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• 札幌医科大学   心臓血管外科   講師  

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• Ten-year follow-up study of a young woman with loeys-dietz syndrome: a case report.

  Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Itaru Hosaka, Jyunji Nakazawa, Nobuyoshi Kawaharada

  Journal of cardiothoracic surgery   18 ( 1 ) 209 - 209  2023年07月  [国際誌]

  　概要を見る

  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 PubMed

• One Year Outcomes of Zilver PTX Versus Eluvia for Femoropopliteal Disease in Real-World Practice: REALDES Study.

  Tsuyoshi Shibata, Yutaka Iba, Masami Shingaki, Osamu Yamashita, Yoshinori Tsubakimoto, Fumiaki Kimura, Atsutoshi Hatada, Fuminori Kasashima, Kyohei Ueno, Keitaro Nakanishi, Kiyofumi Morishita, Tomohiro Nakajima, Junji Nakazawa, Akihito Ohkawa, Itaru Hosaka, Ayaka Arihara, Shingo Tsushima, Nobuyoshi Kawaharada

  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     15266028231179861 - 15266028231179861  2023年06月  [国際誌]

  　概要を見る

  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 IMPACT: This 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 PubMed

• Initial Outcomes of Physician-Modified Inner Branched Endovascular Repair in High-Surgical-Risk Patients.

  Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Akihito Ohkawa, Itaru Hosaka, Ayaka Arihara, Shingo Tsushima, Keishi Ogura, Kenta Yoshikawa, Nobuyoshi Kawaharada

  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     15266028231169183 - 15266028231169183  2023年04月  [国際誌]

  　概要を見る

  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 PubMed

• Temperature analysis of aortic repair with hypothermic circulatory arrest to quantify the injury by cooling.

  Hiroshi Sato, Yutaka Iba, Nobuyoshi Kawaharada, Joji Fukada, Yuu Iwashiro, Shingo Tsushima, Itaru Hosaka, Akihito Okawa, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Takeo Hasegawa, Yukihiko Tamiya

  Interdisciplinary cardiovascular and thoracic surgery   36 ( 1 )  2023年01月  [国際誌]

  　概要を見る

  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 PubMed

• Pararenal aortic aneurysm repair using a physician-modified stent-graft with inner branches.

  Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Itaru Hosaka, Nobuyoshi Kawaharada

  Journal of vascular surgery cases and innovative techniques   8 ( 3 ) 356 - 357  2022年09月  [国際誌]

  DOI PubMed

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• 手術ハイリスク患者のComplex aortic aneurysmに対するPhysician modified inner branched endovascular repairの早期成績

  柴田 豪, 伊庭 裕, 中島 智博, 仲澤 順二, 大川 陽史, 保坂 到, 在原 綾香, 對馬 慎吾, 川原田 修義

  日本外科学会定期学術集会抄録集 ( (一社)日本外科学会 )  123回   SF - 5  2023年04月

• 胸腹部大動脈瘤術後対麻痺の経過中に生じた大腿骨近位部周囲Neurogenic heterotopic ossificationの経験

  保坂 到, 伊庭 裕, 對馬 慎吾, 柴田 豪, 仲澤 順二, 中島 智博, 川原田 修義

  日本心臓血管外科学会雑誌 ( (NPO)日本心臓血管外科学会 )  52 ( 2 ) 128 - 132  2023年03月

  　概要を見る

  症例は生来著患のない59歳男性.検診で高血圧症を指摘され近医を受診した.精査のCT検査でCrawford II型相当の胸腹部大動脈瘤が指摘され,精査加療目的に当科紹介となった.手術侵襲を低減させる目的で,一期目に全弓部置換術,二期目に胸部ステントグラフト内挿術,三期目にIII型相当の胸腹部置換術を行う計画的分割手術を施行した.三期目の胸腹部置換術後に対麻痺を認め種々の支持療法にても改善を得られず,下肢麻痺および膀胱直腸障害が残存した.リハビリ施行ののち術後67日目に回復期病院に転院となった.転院後褥瘡形成や反復する尿路感染を認め抗生剤加療が開始されていたが改善に乏しく,またCT上両側大腿骨周囲に血腫形成と異所性骨化を認め,集学的治療が必要と判断され転院後約4ヵ月で当院へ再入院となった.臨床経過および画像所見から術後対麻痺に合併したNeurogenic heterotopic ossificationと診断した.褥瘡および尿路感染に対する抗生剤加療を継続すると同時に,強度に留意しながらリハビリを継続することで異所性骨化の増悪を認めず経過した.入院後44日目に皮弁を施行し,79日目に再転院となった.Neurogenic heterotopic ossification自体の病態生理は不明な点が多く治療法も定まったものはないが,術後対麻痺を合併した症例においてはNeurogenic heterotopic ossificationが生じるリスクにより術後のリハビリ自体が制限され,手術侵襲からの回復やADL維持を困難にさせる可能性が考えられた.リスク因子に対する適切な予防マネージメントを講じ,早期発見に務めることが重要と考えられた.(著者抄録)

• Analysis of the Relationship between Blood Flow, Function, and CHA2D2-VASc Score in the LAA and LA Using 4D Flow MRI(タイトル和訳中)

  大川 陽史, 伊庭 裕, 中島 智博, 柴田 豪, 保坂 到, 在原 綾香, 對馬 慎吾, 川原田 修義

  日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  87回   PJ020 - 3  2023年03月

• 体外循環中ヘパリン濃度測定による抗凝固管理下で開心術を施行した抗リン脂質抗体症候群合併の1例

  梅田 璃子, 中島 智博, 伊庭 裕, 保坂 到, 大川 陽史, 安田 尚美, 柴田 豪, 仲澤 順二, 川原田 修義

  日本心臓血管外科学会雑誌 ( (NPO)日本心臓血管外科学会 )  52 ( 1 ) 9 - 13  2023年01月

  　概要を見る

  症例は72歳女性.2014年より全身性エリテマトーデス,抗リン脂質抗体症候群(antiphospholipid antibody syndrome;APS)加療のために通院中であった.2020年にリウマチ性重症僧帽弁狭窄症(mitral valve stenosis;MS)により労作時息切れが出現し,あわせて発作性心房細動と冠動脈狭窄を指摘され,手術の方針となった.手術は僧帽弁置換術+三尖弁輪形成術+冠動脈バイパス+肺静脈隔離術+左心耳閉鎖術を行った.APSによる活性化凝固時間(active clotting time;ACT)延長に対する対策として,術中の人工心肺における抗凝固管理は,HMS PLUSを用いて血中ヘパリン濃度指標下に抗凝固管理を行った.周術期に出血性合併症や血栓塞栓症は認めず,術後23日目に自宅退院した.今回,APL患者の人工心肺を用いた開心術において,目標ヘパリン濃度を3.5U/mlに設定しHMS PLUSによるヘパリン濃度測定下に抗凝固管理を行い,合併症なく経過したため報告する.(著者抄録)

• 高度肥満患者の急性大動脈解離に対する体外循環の経験

  長谷川 武生, 橋本 佳苗, 田村 秀朗, 室橋 高男, 中島 智博, 伊庭 裕, 川原田 修義

  体外循環技術 ( (一社)日本体外循環技術医学会編集委員会 )  49 ( 4 ) 387 - 391  2022年12月

  　概要を見る

  高度肥満患者の急性大動脈解離に対する緊急的、部分弓部置換術における体外循環を経験した。症例は50歳代男性、体格指数(body mass index)44、身長170cm、体重127kg、体表面積2.33m2。顎の痛み、腰痛、冷汗を主訴に前医より搬送された。造影CTで急性大動脈解離所見を認め、部分弓部大動脈人工血管置換を実施した。体外循環時間4時間10分、手術時間7時間17分であった。灌流量は5.7～5.9L/min、人工肺手前圧最大値574mmHg、人工肺後圧最大値325mmHgであった。人工肺や回路の破損は認めなかった。低体温循環停止に伴い静脈血貯血槽レベルは、最大使用貯血量の4,000mL、心内血貯血槽は2,000mLに至ったが、血液が溢れ出ることは回避し得た。術後経過は良好で、術後27日目に合併症なく退院した。高度肥満患者の緊急手術に対し、適切な灌流量の設定や事前の準備により、安全な体外循環の実施が可能である。必要な医療材料の常備など、対策を講じておくことが望ましい。(著者抄録)

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