secondary open aortic repair. Herein, the surgical outcomes and problems of such open conversion surgery after TEVAR are investigated. METHODS: This was a retrospective and observational study. From January 2010 to June 2022, 20 patients who underwent open aortic repair after TEVAR were included. The indications for open conversion surgery were as follows: aortic enlargement due to endoleak (EL) in seven patients (type Ia: n = 4, type II: n = 1, type V: n = 2; 35%), stent graft infection including aorto-oesophageal fistula (AEF) in six (30%), retrograde type A aortic dissection (RTAD) in three (15%), and dilatation of adjacent distal aorta or false lumen in four (20%). RESULTS: Seven patients with type Ia EL or RTAD required open aortic arch repair. Four underwent thoraco-abdominal aortic repair for distal aortic enlargement. Descending thoracic aortic replacement was performed in all six infection cases and two patients with type V EL. Furthermore, three patients with AEF received concomitant oesophagectomy. One patient with persistent type II EL underwent intercostal artery ligation and aneurysmorrhaphy via thoracotomy. There were two in hospital deaths (10%), all with AEF. Thus, the rates of in hospital death were 0% in non-infected cases, 33% in graft infections, with 66% in those with AEF. Stroke and paraplegia were observed in two patients (10%). CONCLUSION: When open conversion surgery is required after TEVAR, the indications are complex, often associated with infectious pathology, and are necessarily high risk particularly in patients with AEF. Surgical strategy has to be individualised based on the nature or cause of the complication and extent of aortic involvement.

DOI： 10.1016/j.ejvsvf.2024.12.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Subclavian artery aneurysms (SAAs) are rare, and reports on their treatment remain limited. REPORT: An 83 year old male patient who had undergone endovascular aortic repair (EVAR) for an abdominal aortic aneurysm two years previously was referred to the institution for endovascular treatment of a SAA which he preferred over open surgery. Endovascular repair was undertaken under general anaesthesia and open, access of the right axillary artery with introduction of a 14 F guide sheath; subsequently a 23 × 16 × 100 mm limb graft (Gore Excluder, WL Gore and Associates, Flagstaff, USA) was deployed distally with an additional 23 × 23 × 33 mm proximal cuff (Excluder) with successful SAA exclusion. DISCUSSION: A case of endovascular treatment for a right subclavian artery aneurysm is reported. A successful stent graft from the abdominal EVAR device portfolio was successfully employed.

DOI： 10.1016/j.ejvsvf.2025.05.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The aim of this study was to evaluate the impact of intercostal nerve cryoablation on postoperative pain, opioid usage, and lung expansion after open aortic repair via left thoracotomy. METHODS: This retrospective study included 62 patients who underwent aortic repair via left thoracotomy between 2017 and 2023. Patients were divided into cryoablation (n = 32) and non-cryoablation (n = 30) groups. Pain was assessed using the Numerical Rating Scale (NRS), and lung volume was measured using computed tomography 1 week postoperatively. RESULTS: The cryoablation group showed significantly lower mean NRS scores (1.7 vs. 2.4, p <0.01) and lower opioid consumption (6.2% vs. 56.6%, p <0.01). The left lung volume ratio was significantly higher in the cryoablation group (72.3% vs. 62.4%, p = 0.05). CONCLUSIONS: Intercostal nerve cryoablation effectively reduces postoperative pain and opioid consumption and enhances pulmonary expansion after left thoracotomy. This technique may offer a favorable analgesic option in thoracic aortic surgery.

DOI： 10.5761/atcs.oa.25-00127

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3-25) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5-79.0) years, and the aneurysm diameter was 56 (50-61) mm. Technical success was achieved in 5/6 (83.3%) cases. The median modification and operative times were 56 (45-60) min and 92 (79-308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7-41) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained "unchanged" in four patients, including the one with delayed type Ia endoleak, while two patients experienced "shrinkage". Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes.

DOI： 10.3390/jcm14010039

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An aortoenteric fistula (AEF) is a rare but life-threatening condition where an abnormal connection forms between the aorta and the gastrointestinal tract, most commonly the duodenum. It can be primary (arising spontaneously due to an aortic aneurysm or infection) or secondary (complicating prior vascular surgery). Immediate recognition and surgical intervention are critical to manage severe gastrointestinal bleeding and prevent fatal outcomes. A 71-year-old male developed an AEF following abdominal aortic graft surgery. Four months postoperatively, he presented with persistent lower gastrointestinal bleeding and was diagnosed with a secondary AEF. A staged surgical approach was employed, involving initial bowel resection, stoma creation, and graft cleaning, followed by subsequent aortic graft replacement with omental flap coverage. Postoperatively, a graft rupture at the proximal anastomosis required emergency endovascular stenting, which stabilized the patient. Antibiotic therapy successfully managed graft infection, including meropenem, linezolid, and later levofloxacin. The patient was discharged home on day 65 and has remained free of aortic events for five years. This case illustrates the complexity of AEF management, emphasizing the importance of a multidisciplinary, staged approach to achieve infection control, hemostasis, and long-term stability. He has been followed up in an outpatient clinic since then. He is now 76 years old, five years later, and is progressing without an aortic event.

DOI： 10.7759/cureus.75026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The patient was a 33-year-old male. He was noted to have a systolic murmur in the aortic valve region during childhood and underwent balloon valvuloplasty at a pediatric clinic. However, he was not followed up thereafter. Recently, he began experiencing exertional dyspnea and presented to our cardiology department. Detailed examinations, including echocardiography, revealed moderate aortic regurgitation and stenosis, and a unicuspid aortic valve was suspected morphologically. After discussing the findings with the patient, he opted for surgical treatment. The operation was performed under general anesthesia via a median sternotomy. Intraoperative inspection of the aortic valve confirmed a unicuspid morphology, consistent with the preoperative findings. The unicuspid valve was excised and replaced with a mechanical valve (St. Jude Medical (SJM) 25 mm). The surgery was completed without complications, and the postoperative course was uneventful. The patient was discharged home on postoperative day 10. Five years postoperatively, the patient remains asymptomatic and in good condition. Given the rarity of unicuspid aortic valve cases, this report is of significant clinical value.

DOI： 10.7759/cureus.75305

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The purpose of this study was to statistically analyze the factors that influence cardiovascular surgery recruitment. METHODS: Fifth- and sixth-year medical students and first-year residents who participated in cardiovascular surgery-related events at our university over a 10-year period from April 2013 to August 2022 were included. The primary endpoint was admission to the department of cardiovascular surgery. Gender, participation in sixth-year elective clinical training, participation in national academic conferences, participation in cardiovascular surgery summer school, and the cost of participation in these events (airfares and lodging) were included as analytic factors. RESULTS: Fifty-three participants attended cardiovascular surgery events during the study period. The sample included 48 males (84%) and 9 females (16%), and 3 fifth-year medical students (5%), 45 sixth-year students (79%), and 9 students in their first year of clinical training (16%). Eighteen (32%) of the participants eventually joined the department. Gender, participation in national academic conferences, cardiovascular surgery summer school, and cost of participation were not significantly related to the decision to join the department, but participation in elective clinical training was significantly positively related to the decision to join the department for sixth-year students (p < 0.01). CONCLUSIONS: We statistically analyzed the factors involved in the recruitment of students and initial clinical residents to the department of cardiovascular surgery. The results showed that participation in elective clinical training was significantly positively associated with the decision to join the department, suggesting that efforts to encourage participation in elective clinical training are important.

DOI： 10.1007/s11748-023-01995-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvs.2023.08.115

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Our goal was to evaluate early and mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms from 10 Japanese aortic centres. METHODS: From January 2012 to March 2022, a total of 121 consecutive adult patients who underwent physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were enrolled. We analysed early and mid-term postoperative outcomes, including postoperative complications and mortality. RESULTS: The pararenal and thoraco-abdominal aortic aneurysm groups included 62 (51.2%) and 59 (48.8%) patients, respectively. The overall in-hospital mortality rate was 5.8% (n  =  7), with mortality rates of 3.2% (n  =  2) and 8.5% (n  =  5) in pararenal and thoraco-abdominal aortic aneurysm groups, respectively (P = 0.225). Type IIIc endoleaks occurred postoperatively in 18 patients (14.9%), with a significantly higher incidence (P = 0.033) in the thoraco-abdominal aortic aneurysm group (22.0%, n  =  13) than in the other group (8.1%, n  =  5). Major adverse events occurred in 7 (11.3%) and 14 (23.7%) patients in pararenal and thoraco-abdominal aortic aneurysm groups (P = 0.074), respectively. The mean follow-up period was 24.2 months. At the 3-year mark, both groups differed significantly in freedom from all-cause mortality (83.3% and 54.1%, P = 0.004), target aneurysm-related mortality (96.8% and 82.7%, P = 0.013) and any reintervention (89.3% and 65.6%, P = 0.002). Univariate and multivariate regression analyses demonstrated that ruptures, thoraco-abdominal aortic aneurysms and postoperative type IIIc endoleaks were associated with an increased risk of all-cause mortality. CONCLUSIONS: The mid-term outcomes of physician-modified endografting for pararenal and thoraco-abdominal aortic aneurysms were clinically acceptable and comparable with those in other recently published studies. Notably, pararenal and thoraco-abdominal aortic aneurysms represent distinct pathological entities with different postoperative outcomes.

DOI： 10.1093/icvts/ivae044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In patients with retrosternal neo-esophageal conduit after right thoracotomy, the approach to cardiac surgery could be challenging. Particularly, in patients with infective endocarditis, there is a risk of injury to the conduit through standard median sternotomy. Moreover, right lung adhesions could be predicted. Herein, we present a case of successful mitral valve repair in a patient with infective endocarditis through a redo right thoracotomy after esophageal reconstruction. CASE PRESENTATION: A 66-year-old male patient was diagnosed with infective endocarditis and a large anterior mitral leaflet vegetation after a previous esophageal reconstruction via right thoracotomy for esophageal cancer. Due to the retrosternal esophageal reconstruction, we performed a mitral valve repair through a redo right thoracotomy. After resecting the vegetation, the defect was closed with a fresh autologous pericardial patch. Mitral valve annuloplasty was performed. Postoperatively, antibiotics controlled the infection. The patient was discharged on postoperative day 30. CONCLUSIONS: Successful mitral valve repair was performed for infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

DOI： 10.1186/s40792-024-01836-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 66-year-old man with a history of type 2 diabetes mellitus who was undergoing hemodialysis presented with angina. Coronary angiography revealed triple-vessel coronary artery disease. He underwent multiple percutaneous coronary interventions due to recurrent restenosis and was referred for coronary artery bypass grafting (CABG). The left internal thoracic artery and bilateral saphenous veins were harvested under general anesthesia. Four CABGs were performed: left internal thoracic artery to the left anterior descending artery; saphenous vein graft to the obtuse marginal branch of the circumflex artery; and saphenous vein graft to two sites in the right coronary artery. Intraoperative assessment with transit-time flow measurements showed no abnormalities, and the surgery was completed. On postoperative day seven, coronary and graft angiography revealed dissection of the left internal thoracic artery at its midportion with restricted flow. On postoperative day eight, a surgical intervention was performed to excise the dissected segment of the left internal thoracic artery. The dissection site was identified by fluorescence imaging. The dissected segment was excised, and the artery was re-anastomosed. The postoperative course was uneventful, and graft angiography performed on postoperative day 22 confirmed good blood flow. Fluorescence imaging was valuable in identifying the dissection site in the left internal thoracic artery.

DOI： 10.7759/cureus.55199

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to evaluate midterm outcomes of our novel strategy of postoperative initial 2-day blood pressure management (BPM) after endovascular aneurysm repair (EVAR) for the prevention of subsequent type II endoleak (T2EL) in a single-center series. METHODS: Between 2008 and 2014, 137 patients who underwent EVAR for abdominal aortic aneurysm (AAA) were reviewed. Starting from 2013, the mean blood pressure was maintained between 75 and 90 mmHg for the initial 24 hours after EVAR followed by systolic pressure controlled below 120 mmHg during the next 24 hours in the treatment group (n = 76). The incidence of T2EL detected at 7 days, reintervention, and AAA sac diameter up to 5 years after EVAR were compared with those of the control group comprising of 60 consecutive patients who underwent standard EVAR without BPM prior to 2013. RESULTS: Between the treatment group and the control group, significant differences were achieved in the incidence of T2EL at 7 days (19.7% vs 40.0%; P = .009), a mean decrease of AAA sac diameter at 1-year (-5.1 ± 4.9 vs -2.2 ± 6.7 mm; P = .013) and 2-year (-5.4 ± 7.7 vs -1.7 ± 10.8 mm; P = .045). In addition, there was a significant decrease in the incidence of T2EL detected at 7 days with the use of the Gore Excluder with 22.7% in the treatment group vs 80.0% in the control group (P < .001), which resulted in a significant decrease in the aneurysm sac diameter up to 4 years after EVAR. Survival rate without AAA sac enlargement at 5 years after EVAR (83.0% vs 70.0%; P = .021) in the treatment group was significantly higher than that of the control group, whereas no significant differences were observed in the freedom rates of reintervention, T2EL-related reintervention, and all-cause mortality between the groups. CONCLUSIONS: Postoperative initial 2-day BPM had a preventive effect on AAA sac enlargement until midterm periods, by reducing the incidence of T2EL at 7 days after EVAR. The usage of Gore Excluder under BPM was especially associated with sustained positive effects until the midterm follow-up.

DOI： 10.1016/j.jvs.2023.10.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case report of a 30-year-old Marfan syndrome patient who underwent a David procedure for severe aortic valve insufficiency and Valsalva aneurysm. Harvested aortic walls were examined by pathologists. Although the tunica media of the ascending aorta contained aligned elastic fibers, the aortic root media lacked aligned elastic fibers.

DOI： 10.5761/atcs.cr.22-00044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/omcr/omad140

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background We focused on coronary artery bypass grafting using the great saphenous vein and compared the no-touch great saphenous vein and conventional great saphenous vein. Methods Coronary artery bypass grafting using the great saphenous vein was performed at our hospital over a 15-year period from 2007/04 to 2022/08. The primary endpoint was the patency of the great saphenous vein at discharge, and secondary endpoints were delayed healing of the great saphenous vein harvest wound, delayed healing of the mid-thoracic wound, and factors related to coronary artery bypass surgery. Results There were 183 patients who underwent coronary artery bypass surgery using the great saphenous vein during the study period. There were 131 male patients (72%) and 52 female patients (28%) with a mean age of 69 years (38-94 years). The method of harvesting the great saphenous vein was a no-touch great saphenous vein graft (NT-SVG) in 29 cases (16%) and conventional SVG in 154 cases (84%). Patients were divided into two groups: the NT-SVG group and the standard-collection saphenous vein graft (SVG) group. We compared graft patency at discharge, healing failure of the lower leg wound, healing failure of the mid-thoracic wound, and flow by transit-time flow measurement (TTFM). Conclusion There were no significant differences in perioperative outcomes between the NT-SVG and conventional SVG groups in this study.

DOI： 10.7759/cureus.50777

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 74-year-old man with pemphigoid, for which he was on a daily regimen of 14 mg of prednisolone and immunosuppressive drugs, was admitted to the orthopedic surgery department with a fever of 38 °C. An MRI scan of his head revealed multiple bilateral cerebral infarcts, and echocardiography showed a 30-mm structure attached to the anterior apex of the mitral valve. The patient was diagnosed with infective endocarditis and administered antibiotic therapy. Five days after the diagnosis, the patient underwent mitral valve surgery, during which the mitral valve was observed to be severely deteriorated and hence replaced with a bioprosthetic valve. Blood flow disturbance was observed in the right lower extremity, and a thrombectomy was performed. A dispersed vegetation around the heart was observed and removed. After the surgery, the patient progressed without mediastinitis and had a good postoperative course. He was discharged from the hospital on the 56th postoperative day after continued antibiotic therapy.

DOI： 10.7759/cureus.48474

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 46-year-old male developed a Stanford type B aortic dissection. At age 48, he underwent left open thoracic descending aorta replacement because of the enlargement of the descending thoracic aorta. At 51 years old, he underwent abdominal aorta replacement because of ischemia in the right lower extremity and the enlargement of an abdominal aortic aneurysm. The septum between the true and false lumens was submitted to histopathological examination, which revealed bilateral intimal tissue with the tunica media lying in between.

DOI： 10.7759/cureus.48910

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Stent graft-induced new entry (SINE), defined as the stent graft-induced formation of a new entry point for blood to enter an area, is increasingly being observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection worldwide. We herein describe a case of Stanford type A aortic dissection due to proximal SINE after TEVAR for Stanford type B dissection. CASE PRESENTATION: This case involved a 58-year-old man with type A aortic dissection due to SINE. Six years previously, he had developed severe back pain and was diagnosed with type B aortic dissection after computed tomography examination. Because the primary entry was positioned at the descending aorta, we conducted TEVAR for exclusion of the entry with a GORE TAG conformable thoracic aortic graft. He was thereafter followed by our hospital. Six years later, he developed jaw pain and was examined at another hospital. He was transferred to our hospital because of the possibility of type A dissection. Computed tomography revealed type A aortic dissection with proximal site SINE. Emergency partial arch replacement was conducted, and he was discharged on postoperative day 27. Because the entry was at the lesser curve of the arch, we excluded the entry and conducted partial arch replacement. CONCLUSIONS: In this case, proximal SINE occurred 6 years after TEVAR. Because SINE may occur even in the long term after TEVAR, careful follow-up is necessary.

DOI： 10.1186/s43044-023-00412-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: After a median sternotomy, mediastinitis may develop, necessitating reopening of the chest. Rarely, reoperation due to hematoma after cardiovascular surgery is experienced. In the present case, we experienced a patient who initially had mediastinitis, but later developed a chronic hematoma and underwent multiple surgeries. CASE PRESENTATION: The patient was a 40-year-old man who underwent aortic valve replacement for a bicuspid aortic valve and a graft for a dilated ascending aorta. Postoperatively, he developed hematoma in the anterior mediastinum on multiple occasions with repeated episodes of infection that required multiple median sternotomies. CONCLUSIONS: We reported our experience with a rare case of multiple median sternotomies. In the early stage, mediastinitis due to infection was observed, and in the late stage, mediastinal dilatation due to hemorrhage was observed.

DOI： 10.1186/s43044-023-00411-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Various preventive measures and treatment methods exist to prevent paraplegia during thoracic aortic surgery. Postoperative cerebrospinal fluid drainage (CSFD) is one of the treatment options when paraplegia occurs. This study aimed to evaluate the neurological efficacy of postoperative CSFD in patients undergoing thoracic aortic and thoracoabdominal aortic surgery. METHODS: We analyzed perioperative data from 85 patients who underwent perioperative CSFD for thoracic and thoracoabdominal aortic surgery between January 2006 and December 2022, focusing on neurological changes. A total of 61 patients (72%) received preoperative CSFD, and 24 patients (28%) received postoperative CSFD. Perioperative neurological data were analyzed with a focus on perioperative changes. RESULTS: In the postoperative CSFD group, the manual muscle test (MMT) score before CSFD was 0.8, that just after CSFD was 2.4, and that at discharge was 3.0. Therefore, postoperative CSFD improved MMT scores compared with preoperative CSFD. The mean time between surgery completion and postoperative CSFD implantation was 9.8 hours. However, 6 (25%) of the patients who developed postoperative paraplegia and underwent early postoperative CSFD remained paraplegic without any improvement. In the preoperative CSFD group, there was only one case (2%) of postoperative paraplegia. CONCLUSIONS: Postoperative CSFD improved the neurological prognosis of individuals undergoing thoracic aortic and thoracoabdominal aortic surgery. However, 25% of the patients remained paraplegic despite postoperative CSFD.

DOI： 10.21037/jtd-23-631

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-23-0130

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Effective diagnostic biomarkers for aortic aneurysm (AA) that are detectable in blood tests are required because early detection and rupture risk assessment of AA can provide insights into medical therapy and preventive treatments. However, known biomarkers for AA lack specificity and reliability for clinical diagnosis. METHODS: We performed proteome analysis of serum samples from patients with atherosclerotic thoracic AA (TAA) and healthy control (HC) subjects to identify diagnostic biomarkers for AA. Serum samples were separated into low-density lipoprotein, high-density lipoprotein, and protein fractions, and the major proteins were depleted. From the proteins identified in the three fractions, we narrowed down biomarker candidates to proteins uniformly altered in all fractions between patients with TAA and HC subjects and evaluated their capability to discriminate patients with TAA and those with abdominal AA (AAA) from HC subjects using receiver operating characteristic (ROC) analysis. For the clinical validation, serum concentrations of biomarker candidates were measured in patients with TAA and AAA registered in the biobank of the same institute, and their capability for the diagnosis was evaluated. RESULTS: Profilin 1 (PFN1) and complement factor D (CFD) showed the most contrasting profiles in all three fractions between patients with TAA and HC subjects and were selected as biomarker candidates. The PFN1 concentration decreased, whereas the CFD concentration increased in the sera of patients with TAA and AAA when compared with those of HC subjects. The ROC analysis showed that these proteins could discriminate patients with TAA and AAA from HC subjects. In the validation study, these candidates showed significant concentration differences between patients with TAA or AAA and controls. PFN1 and CFD showed sufficient area under the curve (AUC) in the ROC analysis, and their combination further increased the AUC. The serum concentrations of PFN1 and CFD also showed significant differences between patients with aortic dissection and controls in the validation study. CONCLUSION: PFN1 and CFD are potential diagnostic biomarkers for TAA and AAA and measurable in blood samples; their diagnostic performance can be augmented by their combination. These biomarkers may facilitate the development of diagnostic systems to identify patients with AA.

DOI： 10.1186/s12953-023-00212-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present a case of an 82-year-old male patient with a history of severe mitral regurgitation, severe aortic regurgitation, chronic atrial fibrillation, and suicide attempts due to depression. The patient underwent mitral valvuloplasty and aortic valve replacement for mitral valve regurgitation and aortic valve regurgitation. The patient was extubated on the morning of the sixth postoperative day, but he was reintubated in the evening because of hypotension and an unstable respiratory status. Echocardiography revealed Takotsubo cardiomyopathy development, and the patient was treated with intra-aortic balloon pump (IABP) implantation, which was removed on postoperative day 11.

DOI： 10.7759/cureus.43175

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The purpose of this study is to evaluate the results of vascular surgery performed at our hospital, a tertiary emergency general hospital, in patients undergoing surgery in other departments. The results of the study were reviewed. METHODS: The study included cases in which cardiovascular surgery was performed at the request of other departments over a 15-year period from January 2006 to October 2022. Patient backgrounds, departments that requested surgery, surgical procedures, use of extracorporeal circulation, and surgical techniques were reviewed. Patients with femoral artery exposure or ECMO removal during transcatheter aortic valve implantation (TAVI) requested by cardiology were excluded. RESULTS: There were 58 vascular surgery cases requested by other departments during the study period. The age was 63±14 years, 43 (74%) were male and 15 (26%) were female. The departments of the patients were urology in 29 (50%), gastroenterology in 18 (31%), orthopedics in seven (12%), emergency department in three (5%), and obstetrics and gynecology in one (2%). The following surgical procedures were performed: tumor resection and reconstruction due to tumor invasion of the inferior vena cava in 27 cases (47%), bypass to secure intraperitoneal arterial blood flow in 15 cases (26%), bypass during resection of the femoral tumor in four cases (7%), hemostasis due to trauma in three cases (5%), intraperitoneal hemostasis in three cases (5%), thrombectomy in two cases (3%), and others in four cases (7%). Extracorporeal circulation was used in six (10%) of the patients. CONCLUSION: A 15-year case study of vascular surgery supports operations requested by other departments at our hospital. All reconstructed sites were open at the time of discharge.

DOI： 10.7759/cureus.43833

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of a 71-year-old female with a primary cardiac tumor. The patient had undergone surgery for uterine cancer 10 years ago and presented to a nearby clinic complaining of dyspnea on exertion. Chest X-ray revealed cardiac enlargement, prompting further investigations, which revealed a massive tumor protruding into the left atrium and extending toward the outer wall of the left ventricle. The patient was referred to a cardiac surgery department for myocardial biopsy. The tumor biopsy confirmed a diagnosis of a vascular tumor. Due to the tumor's large size and the difficulty in achieving complete resection, a conservative approach was chosen as the patient expressed a preference for non-surgical treatment. This is an extremely rare case of a large primary cardiac tumor, and we report it accordingly.

DOI： 10.7759/cureus.43818

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report the 10-year surgical course of a 27-year-old woman who underwent two surgeries after being diagnosed with Loeys-Dietz syndrome. As described in previous cases, this patient developed ectopic arterial enlargement. We followed her temporal changes over a 10-year period, including the changes in computed tomography, pathology, and surgery.

DOI： 10.1186/s13019-023-02322-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The saphenous vein (SV) is used as an essential conduit in coronary artery bypass grafting (CABG), but the long-term patency of SV grafts is a crucial issue. The use of the novel "no-touch" technique of harvesting the SV together with its surrounding tissue has been reported to result in good long-term graft patency of SV grafts. We recently showed that perivascular adipose tissue (PVAT) surrounding the SV (SV-PVAT) had lower levels of metaflammation and consecutive adipose tissue remodeling than did PVAT surrounding the coronary artery. However, the difference between SV-PVAT and subcutaneous adipose tissue (SCAT) remains unclear. METHODS AND RESULTS: Fat pads were sampled from 55 patients (38 men, 17 women; mean [±SD] age 71±8 years) with coronary artery disease who underwent elective CABG. Adipocyte size was significantly larger in SV-PVAT than SCAT. The extent of fibrosis was smaller in SV-PVAT than SCAT. There were no significant differences between SCAT and SV-PVAT in macrophage infiltration area, quantified by antibodies for CD68, CD11c, and CD206, or in gene expression levels of metaflammation-related markers. Expression patterns of adipocyte developmental and pattern-forming genes differed between SCAT and SV-PVAT. CONCLUSIONS: The properties of SV-PVAT are close to, but not the same as, those of SCAT, possibly resulting from inherent differences in adipocytes. SV-PVAT has healthy expansion with less fibrosis in fat than SCAT.

DOI： 10.1253/circj.CJ-22-0740

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background The aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitudein the kaolin with heparinase (HKH) assay (MAHKH) of TEG6s Platelet Mapping in cardiovascular surgery including cardiopulmonary bypass (CPB) period. The relationship between each parameter of the assay and laboratory data was also assessed. Methods We included the patients who underwent TEG6s Platelet Mapping during cardiovascular surgery under CPB between November 2021 and May 2022. The correlation between MAHKH and the early parameters was assessed. The association between each parameter of Platelet Mapping and a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000µL was also evaluated by the receiver operating characteristic (ROC) curve. Results In 23 patients who underwent TEG6s Platelet Mapping during the study period, 62 HKH assay data including 59 pairs of data (HKH assay and laboratory data) were analyzed. K and angle, but not R, were significantly correlated with MAHKH (r [95% CI]: -0.90 [-0.94, -0.83], p < 0.0001 for K, and 0.87 [0.79, 0.92], p < 0.0001 for angle). Furthermore, ROC curves suggested that these parameters predicted a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL with high accuracy. Similar results were confirmed in the heparinized blood samples obtained during CPB. Conclusion These findings suggest that not only MAKHK but also K and angle, which are early parameters in the HKH assay, provide clinically significant information that will facilitate rapid decision-making regarding coagulation strategies during cardiovascular surgery including the CPB period.

DOI： 10.7759/cureus.38044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We analyzed the temperature in proximal aortic repair with moderate hypothermic circulatory arrest (HCA) and evaluated the effect of the cooling status on postoperative outcomes. METHODS: A total of 340 patients who underwent elective ascending aortic replacement or total arch replacement with moderate HCA from December 2006 to January 2021 were studied. The change in body temperature trends recorded during surgery was shown graphically. Several parameters, such as the nadir temperature, cooling speed and the degree of cooling (cooling area), which was the area under curve of inverted temperature trends from cooling to rewarming as calculated by the integral method, were analyzed. The relationships between these variables and a major adverse outcome (MAO) postoperatively defined as prolonged ventilation (>72 h), acute renal failure, stroke, reoperation for bleeding, deep sternal wound infection or in-hospital death were evaluated. RESULTS: An MAO was observed in 68 patients (20%). The cooling area was larger in the MAO group than in the non-MAO group (1668.7 vs 1383.2°C min; P < 0.0001). A multivariate logistic model showed that old myocardial infarction, peripheral vascular disease, chronic renal dysfunction, cardiopulmonary bypass time and the cooling area were independent risk factors for an MAO (odds ratio = 1.1 per 100°C min; P < 0.001). CONCLUSIONS: The cooling area, which indicates the degree of cooling, shows a significant relationship with an MAO after aortic repair. This finding indicates that the cooling status with HCA can affect clinical outcomes.

DOI： 10.1093/icvts/ivac282

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-22-0550

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/omcr/omac122

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 50-year-old patient who underwent total aortic arch replacement for acute type A aortic dissection developed recurrent thoracic prosthetic graft infection after omentopexy for the treatment of initial postoperative graft infection of the ascending aorta and transverse aortic arch. We report the successful treatment of the disastrous complication by covering the prosthetic graft with a free latissimus dorsi muscle flap coupled with a pedicled rectus abdominis myocutaneous flap for the reduction of mediastinal dead space, following surgical disinfection with partial graft reconstruction.

DOI： 10.1093/ejcts/ezac460

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jvscit.2022.04.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an accurate prediction is required. However, the standard prediction equation often results in actual values that are lower than the predicted values. This study aimed to clarify the limits of agreement (LOA) and bias of the prediction equations and investigate better the prediction equations. A retrospective study was performed on adult patients between April 2015 and December 2020. Study 1 included 158 patients, and Study 2 included 55 patients. The primary outcomes were the LOA and bias between the predicted and measured Hct values after the initiation of CPB, and two studies were conducted. In Study 1, total blood volume (TBV) was estimated, and the new blood volume index (BVI) was calculated. BVI was also evaluated for the overall value and gender differences. Therefore, the patient's background was compared by gender differences. In, Study 2 the conventional predicted equation (Eq. 1), the predicted equation using the new BVI (Eq. 2), and the predicted equation using the new BVI including physiological factors in the TBV equation (Eq. 3) were compared. In Study 1, BVI was 53 (44-67) mL/kg. In Study 2, bias ± LOA was - 2.5 ± 6.8% for Eq. 1, 0.1 ± 6.6% for Eq. 2, and 0.4 ± 6.2% for Eq. 3. The new equation is expected to predict the Hct value after the initiation of CPB with better LOA and bias than the conventional equation.

DOI： 10.1007/s10047-021-01295-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND Infective endocarditis (IE) is an infectious disease that occurs in valves, centered on the endocardium and ventricular septal defects. It is a serious disease that is easily misdiagnosed and has a high mortality rate if left untreated. Edwardsiella tarda is an extremely rare cause of IE, especially in young and non-immunocompromised hosts. CASE REPORT A woman in her 20s presented to our hospital with fever of unknown cause and liver dysfunction. She was admitted to the Department of Gastroenterological Medicine owing to suspicion of gastrointestinal infection. Gastrointestinal examination, including contrast-enhanced computer tomography and endoscopic ultrasonography, was performed; however, there were no significant findings. Liver dysfunction improved spontaneously, but her fever did not improve with antibiotic treatment. Transthoracic echocardiography was performed on day 9 of hospitalization because E. tarda was detected in a blood culture test, revealing vegetation at the mitral valve. Asymptomatic cerebral infarction was shown by brain magnetic resonance imaging, and mitral valvuloplasty was performed on day 14. After surgery, transthoracic echocardiography was performed on day 22, showing no vegetation or mitral regurgitation. However, postoperative transesophageal ultrasonography performed on day 29 revealed severe mitral regurgitation. Redo mitral valvuloplasty was performed on day 38. She clinically improved and was discharged on day 67. CONCLUSIONS This is the first case in which E. tarda was diagnosed as the causative agent of IE on a native valve in a young and non-immunocompromised host. Aggressive source control resulted in a good clinical outcome.

DOI： 10.12659/AJCR.932387

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report on the ultrastructural features of the aortic wall in a patient with Kommerell diverticulum. A 70-year-old woman with a right aortic arch, aberrant left subclavian artery, and Kommerell diverticulum underwent a successful total arch replacement plus the frozen elephant trunk procedure with anatomical left subclavian artery reconstruction. Small pieces of the ascending aorta, distal arch, right common carotid artery, and left subclavian artery were investigated ultrastructurally. In the ascending aortic wall, multiple cystic cavities were observed in the subintimal region of the media by scanning electron microscopy. Changes in organelles, including mild dilation of rough-surfaced endoplasmic reticulum and mitochondrial swelling and degrading, were also observed in all specimens by transmission electron microscopy. These ultrastructural features may indicate the fragility or stress of the aortic wall and are useful when considering the early surgical intervention of a patient with Kommerell diverticulum.

DOI： 10.1016/j.avsg.2021.02.036

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Perivascular adipose tissue (PVAT) is associated with metabolically driven chronic inflammation called metaflammation, which contributes to vascular function and the pathogenesis of vascular disease. The saphenous vein (SV) is commonly used as an essential conduit in coronary artery bypass grafting, but the long-term patency of SV grafts is a crucial issue. The use of the novel "no-touch" technique of SV harvesting together with its surrounding tissue has been reported to result in good long‑term graft patency of SV grafts. Herein, we investigated whether PVAT surrounding the SV (SV-PVAT) has distinct phenotypes compared with other PVATs of vessels. Methods and Results Fat pads were sampled from 48 patients (male/female, 32/16; age, 72±8 years) with coronary artery disease who underwent elective coronary artery bypass grafting. Adipocyte size in SV-PVAT was significantly larger than the sizes in PVATs surrounding the internal thoracic artery, coronary artery, and aorta. SV-PVAT and PVAT surrounding the internal thoracic artery had smaller extents of fibrosis, decreased gene expression levels of fibrosis-related markers, and less metaflammation, as indicated by a significantly smaller extent of cluster of differentiation 11c-positive M1 macrophage infiltration, higher gene expression level of adiponectin, and lower gene expression levels of inflammatory cytokines, than did PVATs surrounding the coronary artery and aorta. Expression patterns of adipocyte developmental and pattern-forming genes were totally different among the PVATs of the vessels. Conclusions The phenotype of SV-PVAT, which may result from inherent differences in adipocytes, is closer to that of PVAT surrounding the internal thoracic artery than that of PVAT surrounding the coronary artery or that of PVAT surrounding the aorta. SV-PVAT has less metaflammation and consecutive adipose tissue remodeling, which may contribute to high long-term patency of grafting when the no-touch technique of SV harvesting is used.

DOI： 10.1161/JAHA.120.018905

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We investigated the validity of the surgical strategy for aortic arch aneurysm depending on the patient's condition. METHODS: Between 2014 and 2019, 70 patients underwent total arch replacement (TAR) and 14 patients underwent fenestrated thoracic endovascular aortic repair( fTEVAR) for aortic arch aneurysm. We selected the surgical strategy on the basis of the patient's condition with or without frailty and if surgical risks including cancer or a respiratory condition precluded open surgery. RESULTS: The preoperative average ages were 73.3±7.8 years in the TAR group and 73.9±6.1 years in the fTEVAR group (p=0.93). EuroSCORE Ⅱ was 4.3±3.6 in the TAR group and 6.0±3.3 in the fTEVAR group (p=0.03). Frailty was observed in 11 patients (15.7%) in the TAR group and fivepatients (35.7%) in the fTEVAR group (p=0.08). In the fTEVAR group, there were three patients (21.4%) with cancer and three patients (21.4%) with a respiratory condition that precluded open surgery. The overall 30-day mortality rate was 0% for both groups, and the in-hospital mortality rate was 2.9% in the TAR group and 0% in the fTEVAR group (p=0.52). The incidence of stroke was 2.9% (two patients) in the TAR group and 7.1%( one patient) in the fTEVAR group( p=0.43). However, all stroke patients were able to walk at discharge. The cumulative survival rate was 88.9% and 83.5% in the TAR group and 85.1% and 68.1% in the fTEVAR group at two and five years, respectively (p=0.173). There were both 98.1% of patients in the TAR group and 85.7% and 75.0% of patients in the fTEVAR group who were free from reoperations at two and five years, respectively( p<0.01). CONCLUSIONS: Our surgical strategy and outcomes for aortic arch aneurysm were generally appropriate. It is important to select open surgery or TEVAR depending on the patient's condition.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical indication and treatment for patients with Kommerell diverticulum and aberrant subclavian artery are still not well established. A patient with esophageal and tracheal compression resulting from these anatomical abnormalities was successfully treated with a hybrid approach of total arch replacement, frozen elephant trunk technique, aberrant left subclavian artery transection, and left subclavian artery reconstruction through median sternotomy. Compressive symptoms were relieved without resecting the enlarged diverticulum. In this case, the importance of preoperative investigation for the main cause of compressive symptoms is illustrated and a novel treatment strategy is outlined.

DOI： 10.3400/avd.cr.20-00129

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Postoperative acute mesenteric ischemia (AMI) in the long-term hemodialysis (HD) patients could be a disastrous complication leading to high mortality. The objective is to evaluate the association between the presence of superior mesenteric artery calcification (SMAC) and early and late outcomes after aortic valve replacement (AVR) in HD patients. METHODS: Between April 2003 and December 2018, the enrolled 46 HD patients (19 women; mean age 72 years) who underwent AVR for severe aortic valve stenosis were retrospectively reviewed. 25 patients (54.3%) who had severe calcifications of superior mesenteric artery (SMA) were defined as the SMAC group, and the calcification extent of SMA was evaluated on preoperative non-contrast CT using Agaston calcium score [calcification area (cm2) × max CT value (HU)]. The operative outcomes were compared with those of the non-SMAC group comprising 21 patients (45.7%). RESULTS: The following factors in SMAC group were statistically higher compared with those of the non-SMAC group: age (73.6 ± 7.2 vs 69.3 ± 7.1 years; p = 0.04), celiac artery calcification (76.4% vs 17.6%; p < 0.001), calcium score of SMA (692.3 ± 300.0 vs 123.5 ± 180.7; p < 0.001), the incidence of AMI (24.0% vs 4.7%; p = 0.001), and hospital mortality (16.0% vs 0%; p = 0.02). In multivariate analysis, the presence of SMAC was significantly associated with AMI (OR 3.8, p = 0.05) and hospital mortality (OR 2.4, p = 0.02). Calcium score of SMA in patients complicated with AMI was significantly higher than those without AMI (815.7 ± 300.5 vs 366.9 ± 351.2; p < 0.01). CONCLUSION: Quantitative evaluation of SMAC could be a predictive marker of incidence of AMI after AVR in HD patients.

DOI： 10.1007/s11748-020-01352-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In 2011, the Japanese Registry of Acute Aortic Dissection (JRAD) was started in accordance with the model of the International Registration of Acute Aortic Dissection. The aim of this study was to report actual clinical early and midterm outcomes of treatment for acute type A aortic dissection in Japan. METHODS: Between 2011 and 2016, 1217 patients (67.9 years-old, 584 male, 241 >80 years old) who had acute type A aortic dissection within 14 days after the onset of symptoms were enrolled. RESULTS: Among 75% patients managed surgically, 68% underwent surgical procedure with cardiopulmonary bypass. Surgery was not indicated in 25% patients. Overall, 12% died in the hospital, 10.8% after surgical treatment and 16.6% after medical treatment. Multivariable analysis of in-hospital mortality revealed the following risk factors: age older than 80 years (odds ratio, 2.37; P < .01); shock vital status on arrival (odds ratio, 1.89; P = .01); disturbance of consciousness, including coma (odds ratio, 3.32; P < .01); and cardiac arrest, for which resuscitation was needed on arrival (odds ratio, 4.86; P < .01). CONCLUSIONS: JRAD data revealed the actual clinical setting for the treatment of acute type A dissection in Japan. Early surgical results were favorable, with a low in-hospital morality rate, and midterm outcomes in selected medically treated patients were equivalent. Preoperative severe conditions, including shock, need for preoperative cardiopulmonary resuscitation, and disturbance of consciousness, as well as advanced age, were risk factors for in-hospital mortality even though the referral interval was brief.

DOI： 10.1016/j.athoracsur.2019.12.051

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to evaluate our new method to occlude target lumber arteries using N-butyl-2-cyanoacrylate (NBCA) during endovascular aneurysm repair (EVAR) for prevention of type 2 endoleak (T2E). METHODS AND RESULTS: Between 2013 and 2018, 176 patients who underwent EVAR for abdominal aortic aneurysm (AAA) were reviewed. Starting from October 2015, 83 patients (treatment group) underwent NBCA injection into the aneurysmal sac during EVAR. The incidence of T2E at 7 days and AAA sac diameter 12 months after EVAR were compared with those of the control group comprising 93 consecutive patients who underwent EVAR alone before 2015. The incidence of T2E at 7 days was significantly lower in the treatment group (2.4%) than in the control group (22.6%) (P < 0.001). AAA sac diameter at 12 months in the treatment group had a mean decrease of 6.6 mm as compared with the mean 4.4 mm in the control group (P = 0.026). In multivariate analysis, NBCA injection was significantly related to the reduction of incidence of T2E at 7 days (odds ratio = 11.8, P < 0.001) and a decrease in AAA sac diameter at 12 months (P < 0.001). There was no NBCA injection-related complication and reintervention in the treatment group. CONCLUSIONS: NBCA injection might be safe and useful to reduce the incidence of T2Es and to prevent AAA sac expansion.

DOI： 10.1016/j.avsg.2019.12.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A primary aorto-duodenal fistula (ADF), a rare, spontaneous development of a communication between the aorta and duodenum, is a disastrous complication of an abdominal aortic aneurysm. A 73-year-old patient with primary ADF underwent emergent endovascular aneurysm repair (EVAR), followed by staged omentopexy, without removing a stent graft (SG). The patient received long-term treatment with antibiotics, and there has been no evidence of infection during a follow-up period of three years. Emergency EVAR coupled with omentopexy, may be a treatment option for primary ADF, even when it means leaving the SG in a potentially infectious site.

DOI： 10.3400/avd.cr.19-00104

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

DOI： 10.1038/s41598-020-67561-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Ministernotomy has been advocated over recent years as an alternative technique for different cardiovascular surgical procedures to reduce the surgical trauma associated with conventional full sternotomy. In recent years, several reports have addressed minimally invasive approaches to the proximal aorta and aortic arch through a partial upper sternotomy (PUS). We reviewed our experience of minimally invasive open aortic arch reconstruction with a branched graft through a PUS. METHODS: Between February 2016 and December 2018, 22 patients underwent open arch repair through a PUS. Moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion were used for organ protection. The median patient age was 76 years (range, 65-86). Renal insufficiency was observed in 14 patients (64%) and chronic lung disease, in 11 (50%). Total arch replacement was performed in 20 patients (91%), while the remaining 2 (9%) received partial arch replacement with reconstruction of two supraaortic vessels. Aortic valve replacement with a tissue valve or aortic valve repair was each performed concomitantly in one patient (5%) as a concomitant procedure. The median durations of cardiopulmonary bypass, aortic cross-clamping, and circulatory arrest were 214, 109, and 50 min, respectively. RESULTS: No early deaths, permanent neurological deficits, or spinal cord injuries occurred. One patient (5%) required intraoperative conversion to full sternotomy because of bleeding caused by a venting cannula injury. Three patients (14%) required re-exploration because of bleeding. Prolonged ventilation occurred in 2 patients (9%) with severe chronic obstructive pulmonary disease. CONCLUSIONS: Minimally invasive aortic arch reconstruction with branched grafts through a PUS can be safely performed with satisfactory perioperative outcomes.

DOI： 10.1016/j.avsg.2019.10.078

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cardiac metastasis from renal cell carcinoma is an exceptional event, particularly when there is lack of inferior vena cava involvement. Only a few cases have been reported worldwide so far. CASE PRESENTATION: We presented a case of a 58-year-old man diagnosed with isolated right ventricular metastasis of renal cell carcinoma in the absence of direct inferior vena cava extension, who underwent surgical tumor resection using cardiopulmonary bypass. CONCLUSIONS: Surgical resection of the cardiac mass with an understanding of the pathology is needed to prevent sudden death from acute heart failure or tumor embolism and improve the patient's quality of life.

DOI： 10.1186/s40792-019-0733-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Aortic aneurysms are associated with fatal aortic rupture. Current therapeutic approaches are limited to implantation of aortic prostheses and stent-grafts; no effective drugs are available because the pathogenic mechanisms of aortic aneurysms remain unclear. Here, we aimed to elucidate the molecular mechanisms of the initiation and progression of aortic aneurysm by lipidomics. We performed lipidomics analyses of lipids in the aortic media of normal, border, and aneurysm areas from patients with thoracic atherosclerotic aortic aneurysm (N = 30), thoracic nonatherosclerotic aortic aneurysm (N = 19), and abdominal atherosclerotic aortic aneurysm (N = 11) and from controls (N = 8) using liquid chromatography and mass spectrometry. Significant alterations were observed in the lipid profiles of patients with atherosclerotic aortic aneurysms and to a lesser extent in those with nonatherosclerotic aneurysms. Increased triacylglycerols (TGs) and decreased ether-type phosphatidylethanolamines (ePEs) were observed throughout the normal, border, and aneurysm areas of thoracic and abdominal atherosclerotic aortic aneurysms. Prostaglandin D2 increased, but ePEs and TGs decreased in normal areas of thoracic atherosclerotic aortic aneurysms and thoracic nonatherosclerotic aortic aneurysms compared with the control tissues. These findings expand our knowledge of metabolic changes in aortic aneurysms and provide insights into the pathophysiology of aortic aneurysms.

DOI： 10.1038/s41598-019-51885-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although thoracic endovascular aortic repair (TEVAR) is an effective treatment for both complicated and uncomplicated type B aortic dissection (TBAD), the occurrence of retrograde type A aortic dissection (RTAD) after TEVAR could be a disastrous complication. The aim of this study was to examine the safety of zone 2 TEVAR in the treatment of acute and subacute TBAD. METHODS: A Relay stent graft (SG) was placed proximally beyond the left subclavian artery (LSA) as zone 2 TEVAR for complicated or uncomplicated TBAD. LSA was preserved by physician-modified fenestrated TEVAR (F-TEVAR) if anatomically possible or by surgical reconstruction of debranching TEVAR (D-TEVAR) if necessary. Otherwise, LSA was simply covered. Changes in the aortic diameters after TEVAR were evaluated using CT scanning. RESULTS: Between 2013 and 2017, 22 patients (mean age: 63 ± 14 years; 16 males) with TBAD were treated with zone 2 TEVAR. Emergency TEVAR was performed in 9 patients (41%) for complicated TBAD, and elective TEVAR was performed in 13 patients (59%) for uncomplicated TBAD in subacute phases. LSA was preserved in 16 patients via 15 F-TEVAR and 1 D-TEVAR and intentionally covered in 6 patients on emergency TEVAR. Elective TEVAR succeeded in the preservation of LSA flow in all patients (emergency 33% vs. elective 100%; P < 0.01). There were no TEVAR-related complications such as stroke, spinal cord ischemia, and RTAD. Thirty-day mortality was 0%. Aortic remodeling as the expansion of true lumen and shrinkage and complete thrombosed occlusion of false lumen were prominent at the level of SG placement 12 months after TEVAR. During the follow-up period, stent-induced new entry at the distal edge of the SG occurred in 1 patient (4%); however, there was no case of aorta-related mortality. CONCLUSIONS: Zone 2 TEVAR for acute and subacute TBAD might be promising for the prevention of RTAD.

DOI： 10.1016/j.avsg.2019.02.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Isolation selective cerebral perfusion (ISCP) technique is reportedly an effective method for preventing brain complications during the treatment of arch aneurysms. Here we present the case of a patient with intracardiac disease complicated by mobile atheroma in the proximal aorta. In this patient, not only the arterial cannulation of the ascending aorta might have posed a high risk of brain stroke but also the original ISCP technique could not be applied. We applied the ISCP technique for non-aortic disease without using circulatory arrest to prevent aortogenic brain embolism. The patients who underwent treatment using this technique were discharged without neurologic complications.

DOI： 10.3400/avd.cr.18-00146

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Total arch replacement (TAR) is an established standard surgical procedure. We report >1000 cases of TAR using a 4-branched graft with antegrade cerebral perfusion (ACP) during a 15-year period. METHODS: Since May 2001, 1005 patients who underwent total aortic replacement (mean age 69.8 ± 11.2 years; range, 9-92 years; 744 male) underwent TAR with a 4-branched graft. All surgeries were performed under hypothermia with ACP. There were 252 emergent operations for acute aortic dissection or aneurysm rupture. Concomitant operations included coronary arterial bypass grafting in 196 patients, aortic valve repair or replacement in 64, and aortic root replacements in 38. RESULTS: The operation time was 482 ± 171 minutes, cardiopulmonary time was 254 ± 94 minutes, cardiac ischemia time was 145 ± 51 minutes, ACP time was 160 ± 47 minutes, and lower body circulatory arrest time was 62 ± 16 minutes. The hospital mortality rate was 5.2%. The permanent neurological dysfunction rate was 3.6% and temporary neurological dysfunction rate was 6.4%. There were no spinal cord complications. The 5-year survival rate was 80.7% and 10-year survival rate was 63.1%. Fifteen patients (1.5%) underwent reoperation for the arch grafts because of a pseudoaneurysm (11 patients), hemolysis (3 patients), and infection (1 patient). CONCLUSIONS: TAR using a 4-branched graft with ACP could be accomplished with acceptable short- and long-term results.

DOI： 10.1016/j.jtcvs.2018.09.112

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Epicardial adipose tissue (EAT), a source of adipokines, is metabolically active, but the role of EAT mitochondria in coronary artery disease (CAD) has not been established. We investigated the association between EAT mitochondrial respiratory capacity, adiponectin concentration in the EAT, and coronary atherosclerosis. EAT samples were obtained from 25 patients who underwent elective cardiac surgery. Based on the coronary angiographycal findings, the patients were divided into two groups; coronary artery disease (CAD; n = 14) and non-CAD (n = 11) groups. The mitochondrial respiratory capacities including oxidative phosphorylation (OXPHOS) capacity with non-fatty acid (complex I and complex I + II-linked) substrates and fatty acids in the EAT were significantly lowered in CAD patients. The EAT mitochondrial OXPHOS capacities had a close and inverse correlation with the severity of coronary artery stenosis evaluated by the Gensini score. Intriguingly, the protein level of adiponectin, an anti-atherogenic adipokine, in the EAT was significantly reduced in CAD patients, and it was positively correlated with the mitochondrial OXPHOS capacities in the EAT and inversely correlated with the Gensini score. Our study showed that impaired mitochondrial OXPHOS capacity in the EAT was closely linked to decreased concentration of adiponectin in the EAT and severity of coronary atherosclerosis.

DOI： 10.1038/s41598-019-40419-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ejcts/ezy085

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to evaluate the effect of initial 2-day blood pressure management (BPM) after endovascular aneurysm repair (EVAR) for the incidence of subsequent type II endoleak (T2E) and shrinkage of abdominal aortic aneurysm (AAA) sac diameter. METHODS: We reviewed 136 patients who underwent EVAR for atherosclerotic AAA between July 2008 and July 2014 with one of three stent grafts (Excluder [W. L. Gore & Associates, Flagstaff, Ariz], Powerlink [Endologix Inc, Irvine, Calif], and Endurant [Medtronic Vascular, Santa Rosa, Calif]). Starting from 2013, the mean blood pressure of 76 participating patients (treatment group) was maintained at 75 to 90 mm Hg for the initial 48 hours after EVAR. The incidence of T2E at 7 days and AAA sac diameter 12 months after EVAR were evaluated using computed tomography scanning. The results so obtained were then compared with those of the control group composed of 60 consecutive patients who underwent EVAR before 2013. RESULTS: The incidence of T2E at 7 days was significantly lower in patients who received treatment (treatment group, 19.7%; control group, 40.0%; P = .013), and AAA sac diameter at 12 months in the treatment group had a mean decrease of 5.1 mm compared with the mean 2.2 mm in the control group (P = .004). In multivariate regression analysis, BPM was significantly related to the reduction of incidence of T2E at 7 days (odds ratio, 0.31; P = .007) and a decrease in AAA sac diameter at 12 months (P = .005). In addition, although the use of Endurant had less effect, the use of Excluder under controlled blood pressure conditions improved the incidence of T2E from 80% to 23% compared with those under normal postoperative management (P = .001). CONCLUSIONS: The initial 2-day postoperative BPM might have positive effects, such as lower incidence of T2E and facilitation of AAA sac shrinkage.

DOI： 10.1016/j.jvs.2017.05.118

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/jocs.13188

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Spinal cord ischemia is a well-known potential complication of endovascular aneurysm repair (EVAR), and it is usually manifested by paraplegia or paraparesis. We describe a case in which spinal cord ischemia after EVAR presented by isolated bladder and rectal incontinence without other neurological deficits. A 63-year-old woman presented with intermittent claudication secondary to an infrarenal abdominal aortic aneurysm (AAA), and a left common iliac artery obstruction, for which she underwent EVAR using an aorto-uniiliac (AUI) device and ilio-femoral artery bypass. On postoperative day 3, she developed urinary and fecal incontinence without signs of paraplegia or paraparesis. Magnetic resonance imaging (MRI) showed a hyper-intense signal in the spinal cord. She received hyperbaric oxygen (HBO) therapy and was discharged after 18 days when her urinary and fecal incontinence were almost resolved. This report suggests that spinal cord ischemia after EVAR for aortoiliac occlusive disease might present as bladder and rectal incontinence without other neurological manifestations.

DOI： 10.1186/s40792-016-0140-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We sought to compare the outcomes of Carpentier-Edwards PERIMOUNT (CEP), Magna and Magna Ease valves in Japanese elderly patients with severe aortic valve stenosis (AS). METHODS: We retrospectively identified 136 patients (mean age 76.61 ± 5.5 years old) who had undergone isolated surgical aortic valve replacement (SAVR) using CEP, Magna, and Magna Ease valves at a single institution, from January 2001 to December 2013. We compared the valves according to their survival rates, freedom from major adverse cardiovascular and cerebrovascular events (MACCE), and durability and hemodynamic performance by echocardiographic data. RESULTS: The thirty-day mortality after isolated SAVR in all the valve groups was "zero". The differences among the three groups in terms of survival rates, freedom from MACCE at 2 years, durability and hemodynamic performance of the valves by echocardiographic data was not statistically significant. CONCLUSION: All CEP, Magna and Magna Ease valves seemed to be similarly useful in Japanese elderly patients with severe AS. Our data did not clearly support the superiority of one valve over another. A longer follow-up period might be necessary to compare the durability and hemodynamic performance of these valves with more certainty.

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記述言語：英語  

DOI： 10.1016/j.athoracsur.2016.04.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Primary cardiac sarcomas are extremely rare. Furthermore, the myxofibrosarcomas are one of the rarest forms of cardiac sarcomas, and its prognosis is known to be quite poor. CASE PRESENTATION: This is a case of a 23-year-old man who presented with acute severe congestive heart failure caused by almost complete obstruction of the mitral valve due to a large left atrial tumor. The patient required endotracheal intubation before his arrival to the hospital, and underwent an emergent surgical excision of the tumor. The tumor had a complex shape and originated from the orifice of the right upper pulmonary vein. Because the tumor seemed to extend over most of the surface of the left atrium, it seemed impossible to reconstruct the left atrium had we done a complete transmural resection. Instead, we carefully peeled the tumor leaving the outer layer of the left atrial wall. We applied cryoablation to the attached site, in order to prevent a recurrence of the tumor. The pathology report revealed that the tumor was a myxofibrosarcoma, and it seemed to originate from the heart. The patient received radiation therapy after the surgery and continues to be alive and well after 1-year, without apparent recurrence. CONCLUSIONS: Cardiac myxofibrosarcoma can cause acute, severe left-sided heart failure. Non-transmural atrial wall resection with cryoablation might be effective for patients with cardiac myxofibrosarcomas with extensive atrial attachment.

DOI： 10.1186/s13019-016-0490-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jtcvs.2015.10.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A patient with an aortobronchial fistula secondary to a thoracic endovascular aortic repair was successfully treated with a re-thoracic endovascular aortic repair with debranching technique. Five months postoperatively, the aneurysm had shrunk; however, computed tomography revealed air in the thrombo-excluded aortic aneurysmal sac without signs of infection. Because of worsening air finding at the eighth month, we performed a resection of the residual fistula and wrapped the stent graft in a pedicled muscle flap.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although previous reports have described the repair of distal aortic arch aneurysms through debranching and chimney techniques, these methods invariably involve surgical management of the carotid artery. We report clinical results of thoracic endovascular aortic repair (TEVAR) using fenestrated stent grafts in the treatment of aortic arch aneurysms located less than 15 mm from the left common carotid artery. METHODS: A semi-custom-made fenestrated stent graft designed to fit aortic arch tortuosity and preserve blood flow at least into the brachiocephalic and left common carotid arteries was placed from zone 0. RESULTS: From 2007 through 2013, TEVAR from zone 0 was performed on 37 high-risk patients for open surgery (mean age 78.2 years). The mean length between the left common carotid artery and aortic aneurysm was 11.1 mm (range, 5 to 15 mm). The left subclavian artery was preserved for 26 patients (70.3%) through surgical reconstruction (n = 19) and graft fenestration (n = 7). The early mortality rate was 0%. Postoperative strokes and spinal cord ischemia occurred in 2 (5.4%) and 3 (8.1%) patients, respectively. Although type I endoleaks at discharge were noted in 12 (32.4%) patients, aneurysm enlargement was noted during follow-up in 6 (16.2%). Four patients (10.8%) underwent secondary interventions consisting of 3 coil embolization procedures; 2 re-TEVARs and 1 open conversion. There were no aorta-related late deaths. Survival and aorta-related event-free rates at 2 years were 86.3% and 88.8%, respectively. CONCLUSIONS: Thoracic endovascular aortic repair using fenestrated stent graft from zone 0 can be considered as one of therapeutic options for high-risk patients with aortic arch diseases.

DOI： 10.1016/j.athoracsur.2015.01.071

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Acute aortic dissection is the most common acute aortic condition requiring urgent surgical therapy. Due to lack of typical symptoms, it is sometimes difficult to identify acute aortic dissection causing ischemic stroke. We report a case of a patient with acute ischemic stroke who was deemed ineligible for intravenous recombinant tissue plasminogen activator treatment based on a finding of acute aortic dissection detected by carotid ultrasonography. After urgent aortic replacement surgery, the patient recovered with no neurological deficit. This case underscores the crucial role of carotid ultrasonography for the investigation of possible underlying acute aortic dissection when considering the use of intravenous recombinant tissue plasminogen activator therapy for hyperacute stroke.

DOI： 10.1111/jon.12186

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Arch aneurysm combined with insufficient Zone 1 length remains challenging. While a chimney stentgraft with supra-aortic bypass is a recognized solution for arch aneurysm, no definite strategy has been established yet. The aim of this study was to investigate efficacy of chimney stentgraft for patients with zone 1 of insufficient length. METHODS: Between 2011 and 2013, 10 consecutive patients with aortic arch aneurysm who were treated with a chimney stentgraft were retrospectively reviewed. The minimum length of zone 1 and length of landing zone inside zone 0 were measured on pre-/post-operative 3D-CT. RESULTS: Neither in-hospital mortality nor postoperative stroke was encountered. The minimum median length of zone 1 (zone 2 for bovine aortic arch of two patients) on preoperative 3D-CT was 10.1 mm [range: 3.9-15.3]. On postoperative 3D-CT, the median proximal landing length on a major curvature proximal to brachio-cephalic artery was 37.5 [range: 20.9-63.9] mm. Type Ia endoleak was observed in two patients with a landing length along the major curvature of less than 30 mm. CONCLUSION: For patients with insufficient length of zone 1, aneurysm exclusion could be achieved with a chimney stentgraft ensuring sufficient length (>30 mm) of the landing zone inside the ascending aorta along major curvature.

DOI： 10.3400/avd.oa.15-00043

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We reviewed magnetic resonance (MR) findings of the spinal cord in patients who had a spinal cord injury after descending and thoracoabdominal aortic repair, to speculate the specific cause of the injury. METHODS: Between 2000 and 2012, 746 patients underwent descending or thoracoabdominal aortic surgery: 480 received an open repair with adjuncts of spinal cord protection [distal perfusion, cerebrospinal fluid (CSF) drainage, reattachment of intercostal arteries and hypothermia] and 266 received an endovascular repair. Twenty-six (3.5%) suffered a spinal cord injury. Of these, 18 (14 open repair and 4 endovascular repair) underwent postoperative spinal cord MRI. Preoperative identification of the Adamkiewicz artery (ARM) was obtained in all patients except 1. Aortic pathology was dissection in 2 and non-dissection in 16 patients. RESULTS: There were 3 types MRI finding: sporadic infarction involving a range of spinal cord (sporadic); focal and asymmetrical infarction within a few segments of vertebra (focal); and diffuse and symmetrical infarction around the level of the ARM (diffuse). In endovascular repair, sporadic infarction was observed in all patients (4 of 4). In open repair, sporadic infarction was observed in 3 (21%), focal infarction in 7 (50%) and diffuse infarction in 4 (29%). In all patients who had sporadic or focal infarction, the aortic pathology was non-dissection. CONCLUSIONS: From these findings, embolism is 1 of the major causes of spinal cord injury in the era of adjuncts to optimize spinal cord haemodynamics during aortic repair.

DOI： 10.1093/icvts/ivu148

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Recent advances in endovascular aortic repair have changed the treatment of aortic arch aneurysms. The purpose of this study was to compare the early and mid-term outcomes of open repair and hybrid arch repair for aortic arch aneurysms. METHODS: This study included 143 and 50 patients who underwent open aortic repair and hybrid thoracic endovascular aortic repair (TEVAR), respectively, for non-dissecting aortic arch aneurysms from 2008 to 2013. The European System for Cardiac Operative Risk Evaluation II scores were 4.35 ± 3.65% and 7.78 ± 5.49% for the open and hybrid TEVAR groups, respectively (P < 0.001). Furthermore, 35 patients from each group were matched using propensity scores to adjust for differences in patient characteristics. RESULTS: There was no significant difference in early mortality between the open and hybrid groups (3 vs 2%, P = 0.76). Early morbidity was equivalent in both groups, but intensive care unit (ICU) lengths of stay were shorter in members of the hybrid group (4.7 vs 1.6 days, P = 0.018). During the follow-up, survival rates were not significantly different (87 vs 81% at 3 years, P = 0.13), but reinterventions for the aortic arch were required in 1 patient (pseudoaneurysm) in the open group and 5 (endoleak in 4, brachiocephalic artery stenosis in 1) in the hybrid group. The rates of freedom from reintervention at 3 years were 99% in the open group and 80% in the hybrid group (P < 0.001). Propensity score matching yielded similar results for shorter ICU and hospital lengths of stay and more frequent reintervention in the hybrid group. CONCLUSIONS: Surgical outcomes in both groups were satisfactory. Hybrid TEVAR was superior in terms of early recovery from surgery; however, open arch repair showed more reliable long-term outcomes. When properly selected according to patient risk, these two strategies improve the surgical results in all patients with aortic arch aneurysms.

DOI： 10.1093/ejcts/ezt615

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 31-year-old man presented with sudden abdominal pain. Computed tomography showed type B aortic dissection and a huge retroperitoneal hematoma. Accordingly, we diagnosed rupture of the abdominal aorta which was of almost normal caliber. Emergency open abdominal aortic repair was performed successfully. Pathology of the aortic wall revealed diffuse medial degeneration with severe elastin fragmentation, but gene analysis found no gene mutation that could lead to a connective tissue disorder.

DOI： 10.1177/0218492313475673

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Recently, some technical improvements in aortic arch repair have brought better outcomes. In this article, we reviewed our surgical results of open arch repair using selective cerebral perfusion(SCP). METHODS: Between 2001 and 2012, a total of 813 patients (median age of 70 years) underwent total arch replacement with SCP. We preferably use the right axillary artery cannulation for SCP and stepwise technique for distal anastomosis. The temperature at hypothermic circulatory arrest was moder ate in 46%, and deep in 54%.Of them, 22% had emergency surgery. RESULTS: Early mortality was 5.2% in all. The incidences of permanent( PND) and temporary neurological deficits were 3.4% and 7.3%. No spinal cord injury occurred, even with moderate hypothermia. The cumulative survival rates were 78.4% and 49.9% at 5 and 10 years, respectively. The freedom from arch reoperation was 98.0% and 96.2% at 5 and 10 years, respectively. CONCLUSIONS: Open total arch replacement using selective cerebral perfusion with some technical improvement provides favorable outcome, even in long-term period.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. METHODS: From 2001 to 2011, 1007 patients (median age, 72 years) underwent open arch repair with selective cerebral perfusion through the right axillary artery and hypothermic circulatory arrest: deep (<25 °C) in 48% and moderate (25 °-28 °C) in 52%. Of the 1007 patients, 73% underwent total arch replacement and 26% emergent surgery for aneurysm rupture or acute aortic dissection. RESULTS: The early mortality was 4.7% for all patients. Permanent and temporary neurologic dysfunction occurred in 3.5% and 6.7%, respectively. No spinal cord injury occurred, even with moderate hypothermia. The independent predictors of in-hospital mortality included chronic obstructive pulmonary disease, liver dysfunction, chronic kidney disease, and concomitant coronary artery bypass. The independent predictors of permanent neurologic dysfunction included cerebrovascular disease, emergency surgery, and concomitant coronary artery bypass. The cumulative survival rate was 80.4% and 71.2% at 5 and 8 years, respectively. Freedom from reoperation related to the initial arch repair was 98.0% and 96.9% at 5 and 8 years, respectively. CONCLUSIONS: Conventional open arch repair yielded satisfactory outcomes and should remain the standard therapy, with good long-term durability in all but high-risk patients.

DOI： 10.1016/j.jtcvs.2012.11.047

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder (CTD) caused by mutations in transforming growth factor-beta receptor (TGFBR)1 and TGFBR2. Surgical outcomes of aortic repair in patients with LDS are poorly known. METHODS: We enrolled 16 patients with TGFBR mutations identified by gene analysis in this study. Between 1993 and 2011, they underwent 41 aortic surgical procedures. Ten patients (group D: dissection group) underwent aortic repair for acute or chronic aortic dissection as a first surgical intervention, and 6 patients (group N: nondissection group) underwent surgical treatment for aortic root dilatation. The mean follow-up period was 103.7 ± 92.3 months (range, 2- 276 months). RESULTS: There were no in-hospital deaths. In group N, valve-sparing root replacement (VSRR) was performed in all patients. The residual aorta in 9 patients (90%) from group D required further repairs, 3 times on average. Moreover, in 4 patients (40%), the aorta was entirely replaced in serial procedures. In group N, aortic dissection occurred in only 1 patient (17%). The aortic event-free rates at 5 years were 40% in group D and 80% in group N, respectively (p = 0.819). One late death due to arrhythmia occurred 1 month after VSRR. The cumulative survival rates at 5 years were 100% in group D and 83% in group N, respectively (p = 0.197). CONCLUSIONS: Surgical outcomes for patients with LDS were satisfactory. Once aortic dissection occurred, the aorta expanded rapidly, requiring further operations. Therefore, early surgical intervention may improve prognosis by preventing a fatal aortic event.

DOI： 10.1016/j.athoracsur.2012.05.111

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: For aortic arch aneurysms, conventional total arch replacement has been the standard surgical option. In selected high-risk patients, we have attempted less invasive hybrid procedure involving supra-aortic bypass and endovascular stent-graft placement. We review the early and midterm outcomes to clarify the impact of the hybrid procedure. METHODS: Between October 2007 and December 2010, 27 patients were treated with the hybrid procedure. During the same period, 191 patients underwent elective conventional total arch replacement. On retrospective analysis, the hybrid procedure was feasible in 103 patients (hybrid feasible) and not feasible in 88 patients (hybrid impossible). Patients undergoing the hybrid procedure attained significantly higher additive (11.6 ± 2.2 vs 9.5 ± 2.4, 10.3 ± 2.8, P < .001, P = .044) and logistic (31.1 ± 14.1 vs 18.8 ± 12.6, 23.7 ± 16.0, P < .001, P = .047) European System for Cardiac Operative Risk Evaluation scores than hybrid-feasible and hybrid-impossible groups. RESULTS: Although the patients in the hybrid group had significantly higher risk, the early outcomes including mortality and morbidity were similar among the 3 groups, as were the 2-year survivals during the follow-up period: 85.9% for the hybrid group, 89.6% for the hybrid-feasible group, and 86.7% for the hybrid-impossible group (P = .510, .850, log-rank test). In the hybrid group, 2 patients required reintervention for type I endoleak. CONCLUSIONS: The early and midterm outcomes of the hybrid procedure for aortic arch aneurysms were satisfactory. This procedure has the potential to be an alternative for conventional total arch replacement for high-risk patients.

DOI： 10.1016/j.jtcvs.2011.06.024

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 31-year-old woman with Marfan syndrome required aortic root repair for annuloaortic ectasia in the 16th week of her first pregnancy. Aortic root reimplantation was successfully performed with a higher-flow-rate cardiopulmonary bypass of 3.4-3.6 l/min/m2 at normothermia for fetal survival. During the surgery, a cardiotocography and transesophageal echo probe attached on the patient's abdomen allowed adequate monitoring of the fetal heartbeat. The postoperative course was uneventful, and a healthy baby was delivered by cesarean section at 37 weeks' gestation.

DOI： 10.1007/s00595-011-0069-5

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of the present study was to review the clinical profile and outcome of emergency surgery for complicated acute type B aortic dissection. METHODS AND RESULTS: A total of 34 consecutive patients requiring surgical treatment for complicated acute type B aortic dissection between 2003 and 2010 were examined. The median age was 64.0 years (range, 19-82 years). Indication for emergency surgery was aortic rupture in 11 patients, rapid expansion of the dissecting aorta in 5, dissection involving a non-dissecting aneurysm in 6, and organ malperfusion in 12. All of 3 patients with open aortic rupture died during surgery. Operative mortality was 9.7% (central operation, 14.2%; peripheral operation, 7.1%; thoracic endovascular aneurysm repair, 0%). There were 2 aortic ruptures within 1 week after operation. Two patients suffered from persistent organ malperfusion after emergency surgical relief of ischemia and died. The 1- and 5-year survival rates were 74.1 ± 8.1% and 64.8 ± 11.2%. The actual rate of freedom from aortic events at 1- and 5- years was 83.0 ± 7.0% and 58.7 ± 11.4%. CONCLUSIONS: Emergency surgery for complicated acute type B dissection still has a high mortality rate for patients with open rupture and critical visceral ischemia. Medical treatment is best given immediately after admission, and adequate surgical treatment without delay is crucial.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Three cases with lesions in the right aortic arch (RAA) are presented. For two patients, whose RAA contained a retroesophageal segment, the primary treatment was total arch replacement (TAR) for acute type A dissection or severe arch angulation with thoracic endovascular aneurysm repair (TEVAR) as second-stage surgery. The third patient, who had RAA with mirror image branching, underwent supra-aortic bypass followed by TEVAR. There was no operative mortality, but the condition of two patients who underwent TAR was complicated by bilateral recurrent nerve palsy, which can be critical. The combination of TEVAR and supra-aortic bypass might thus be preferable for patients with RAA.

DOI： 10.3400/avd.cr.11.00032

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study determined the midterm outcome of valve-sparing aortic root replacement for patients with inherited connective tissue disorders. METHODS: From 1993 to 2008, 94 patients underwent valve-sparing aortic root replacement. Sixty patients (64%), average age 33 years (range, 15 to 61 years), had inherited connective tissue disorders: Marfan syndrome, 54 (92%); Loeys-Dietz syndrome, 5 (8%); and smooth muscle α-actin (ACTA2) mutation in 1. Median preoperative sinus diameter was 52 mm (range, 42 to 76 mm), and moderate/severe aortic regurgitation was present in 14 (23%). Seven (12%, 1993 to 1999) underwent remodeling procedures, and 53 had reimplantation procedures. Cusp repair was performed in 4. Median follow-up was 55 months (range, 1 to 149 months). There were 15 patients in the early term (1993 to 2000) and 45 in the late term (2001 to 2008). RESULTS: Four late deaths occurred (cardiac, 3; aortic, 1), with 10-year survival of 86%. Rates of freedom from aortic valve replacement at 5 and 10 years were 85% and 58% in remodeling and 96% and 58% in reimplantation. Risk factors for reoperations were postprocedure intraoperative aortic insufficiency greater than mild (p = 0.046), remodeling procedure (p = 0.016), and early term (p = 0.0002). One patient (2%) with none/trivial postprocedure aortic insufficiency required aortic valve replacement. Freedom from reoperation in patients with none/trivial postprocedure aortic insufficiency at 5 and 10 years was 100% and 67%. CONCLUSIONS: Meticulous control of aortic insufficiency during operation would bring favorable midterm durability in valve-sparing aortic root replacement using a reimplantation technique, even in patients with inherited connective tissue disorders.

DOI： 10.1016/j.athoracsur.2011.06.090

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is still challenging. The outcome of patients with proximal pulmonary artery disease is generally better than that of a distal lesion. However, we experienced poor results in two difficult cases having predominant proximal lesions even after effective PEA. Both of them had a long-time history of CTEPH and preoperative condition was critical. Although relatively large amount of thickened intima with massive thrombi were extracted from the proximal pulmonary arteries, they required postoperative percutaneous cardiopulmonary support due to residual pulmonary hypertension. Both of them finally died from pulmonary bleeding and adult respiratory distress syndrome.

DOI： 10.3400/avd.cr.11.00003

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The long-term outcomes of combined mitral repair and maze procedure for patients with nonrheumatic mitral regurgitation and chronic atrial fibrillation were evaluated. METHODS: Between June 1992 and December 2008, 187 patients underwent a combined mitral repair and maze procedure. The mean follow-up period was 7.4 ± 4.3 years. Chordal reconstruction was performed in 69 patients, leaflet resection in 91, edge-to-edge leaflet suture in 30, and ring annuloplasty in 156. In addition, a cryo-maze procedure was applied in 110, and a Cox-Kosakai maze and radiofrequency maze were applied in the others. RESULTS: There were 2 operative deaths and the 15-year survival was 71%. The 15-year freedom from greater than grade 3 mitral regurgitation was 61%; rates of freedom from heart failure (New York Heart Association class ≥ III) and reoperations were 79% and 91%, respectively. Cardiac function was improved and left ventricular size was decreased significantly postoperatively. Multivariate analysis showed that a large left ventricular diastolic diameter (≥65 mm) was an independent risk factor for recurrent mitral regurgitation. Eleven thromboembolic episodes (0.79%/patient-year) were detected during follow-up examinations, of which 7 occurred in patients with recurrent atrial fibrillation. Sinus rhythm was regained in 86% after 6 months and in 63% after 15 years. Multivariate analysis showed that a small-voltage f wave was an independent risk factor for AF recurrence. CONCLUSIONS: A combined mitral valve repair and maze procedure provided low rates of morbidity and mortality and led to well-preserved cardiac function. Left ventricular diastolic diameter and f-wave voltage can be accurate predictors of good long-term outcome.

DOI： 10.1016/j.jtcvs.2010.01.030

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This article discusses the multidisciplinary approach to prevent spinal cord ischemia (SCI) with reference to the incidence of SCI after thoracic endovascular aneurysm repair (TEVAR) associated with closure of the intercostal-lumbar artery that supplies the Adamkiewicz artery (ICA-AKA). METHODS: We reviewed 60 patients [49 men, 57 to 89 years old] who underwent TEVAR (TAG [W. L. Gore & Associates, Flagstaff, AZ] 42; the Matsui-Kitamura (Kanazawa, Japan) 10; Talent [Medtronic Inc, Santa Rosa, CA] 5; TAG and Talent 3) for part of or the entire distal descending aorta between T7 and L2. These patients had frequently undergone aortic surgeries: ascending aorta (4), aortic arch (25), descending aorta (4), thoracoabdominal aorta (3), and abdominal aorta (19). The multidisciplinary approach consists of identification of the ICA-AKA by magnetic resonance angiography or computed tomographic angiography to avoid unnecessary coverage of the ICA-AKA, in combination with monitoring of motor evoked potentials, augmentation of mean arterial pressure (> 80 mm Hg), and cerebrospinal fluid drainage. RESULTS: Spinal cord ischemia occurred in 4 patients and patent ICA-AKAs were covered in 3 of them. The overall incidence of SCI was 6.7% and 9.4% in the group of 32 patients whose patent ICA-AKAs were covered by TEVAR. After treatment for SCI, 3 patients regained full ambulatory ability. Significant risk factors were identified as the artificial graft at the proximal landing zone, the number of covered zones (>8), the length of aortic coverage (>250 or >300 mm), and the length of the uncovered distal aorta (<60 mm). CONCLUSIONS: A multidisciplinary approach is essential to prevent SCI after TEVAR for the distal descending aorta. This approach includes the preservation of patent ICA-AKAs after their identification, early diagnosis of SCI during TEVAR by monitoring motor evoked potentials, and prophylaxis and treatment of SCI by increasing mean arterial pressure to at least 80 mm Hg and performing cerebrospinal fluid drainage.

DOI： 10.1016/j.athoracsur.2010.04.067

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We sought to delineate the safety and efficacy of sequential and composite coronary artery bypass grafting (CABG) with exclusively arterial grafts to more than five coronary branches including small coronary vessels. METHODS: We reviewed the clinical records of 633 consecutive patients with 2617 bypass grafts who underwent total arterial off-pump complete revascularisation for three-vessel coronary regions without aortic manipulation. Group I consisted of 263 patients with a single in situ internal thoracic artery (ITA), while group II consisted of 370 patients with bilateral in situ ITA. Subgroups I-A and I-B consisted of 242 patients with three or four distal anastomoses and 21 patients with more than five distal anastomoses, respectively. Subgroups II-A and II-B consisted of 199 patients with three or four anastomoses and 171 patients with more than five anastomoses, respectively. RESULTS: The early mortality and morbidity rate and the angiographic graft patency in the groups I and II were similar, while the rate of antegrade flow in group II (92.4%, 1349/1460) was significantly higher than that in group I (89.4%, 638/714, p=0.02). Intra-operative graft flow measured at the proximal portion of the in situ ITA in group II (79+/-35 ml min(-1)) was significantly larger that that in group I (53+/-31 ml min(-1), p<0.0001). The patency rate of bypass grafts to small coronary vessels (1.25 mm or less in diameter) was 97.4% (626/643). The early mortality rates in subgroups I-A and I-B were 1.2% (3/242) and 0% (0/21), respectively (p=0.61). The graft flow and incidence of competitive flow was comparable in subgroups I-A and I-B. The early mortality rates in subgroups II-A and II-B were 0.5% (1/199) and 0.6% (1/177), respectively (p=0.91). The graft flow to five or more coronary branches (81+/-35 ml min(-1)) was significantly greater than that to three branches (67+/-30 ml min(-1), p=0.01). CONCLUSIONS: For more than five target branches, sequential and composite arterial grafting with the ITA and a radial artery was safe and reliable, even when the target vessels were small. Bilateral in situ ITA would be feasible for the patients with multiple stenotic lesions, because of abundant bypass flow and less incidence of competitive flow. Durable completeness of revascularisation can be expected.

DOI： 10.1016/j.ejcts.2009.06.047

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Atrial fibrillation (AF) is the common arrhythmia associated with valvular heart disease, and surgical ablation to treat AF is reported to contribute to eliminate mortality and morbidity. We report our clinical results of cryomaze procedure obtained in over 10-years' experience. METHOD: Since 1998 when we introduced cryoablation to reduce cut-and-sew line, 268 patients (145 males and 123 females, mean age of 61.2-year old) underwent cryomaze procedure concomitant with mitral valve surgery. We retrospectively obtained preoperative and follow-up data from medical records, and investigated survival rate, freedom from permanent AF recurrence rate and risk factors for recurrence. RESULTS: Three in-hospital deaths were noted (1.1%), and 243 patients (91.8% of survived patients) were discharged restoring to sinus rhythm. Pacemaker implantation during hospital stay was required in 12 cases (4.5%). There were five late deaths, and 5- and 10-year cumulative survival rates were both 93.2%. Multivariate analysis revealed that huge left atrium, longer history of AF and smaller f-wave in electrocardiogram were the independent risk factors for recurrence of permanent AF. Older age and re-do cardiac surgery were not significant factors. CONCLUSION: Cryoablation based maze procedure for AF adjunct to mitral valve surgery is an effective and long-term promising solution for restoring sinus rhythm. Patient selection criterion concerning left atrial size, duration of AF and f-wave voltage might be reasonable to improve the results.

DOI： 10.1016/j.ejcts.2009.03.032

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 46-year-old female was admitted to our hospital complaining of dizziness. Echocardiography and magnetic resonance imaging showed a pedicled tumor in the right ventricular outflow tract (RVOT), causing severe obstruction during systole. Resection was performed under cardiopulmonary bypass. Postoperative course was uneventful, with complete disappearance of major symptoms. Histological examination revealed the nature of the tumor to be a benign hemangioma. As reports of cardiac hemangioma causing severe RVOT obstruction are extremely rare, this case warrants attention.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 24-year-old woman with atopic dermatitis was admitted to our hospital with fever. Echocardiography showed a huge vegetation attached to the posterior mitral commissure without mitral valve dysfunction. Blood culture identified methicillin-sensitive Staphylococcus aureus. The serum level of antiphospholipid antibody was elevated. A splenic infarction occurred on the second hospital day. Surgery to resect the residual mobile vegetation was performed uneventfully on the 6th hospital day. The postoperative course was uneventful, and the patient was discharged after 4 weeks of antibiotic therapy. Preservation of the mitral valve is rare in the face of virulent Staphylococcus infection and the presence of a huge mobile vegetation. These findings were apparently related to the high serum level of infection-related antiphospholipid antibody and atopic dermatitis.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

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記述言語：日本語   出版者・発行元：(一社)日本静脈学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01122&link_issn=&doc_id=20240528210003&doc_link_id=10.4326%2Fjjcvs.53.100&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.53.100&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床腎移植学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J06262&link_issn=&doc_id=20231215350007&doc_link_id=%2Fem0sfcrt%2F2023%2F001102%2F007%2F0140-0143%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem0sfcrt%2F2023%2F001102%2F007%2F0140-0143%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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記述言語：日本語   出版者・発行元：(一社)日本フットケア・足病医学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01122&link_issn=&doc_id=20230731170013&doc_link_id=10.4326%2Fjjcvs.52.269&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.52.269&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01375&link_issn=&doc_id=20230731050002&doc_link_id=%2Fdc7hksrg%2F2023%2F006801%2F003%2F0009-0014%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2023%2F006801%2F003%2F0009-0014%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本リンパ腫学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01122&link_issn=&doc_id=20230330180011&doc_link_id=10.4326%2Fjjcvs.52.128&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.52.128&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01122&link_issn=&doc_id=20230130180003&doc_link_id=10.4326%2Fjjcvs.52.9&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.52.9&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本体外循環技術医学会編集委員会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01122&link_issn=&doc_id=20221121310009&doc_link_id=10.4326%2Fjjcvs.51.368&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.51.368&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本血液学会-東京事務局  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01122&link_issn=&doc_id=20220728190012&doc_link_id=10.4326%2Fjjcvs.51.249&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.51.249&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01375&link_issn=&doc_id=20220721160002&doc_link_id=%2Fdc7hksrg%2F2022%2F006701%2F003%2F0010-0015%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2022%2F006701%2F003%2F0010-0015%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01375&link_issn=&doc_id=20220721160006&doc_link_id=%2Fdc7hksrg%2F2022%2F006701%2F007%2F0033-0038%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2022%2F006701%2F007%2F0033-0038%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00679&link_issn=&doc_id=20220419490006&doc_link_id=%2Fah2sinzd%2F2022%2F005404%2F010%2F0459-0465%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2022%2F005404%2F010%2F0459-0465%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01122&link_issn=&doc_id=20220328200010&doc_link_id=10.4326%2Fjjcvs.51.118&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.51.118&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(公社)日本生化学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床麻酔学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00349&link_issn=&doc_id=20210407130007&doc_link_id=1390569015606140672&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390569015606140672&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02873&link_issn=&doc_id=20210910290005&doc_link_id=%2Ffj4kekka%2F2021%2Ft03003%2F001%2F0189-0193%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2021%2Ft03003%2F001%2F0189-0193%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01122&link_issn=&doc_id=20200124310005&doc_link_id=10.4326%2Fjjcvs.49.25&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.49.25&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡技師会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J02873&link_issn=&doc_id=20180717420010&doc_link_id=%2Ffj4kekka%2F2018%2F002703%2F010%2F0225-0228%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2018%2F002703%2F010%2F0225-0228%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J02115&link_issn=&doc_id=20171226130004&doc_link_id=%2Fao7heati%2F2018%2F003101%2F006%2F0029-0038%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7heati%2F2018%2F003101%2F006%2F0029-0038%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01122&link_issn=&doc_id=20180126210002&doc_link_id=10.4326%2Fjjcvs.47.7&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.47.7&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J02873&link_issn=&doc_id=20171127520008&doc_link_id=%2Ffj4kekka%2F2017%2F002605%2F008%2F0271-0274%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2017%2F002605%2F008%2F0271-0274%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：北海道外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本Acute Care Surgery学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本体外循環技術医学会編集委員会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

医中誌

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J00679&link_issn=&doc_id=20140724250032&doc_link_id=%2Fah2sinzd%2F2014%2F004607%2F034%2F0971-0974%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2014%2F004607%2F034%2F0971-0974%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)南江堂  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00349&link_issn=&doc_id=20130926210010&doc_link_id=1390845713011846016&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390845713011846016&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本心臓血管麻酔学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本組織移植学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本組織移植学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J01122&link_issn=&doc_id=20130719170002&doc_link_id=10.4326%2Fjjcvs.42.255&url=https%3A%2F%2Fdoi.org%2F10.4326%2Fjjcvs.42.255&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脳神経超音波と栓子検出学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J02873&link_issn=&doc_id=20130509240007&doc_link_id=%2Ffj4kekka%2F2013%2F002203%2F007%2F0645-0648%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj4kekka%2F2013%2F002203%2F007%2F0645-0648%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J01422&link_issn=&doc_id=20120531310001&doc_link_id=10.7133%2Fjca.52.1&url=https%3A%2F%2Fdoi.org%2F10.7133%2Fjca.52.1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

医中誌

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