Details of a Researcher - NAKAJIMA Tomohiro

Papers - NAKAJIMA Tomohiro

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Right External Iliac Artery Resection and Reconstruction Because of Cecum Cancer Invasion: A Case Report.

Tomohiro Nakajima, Yutaka Iba, Masayuki Ishii, Maho Toyota, Koichi Okuya

Cureus 17 ( 5 ) e84916 2025.05 [International journal]

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.

Spontaneous Forearm Hemorrhage in a Patient With Polycystic Kidney Disease: A Case Report.

Tomohiro Nakajima, Akihiro Tabata

Cureus 17 ( 4 ) e81864 2025.04 [International journal]

The patient is a 73-year-old woman. She had a brain hemorrhage at 53 years of age and underwent craniotomy and hematoma removal. At 55 years of age, she was treated for multiple renal cysts. An infection has spread to the existing renal cyst. The patient's renal function gradually deteriorated, and she underwent hemodialysis at 56 years of age. At 58 years of age, an internal shunt was created using an autologous blood vessel in the left elbow fossa. Thereafter, she was hospitalized six times because of a cyst infection and received antibiotic treatment. At 72 years of age, she experienced a brain hemorrhage and received conservative treatment at our hospital. Presently, she presented with swelling in the left forearm. Upon further examination, bleeding was found in the left forearm muscles. Hemostatic surgery was performed under general anesthesia. Here, we report a rare case of forearm hemorrhage in a patient with comorbid cystic kidney disease.

Effects of temperature on transient neurologic dysfunction after total arch replacement.

Keitaro Nakanishi, Hiroshi Sato, Yutaka Iba, Ayaka Arihara, Shuhei Miura, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Takeo Hasegawa, Nobuyoshi Kawaharada

General thoracic and cardiovascular surgery 73 ( 3 ) 155 - 163 2025.03 [Domestic journal]

OBJECTIVES: The relationship between cooling status during aortic surgery with hypothermic circulatory arrest and postoperative neurologic dysfunction remains unknown. In the present study, we evaluated the effect of cooling status on transient neurologic dysfunction after total arch replacement. METHODS: We studied patients who underwent elective total arch replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion from December 2011 to January 2021. Changes in tympanic temperature trends recorded during surgery were plotted. Several parameters, including the nadir temperature, cooling speed, and degree of cooling (cooling area, or the area under the curve of inverted temperature trends from cooling to rewarming as calculated by the integral method), were analyzed. The relationships between these variables and transient neurologic dysfunction were evaluated. RESULTS: Transient neurologic dysfunction was observed in 33 (14.5%) of the 228 included patients. In the transient neurologic dysfunction group, the cooling area was larger (2417.3 vs. 1920.8 °C min; P < 0.001) and the cooling speed was higher (0.68 vs. 0.51 °C/min; P < 0.001) than in the non-transient neurologic dysfunction group. A multivariate logistic model revealed that both the cooling area (odds ratio = 1.13 per 100 °C min; P < 0.001) and cooling speed (odds ratio = 3.69 per °C/min; P = 0.041) were independent risk factors for transient neurologic dysfunction. CONCLUSIONS: Both the cooling area, which indicates the degree of cooling, and cooling speed had significant relationships with transient neurologic dysfunction after total arch replacement. Together, these findings indicate that overcooling and rapid cooling may contribute to brain injury.

Unsuccessful Thrombin Injection for Right Femoral Artery Pseudoaneurysm: A Case Report.

Tomohiro Nakajima, Yu Iwashiro, Tsuyoshi Shibata, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 17 ( 3 ) e80640 2025.03 [International journal]

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.

Unraveling Novel Subsets of Lymphocytes Involved in Sac Expansion in the Tertiary Lymphoid Structure Within an Abdominal Aortic Aneurysm.

Itaru Hosaka, Ippei Ikegami, Takuma Mikami, Tatsuya Sato, Toshifumi Ogawa, Kei Mukawa, Marenao Tanaka, Keisuke Endo, Yukinori Akiyama, Akihito Ohkawa, Junji Nakazawa, Tsuyoshi Shibata, Tomohiro Nakajima, Yutaka Iba, Chikara Shiiku, Satoshi Sumino, Ryuji Koshima, Kenichi Takano, Shingo Ichimiya, Nobuyoshi Kawaharada, Masato Furuhashi

Journal of the American Heart Association 14 ( 6 ) e040279 2025.02 [International journal]

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.

The Degradation of Abdominal Aortic Prosthesis After 37 Years.

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Keishi Ogura, Nobuyoshi Kawaharada

Cureus 17 ( 1 ) e77408 2025.01 [International journal]

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.

Open Aortic Repair After Thoracic Endovascular Aortic Repair: Strategic Insights From a Single Centre Surgical Experience.

Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Tsuyoshi Shibata, Shuhei Miura, Nobuyoshi Kawaharada

EJVES vascular forum 63 32 - 40 2025 [International journal]

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.

Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm.

Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Kei Mukawa, Yu Iwashiro, Nobuyoshi Kawaharada

Journal of clinical medicine 14 ( 1 ) 2024.12 [International journal]

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.

Long-Term Outcomes and Late Complications of Thoracic Endovascular Aortic Repair Using the GORE TAG or Conformable GORE TAG.

Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Taku Sakurada, Satoshi Muraki, Toshiyuki Maeda, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Keitaro Nakanishi, Takakimi Mizuno, Kei Mukawa, Nobuyoshi Kawaharada

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 15266028241305960 - 15266028241305960 2024.12 [International journal]

PURPOSE: Previous clinical studies have reported on the short- and mid-term prognoses of thoracic endovascular aortic repair (TEVAR) using the GORE thoracic aortic graft (TAG) or conformable GORE TAG. We evaluated the long-term prognoses of patients who underwent TEVAR using the GORE TAG or conformable GORE TAG in a real-world setting. MATERIALS AND METHODS: This retrospective observational study analyzed the data of all consecutive patients aged 20 years or older who underwent TEVAR using either the GORE TAG or the conformable GORE TAG at a single center. The surgical criteria did not deviate from global standards. In principle, TEVAR was performed with the TAG or conformable thoracic aortic graft (CTAG) according to the manufacturer's instructions. The primary outcomes of this study were the 10-year overall survival rate and the rate of freedom from aorta-related deaths at 10 years. RESULTS: Between January 2011 and December 2021, 331 patients underwent TEVAR, of whom 175 consecutive patients treated with TEVAR using either the GORE TAG or the conformable GORE TAG were enrolled. The mean age of the patients was 72.1 ± 9.3 years. In addition, the aneurysm and chronic dissection were 61.7% and 38.3%, respectively. Of all patients, 157 had a proximal landing zone ≥3, and 18 had a zone <3. The mean follow-up time was 46.5 ± 33.1 months. The 30-day mortality rate was 2.86%. The 3-, 5-, 7-, and 10-year overall survival rates were 76.9 ± 3.4%, 63.4 ± 4.1%, 55.9 ± 4.9%, and 42.4 ± 8.4%, respectively. The rate of freedom from aorta-related deaths at 3, 5, 7, and 9 years was 97.4 ± 1.3%, 95.0 ± 2.1%, 95.0 ± 2.1%, and 95.0 ± 2.1%, respectively. Late complications occurred in 23 (13.1%) patients. Endovascular re-intervention was performed because of endoleak, false lumen enlargement, or stent graft-induced new entry tear in 14 patients. Three patients required open conversion, and 6 were observed without re-intervention. CONCLUSIONS: Thoracic endovascular aortic repair using the GORE TAG or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. CLINICAL IMPACT: Thoracic endovascular aortic repair using the GORE thoracic aortic graft (TAG) or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. The 30-day mortality rate was 2.86%. During 10 years of follow-up, the overall survival rate was low; however, the risk of aorta-related deaths was also low. No significant differences in freedom from late complications and re-intervention are seen between the TAG and conformable thoracic aortic graft (CTAG) groups. Further investigations into the treatment of late complications are required.

Clinical Frailty Scale Predicts Outcomes After Elective Thoracic Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study.

Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Keitaro Nakanishi, Takakimi Mizuno, Kei Mukawa, Nobuyoshi Kawaharada

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 15266028241302658 - 15266028241302658 2024.12 [International journal]

PURPOSE: The Clinical Frailty Scale (CFS), used to define frail patients, is significantly associated with clinical outcomes. The CFS can predict postoperative prognosis after cardiovascular procedures. However, no reports exist on the relationship between frailty defined by the CFS and thoracic endovascular aortic repair (TEVAR) outcomes. MATERIALS AND METHODS: We analyzed data obtained from patients who underwent TEVAR between January 2011 and December 2021. Frailty was assessed using the 9-point CFS and was defined as a score of ≥5 points. The primary outcome was the 5-year overall survival rate. The secondary outcomes included the rate of freedom from aneurysm-related death at 5 years, postoperative complications, length of stay, rate of nonhome discharge, need for mobility assistance, 30-day mortality rate, and re-intervention rate. RESULTS: Of 331 patients who underwent TEVAR, 186 were included. The mean age of frail (n=36) and nonfrail (n=150) patients was 73.2 ± 7.3 years and 70.9 ± 9.0 years, respectively (p=0.15). The length of stay (17 [9-39] vs 11 [10-16] days; p=0.09) and re-intervention rate (8.3% vs 13.3%; p=0.58) were not significantly different, although frail patients had a higher rate of nonhome discharge (33.3% vs 4.7%; p<0.001), need for mobility assistance (38.9% vs 6.0%; p<0.001), and 30-day mortality (11.1% vs 0.7%; p=0.005) than nonfrail patients. The 5-year overall survival rate after TEVAR was 6.2 ± 5.5 and 84.5 ± 3.4% in frail and nonfrail patients (p<0.001). The median survival time was 22 (6-40) and 136 (87-138&x41; months, the number of recorded deaths in 5 years was 28 (77.8%) and 18 (12.0%; p<0.001), and the rate of freedom from aneurysm-related death at 5 years was 80.7%±11.2% and 96.9%±1.5% (p=0.01) in frail and nonfrail patients, respectively. The mean follow-up time was 53.3 ± 2.7 months. Multivariate Cox regression indicated that the CFS (hazard ratio, 10.14; 95% confidence interval, 5.06-20.32) was significantly associated with overall survival. CONCLUSION: The CFS is a valuable prognosis predictor, and TEVAR for frail patients with a high surgical risk could not improve the overall survival. Thoracic endovascular aortic repair in frail patients should be approached cautiously. CLINICAL IMPACT: The Clinical Frailty Scale (CFS) could be a useful predictor of prognosis in patients undergoing thoracic endovascular aortic repair (TEVAR). A significant difference was observed between frail and nonfrail patients in the 5-year overall survival rate following TEVAR. Thoracic endovascular aortic repair for frail patients (CFS was ≥5 points) could not improve overall survival because their death was attributed to their comorbidities. Thus, TEVAR in frail patients should be approached cautiously.

A Case of Problem-Free Survival Five Years After Abdominal Aortic Sigmoid Colon Fistula Surgery.

Tomohiro Nakajima, Tsuyoshi Shibata, Shuhei Miura, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 16 ( 12 ) e75026 2024.12 [International journal]

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.

Aortic Unicuspid Valve Surgery in a Young Patient: A Case Report.

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Masayuki Akatsuka, Nobuyoshi Kawaharada

Cureus 16 ( 12 ) e75305 2024.12 [International journal]

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.

Luminal shape and aortic remodelling after total arch replacement for type A aortic dissection: conventional and frozen elephant trunks.

Hiroshi Sato, Yutaka Iba, Takuma Mikami, Shingo Tsushima, Hiroki Uchiyama, Itaru Hosaka, Kei Mukawa, Yu Iwashiro, Ayaka Arihara, Shuhei Miura, Tsuyoshi Shibata, Jyunji Nakazawa, Tomohiro Nakajima, Shigeki Komatsu, Nobuyoshi Kawaharada, Joji Fukada

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 66 ( 5 ) 2024.11 [International journal]

OBJECTIVES: This study was performed to assess postoperative aortic remodelling (AR) after total arch replacement for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen was analysed based on elliptical Fourier analysis and evaluated as a predictor of AR. METHODS: This study involved patients who underwent total arch replacement with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual true lumen at all four levels was analysed based on elliptical Fourier analysis to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting was performed for adjustment between the groups. RESULTS: In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The inverse probability of treatment weighting-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR. CONCLUSIONS: In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual true lumen can be an important reference for predicting postoperative AR.

Multicentre retrospective analysis of physician-modified fenestrated/inner-branched endovascular repair for complex aortic aneurysms.

Tsuyoshi Shibata, Yutaka Iba, Kiyomitsu Yasuhara, Noriaki Kuwada, Yoshiaki Katada, Hitoki Hashiguchi, Takeshi Uzuka, Itaru Hosaka, Tomohiro Nakajima, Nobuyoshi Kawaharada

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 66 ( 5 ) 2024.11 [International journal]

OBJECTIVES: In this multicentre retrospective observational study, we present the early outcomes of physician-modified fenestrated/inner-branched endovascular repair for pararenal and thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. METHODS: We comprehensively reviewed the clinical data and outcomes of consecutive patients treated with physician-modified fenestrated/inner-branched endovascular repair for pararenal or thoracoabdominal aortic aneurysms at 6 centres between December 2020 and December 2021. Primary end-points included technical success, in-hospital mortality rates, major adverse events. RESULTS: Seven and 31 patients (median age, 80.5 years) had pararenal and thoracoabdominal aortic aneurysms, respectively, involving 93 renal-mesenteric arteries incorporated through 10 fenestrations or 83 inner branches. Seven patients (18.4%) were treated non-elective conditions. The technical success rate was 89.5%. The median operative time was 334.5 min. Ten patients (26.3%) experienced major adverse events, including in-hospital mortality in 6 patients (15.8%), acute kidney injury in 3 patients (7.9%), respiratory failure in 3 patients (7.9%), bowel ischaemia in 1 patient (2.6%), stroke in 1 patient (2.6%) and paraplegia in 1 patient (2.6%). Among elective cases, in-hospital deaths occurred in 3 patients (9.7%), while in non-elective cases, the mortality rate was higher, with 3 patients (42.9%) succumbing. The median follow-up duration was 14 months. CONCLUSIONS: Physician-modified fenestrated/inner-branched endovascular repair is a viable treatment for pararenal or thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. It provides customization without location constraints or production delays, but further validation is needed to ensure long-term reliability.

A Case of Acute Aortic Dissection in an Older Patient of Advanced Age.

Tomohiro Nakajima, Kei Mukawa, Yutaka Iba, Tsuyoshi Shibata, Nobuyoshi Kawaharada

Cureus 16 ( 11 ) e74567 2024.11 [International journal]

The patient an 85-year-old female resided in a care facility where she maintained an independent daily activity level. She was discovered hunched over a table in her room, displaying reduced responsiveness and prompting an emergency call. Initially, her blood pressure was within 60 mmHg, and she was transported by ambulance to our hospital. Further examination revealed acute Stanford type A aortic dissection accompanied by signs of cardiac tamponade, necessitating urgent surgery. The operation was performed under general anesthesia and tracheal intubation. After exposing the femoral vessels through an incision in the right groin, cannulation was achieved for cardiopulmonary bypass. Subsequently, a median sternotomy was performed and the pericardium was opened. Blood within the pericardial cavity was carefully exposed and blood pressure was monitored. The pericardial cavity contained a large number of dark red hematomas. A left ventricular vent was inserted and cooling was initiated. The circulatory arrest was achieved at a rectal temperature of 28°C, accompanied by antegrade cerebral perfusion and selective antegrade myocardial protection to facilitate cardiac arrest. The entry tear was located on the dorsal aspect of the ascending aorta. Additionally, the ascending aorta was trimmed proximal to the brachiocephalic artery and a 26-mm Gelweave graft was anastomosed. Circulation was subsequently resumed, and rewarming commenced. The proximal dissection was extended to the non-coronary cusp, where BioGlue was applied to bond the intima and adventitia, followed by a partial adventitial inversion. The proximal anastomosis was then completed. The total operation duration was 366 min. The patient was extubated, and oral intake was initiated the following day. However, postoperative delirium persisted, and the patient developed a cerebral infarction triggered by paroxysmal atrial fibrillation. Her daily activities declined, and she experienced complications including pneumonia and urinary tract infection, which responded to antibiotic therapy. The patient was discharged on postoperative day 49.

Prevention of cardiac tamponade by left intercostal Pericardiotomy for massive recurrent pericardial effusion: a case report.

Tomohiro Nakajima, Kei Mukawa, Hidemichi Kouzu, Ayaka Kamada, Nobuyoshi Kawaharada

Oxford medical case reports 2024 ( 11 ) omae139 2024.11 [International journal]

This case involved an 89-year-old woman with a history of left nephrectomy for left renal cell carcinoma at the age of 87 years. She had been gradually accumulating pericardial effusion for the past 4 years. She presented with signs of tachycardia and hypotension suggestive of cardiac tamponade due to pericardial effusion, and pericardiocentesis was performed below the xiphoid process in the cardiology department. Serous fluid was aspirated, and malignancy was ruled out by various tests. The patient subsequently developed recurrent pericardial effusion and was admitted to the hospital. Cardiovascular surgery was performed for pericardial drainage. A left intercostal incision was made for pericardiotomy and drainage of the pericardial effusion, allowing it to accumulate in the left pleural cavity in case of future accumulation. Pathological examination of the pericardium revealed no specific findings, and no cancer cells were present in the pericardial fluid. Prednisolone therapy was initiated for idiopathic pericarditis.

Diaphragmatic Nerve Paralysis After Redo Aortic Valve Replacement That Improved Over Time and Led to Successful Ventilator Weaning: A Case Report.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Takeo Hasegawa, Nobuyoshi Kawaharada

Cureus 16 ( 11 ) e74783 2024.11 [International journal]

We report a 75-year-old female with a history of two heart operations: aortic valve replacement (St. Jude MedicalTM 21 mm) at the age of 44 years for severe rheumatic aortic stenosis and mitral valve replacement (CarbomedicsTM 29 mm) at the age of 51 years for rheumatic mitral regurgitation. Decades later, she presented with exertional dyspnea. Echocardiography revealed aortic stenosis with an effective orifice area of 0.79 cm². Coronary angiography showed #6 75% stenosis and a limited mechanical valve opening. After a thorough discussion, the patient agreed to undergo redo surgery. The surgery involved re-median sternotomy, left internal thoracic artery (LITA) harvesting, pannus removal, and replacement of the aortic valve with a 20 mm ATS advanced performance (AP) prosthesis (ATS Medical, Minneapolis, MN) in a supra-annular position. The LITA-left anterior descending (LAD) bypass was completed, and the patient was weaned from the cardiopulmonary bypass without complications. Postoperatively, the right phrenic nerve paralysis caused transient respiratory challenges requiring tracheotomy and prolonged ventilation. Rehabilitation improved diaphragmatic function and respiratory independence. At six months, the right phrenic nerve function had recovered, and the patient resumed walking independently with a cane. Two years postoperatively, the patient remained ambulatory and attended independent outpatient follow-ups. This report highlights the potential for gradual recovery from phrenic nerve paralysis following open heart surgery, emphasizing the importance of long-term multidisciplinary care.

A Case of Infective Endocarditis Following Bone Marrow Transplantation for Myelodysplastic Syndrome.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Yu Iwashiro, Nobuyoshi Kawaharada

Cureus 16 ( 11 ) e73564 2024.11 [International journal]

A 63-year-old man was diagnosed with myelodysplastic syndrome (MDS) at the age of 62 by the hematology department. The patient underwent four cycles of azacitidine (AZA) therapy, followed by successful bone marrow transplantation (BMT). Subsequently, he was hospitalized twice for graft-versus-host disease (GVHD). Prednisolone was initially administered at 60 mg and was gradually tapered to 10 mg/day. Additionally, the patient was prescribed 10 mg/day of a Janus kinase inhibitor. At age 63, approximately one month prior to admission, he began experiencing recurrent upper respiratory symptoms with fevers of around 37°C. He developed a persistent fever of 38°C, accompanied by dyspnea on exertion, and visited the hematology outpatient clinic. Chest radiography revealed prominent pulmonary congestion, leading to the decision to perform echocardiography, which revealed severe aortic valve regurgitation with vegetation attached to the valve. Laboratory findings included a white blood cell count of 13,200/μL and a C-reactive protein (CRP) level of 13.7 mg/dL. Blood cultures revealed the presence of gram-positive cocci. As the patient's respiratory condition progressively worsened, emergency aortic valve replacement was planned. Additionally, because of a history of percutaneous coronary intervention (PCI) at another institution, he was referred for a coronary artery bypass graft (CABG) on the right coronary artery to be performed concurrently. Surgery was performed via median sternotomy under cardioplegic arrest. The aortic valve was perforated at the right coronary cusp and was covered with vegetation. The patient underwent aortic valve replacement with a biological valve, and a saphenous vein graft was used for bypass grafting to the posterior descending branch of the right coronary artery. Postoperatively, antibiotic therapy was administered without infection recurrence. The patient was discharged 47 days postoperatively. This case demonstrated the rapid progression of infective endocarditis following BMT, highlighting the need for prompt recognition and management.

Patient-Related Progression of Steeper Sternal Wire Angles: A Case Report.

Tomohiro Nakajima, Tsuyoshi Shibata, Yu Iwashiro, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 16 ( 10 ) e71324 2024.10 [International journal]

A 78-year-old female presented with a history of left atrial myxoma resection 12 years before presentation. The initial surgery involved a median sternotomy and cardiopulmonary bypass for tumor excision. Sternal closure was achieved using six titanium wires, with the lowermost wire noted to be slightly elevated from the sternum immediately post-operation. The patient, an active individual who regularly practiced yoga, including frequent prone positions, was discharged from follow-up two years postoperatively without complications. However, 12 years after the initial surgery, the patient experienced pain at the lower end of the median sternotomy site, prompting her first visit to our outpatient clinic within a decade. Physical examination revealed palpable subcutaneous protrusion of the lowermost sternal wire with visible skin discoloration. Although no evidence indicated wire penetrating the skin, wire removal was deemed necessary. Comparison with previous lateral chest radiographs demonstrated a progressive increase in wire angulation over time. The patient was admitted and the protruding wire was removed under local anesthesia. Her postoperative course was uneventful, leading to discharge on the sixth day after the procedure.

脈管分野において人工知能が果たす役割 Graph based clusteringを用いた腹部大動脈瘤拡大因子としての濾胞関連新規リンパ球サブセットの同定と機能的意義の解明

保坂到, 池上一平, 三上拓真, 佐藤達也, 小川俊文, 田中希尚, 遠藤圭佑, 秋山幸功, 大川陽史, 仲澤順二, 柴田豪, 中島智博, 伊庭裕, 高野賢一, 一宮慎吾, 川原田修義, 古橋眞人

脈管学 ( (一社)日本脈管学会 ) 64 ( Suppl. ) S114 - S114 2024.10

腹部大動脈瘤拡大因子としての瘤壁三次リンパ組織形成および濾胞関連新規リンパ球サブセットの解明

保坂到, 池上一平, 三上拓真, 佐藤達也, 小川俊文, 武川慶, 田中希尚, 遠藤圭佑, 秋山幸功, 大川陽史, 仲澤順二, 柴田豪, 中島智博, 伊庭裕, 高野賢一, 一宮慎吾, 川原田修義, 古橋眞人

脈管学 ( (一社)日本脈管学会 ) 64 ( Suppl. ) S149 - S150 2024.10

Infected Abdominal Aortic Aneurysm Successfully Treated With Endovascular Aortic Repair and Antibiotics: A Case Report.

Tomohiro Nakajima, Tsuyoshi Shibata, Naomi Yasuda, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 16 ( 8 ) e68287 2024.08 [International journal]

Surgical treatment of infected aneurysms is problematic due to their high complication and mortality rates. Infected aortic aneurysms are at high risk of rupture and should be operated on as soon as possible after diagnosis. A 72-year-old female patient with a medical history of diabetes mellitus, hyperlipidemia, and hypertension presented with a fever of 38°C and back pain, without any apparent cause, in 2021. Her C-reactive protein (CRP) level increased to 20 mg/dL. Further evaluation with contrast-enhanced computed tomography (CT) revealed a low-density area with air pockets surrounding the abdominal aorta. The patient was diagnosed with native abdominal aortic infection and transferred to our hospital for treatment. The next day, endovascular aortic repair (EVAR) was performed using an Endurant stent graft (161682). Postoperatively, the patient was treated with antibiotics, and subsequently, blood infection was alleviated. Moreover, the CRP levels normalized. Follow-up contrast-enhanced CT showed resolution of the air pockets surrounding the abdominal aorta. The patient was discharged home on postoperative day 33. During her three-year follow-up as an outpatient, no recurrence of the infection was detected. While open surgical repair with prosthetic graft replacement is often the preferred treatment for infected abdominal aortic aneurysms, in select cases, as demonstrated by our patient, EVAR can be employed to prevent rupture, followed by antibiotic therapy to achieve infection control.

Long-term outcomes of primary surgical repair for communicating DeBakey IIIb chronic dissecting aortic aneurysm.

Shuhei Miura, Yutaka Iba, Kei Mukawa, Keitaro Nakanishi, Takakimi Mizuno, Ayaka Arihara, Tsuyoshi Shibata, Junji Nakazawa, Tomohiro Nakajima, Nobuyoshi Kawaharada

JTCVS open 20 1 - 13 2024.08 [International journal]

OBJECTIVE: This study aimed to evaluate the long-term outcomes of surgical strategies for communicating DeBakey IIIb chronic dissecting aortic aneurysm, considering the optimal primary surgical repair to prevent aortic events. METHODS: From 2002 to 2021, 101 patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm who underwent surgical repair were categorized based on the primary surgical repair: 1-stage repair of thoracoabdominal aortic aneurysm (TAAAR) (n = 22) or staged repair, such as descending thoracic aneurysm repair (DTAR) (n = 43) or total arch replacement with elephant trunk implantation (TARET) (n = 25), and thoracic endovascular aortic repair (TEVAR) (n = 11). Early and late postoperative outcomes were compared among the groups. RESULTS: Early outcomes for TAAAR, DTAR, TARET, and TEVAR were associated with the incidence of stroke (9.1% vs 0% vs 4.0% vs 9.1%, respectively), spinal cord injury (13.6% vs 4.7% vs 8.0% vs 0%, respectively), and in-hospital mortality (9.1% vs 2.3% vs 0% vs 9.1%, respectively). During follow-up, the 10-year overall survival and 7-year aortic event-free rates for TAAAR, DTAR, TARET, and TEVAR were 61.8%, 71.6%, 21.5%, and 26.5% and 93.8%, 84.3%, 74.4%, and 51.4%, respectively. TAAAR had significantly higher overall survival (P = .05) and aortic event-free rates (P = .03) than TEVAR. TARET (hazard ratio, 2.27; P < .01) and TEVAR (hazard ratio, 3.40; P < .01) were independently associated with the incidence of aortic events during follow-up. CONCLUSIONS: Considering the optimal primary surgical repair based on long-term outcomes, TEVAR was not a durable treatment option. Patient-specific TAAAR or DTAR should be considered rather than defaulting to minimally invasive primary repairs for all patients with communicating DeBakey IIIb chronic dissecting aortic aneurysm.

Multivariate analysis of the factors affecting medical students' decision to join the cardiovascular surgery department.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Shingo Tsushima, Ayaka Arihara, Itaru Hosaka, Akihito Ohkawa, Jyunji Nakazawa, Nobuyoshi Kawaharada

General thoracic and cardiovascular surgery 72 ( 8 ) 501 - 504 2024.08 [Domestic journal]

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.

Treatment Strategies for Acute Aortic Dissection With Malperfusion: A Retrospective Study.

Tomohiro Nakajima, Tsuyoshi Shibata, Kei Mukawa, Shuhei Miura, Ayaka Arihara, Takakimi Mizuno, Keitaro Nakanishi, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 16 ( 7 ) e65822 2024.07 [International journal]

BACKGROUND: Aortic dissection with malperfusion necessitates emergency surgery and is associated with poor outcomes. Therefore, in this study, we analyzed patients' treatment courses from the initial management to hospital discharge in cases of acute aortic dissection (AAD) with malperfusion and investigated the risk factors associated with mortality. METHODS: We evaluated cases of AAD with malperfusion treated at our institution over a 16-year period from 2007 to 2022. The primary endpoint was in-hospital mortality. The study's primary outcome measure was mortality during hospitalization. We collected and analyzed data encompassing preoperative patient characteristics, Stanford classification, sites of preoperative malperfusion, surgical techniques employed, and postoperative complications. These variables were examined to identify factors associated with in-hospital mortality. RESULTS: During the study period, 366 patients were admitted with AAD, 102 of whom had malperfusion. There were 62 men (61%) and 40 women (39%), with a mean age of 64 ± 13 years (range: 28-87 years). According to the Stanford classification, 75 (74%) and 27 (26%) patients had type A and B aortic dissection, respectively, and 29 patients (28%) presented with shock. Preoperative malperfusion sites included the brain, coronary arteries, abdominal viscera, limbs, and spinal cord in 40 (39%), 10 (10%), 34 (33%), 52 (51%), and six (6%) patients, respectively. Eleven (11%) patients required immediate intervention in the emergency department. The treatments administered to the patients were as follows: ascending aortic replacement, 30 (29%) patients; aortic arch replacement, 34 (33%) patients; root replacement, three (3%) patients; thoracic endovascular aortic repair (TEVAR), 12 (12%) patients; non-anatomic bypass, five (5%) patients; and conservative management, five (5%) patients. In-hospital mortality occurred in 23 (23%) patients. Multivariate logistic regression analysis identified preoperative coronary malperfusion as an independent risk factor of mortality. CONCLUSION: Preoperative coronary malperfusion is an independent risk factor for in-hospital mortality in patients with AAD presenting with malperfusion.

A Case Report on the Utilization of a Hemostasis Analyzer System in the Management of a Patient With Essential Thrombocythemia.

Tomohiro Nakajima, Kei Mukawa, Yutaka Iba, Yu Iwashiro, Nobuyoshi Kawaharada

Cureus 16 ( 7 ) e63787 2024.07 [International journal]

Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by persistent elevation of platelet count due to abnormal proliferation of megakaryocytes. While some cases may be asymptomatic, the condition is associated with an increased risk of complications such as thrombosis and bleeding tendencies, necessitating appropriate management tailored to individual cases. Hemostasis analyzer systems are automated analytical devices designed for comprehensive evaluation of blood coagulation function. These systems enable rapid and accurate measurement of multiple parameters, including coagulation time, platelet function, and fibrin formation, thus facilitating a holistic assessment of hemostatic function. A 76-year-old male patient presented to our hospital. At the age of 65, he received treatment for promyelocytic leukemia and achieved remission. At 75 years, he developed leukocytosis, thrombocytosis, and progressive anemia. A comprehensive examination, including bone marrow biopsy and genetic testing, revealed a JAK2 mutation, leading to the diagnosis of ET. At the age of 76 years, he complained of chest discomfort during exertion. Further investigation revealed severe aortic valve stenosis and two-vessel coronary artery disease. The patient underwent aortic valve replacement and three-vessel coronary artery bypass grafting. A hemostasis analyzer system was used to monitor coagulation function throughout the procedure. Compared with the normal range, his coagulation profile showed a tendency toward hypercoagulability. Intraoperative and postoperative transfusions were performed as required. The patient's postoperative course was uneventful without any complications related to bleeding or thrombosis.

Transprosthetic cuff leakage of a bovine pericardial aortic bioprosthesis in a redo case.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Shingo Tsushima, Nobuyoshi Kawaharada

Indian journal of thoracic and cardiovascular surgery 40 ( 4 ) 476 - 478 2024.07 [International journal]

A 79-year-old man underwent bioprosthetic valve replacement for aortic regurgitation 10 years previously (Carpentier-Edwards PERIMOUNT Magna Ease, 21 mm; Edwards Lifesciences, Irvine, CA, USA). The indexed effective orifice area decreased to 0.422 cm2/m2, and heart failure symptoms appeared. The patient underwent aortic valve replacement through a redo median sternotomy. A perivalvular leak was observed on transesophageal echocardiography at the time of weaning from cardiopulmonary bypass. The patient was judged to have a leak characteristic of bioprosthetic valves and was monitored closely. Postoperative echocardiography showed that the perivalvular leak had decreased to a trivial level, indicating that the intraoperative decision had been correct. We report this case because such intraoperative judgments are difficult to make.

A screw-type pacemaker lead implanted in the right atrium perforated the ascending aorta.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Ayumu Osamura, Naoyuki Kamiyama, Ryo Nishikawa, Junji Nakazawa, Nobuyoshi Kawaharada

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology 76 ( 1 ) 63 - 63 2024.05 [International journal]

BACKGROUND: Perforation by pacemaker leads, although rare, is a complication reported since the introduction of pacemaker therapy. Although historically reported frequencies were as high as 5%, recent reports have cited frequencies ranging from 1 to 2%. We report a case where a screw-type atrial lead slightly penetrated the right atrial wall, causing chronic abrasion of the ascending aorta, resulting in shock. CASE PRESENTATION: A 54-year-old male presented with dilated cardiomyopathy diagnosed at 40 years of age when he developed decompensated heart failure. Despite ongoing treatment, his heart failure worsened, leading to hospitalization at the age of 54. During his hospital stay, he experienced cardiac arrest that required cardiopulmonary resuscitation, followed by a return of spontaneous circulation. He was subsequently transferred to our institution after initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). Echocardiography revealed an ejection fraction of 25%, left ventricular end-diastolic diameter of 60 mm, and severe mitral regurgitation (MR). Transcatheter mitral valve repair was performed to treat severe MR, followed by implantation of a cardiac resynchronization therapy defibrillator (CRT-D). Three months later, the patient was brought to our emergency department by ambulance because of hypotension. Contrast-enhanced computed tomography revealed pericardial effusion causing cardiac tamponade, necessitating emergency pericardial decompression via left fourth intercostal mini-thoracotomy and drain placement. Upon transfer to the intensive care unit, 1200 mL of blood was drained from the chest tube, prompting a return to the operating room for a median sternotomy. It was discovered that the pacemaker lead on the left side of the right atrium had slowly eroded into the aorta, leading to perforation. The ascending aorta was repaired and hemostasis was achieved; the patient recovered uneventfully and was discharged on postoperative day 18. CONCLUSIONS: The pacemaker lead perforated the right atrium; chronic abrasion of the lead against the ascending aorta resulted in bleeding from the ascending aorta 3 months later.

A Suspected Case of Adhesion to the Iliac Vein During the Left Femoral Arthroplasty.

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Ima Kosukegawa, Nobuyoshi Kawaharada

Cureus 16 ( 5 ) e60589 2024.05 [International journal]

An 85-year-old man underwent hemiarthroplasty for a left intertrochanteric femoral fracture at another hospital two years prior. While under outpatient monitoring, the left femur displacement occurred. Therefore, total hip arthroplasty of the left hip was scheduled. However, during acetabular cup insertion damage to the inner plate led to a sudden decrease in blood pressure from 120 to 60 mmHg. The physicians suspected a pelvic vascular injury and promptly stopped the procedure. In case of adhesion between the acetabular cup and the left iliac vein, intraoperative vascular damage would be repaired via endovascular intervention. Subsequently, orthopedic surgery was cautiously performed, taking into account the potential of a vascular injury. The surgery proceeded as planned without vascular intervention. This case involved a patient with suspected injury to the iliac vein and artery during acetabular cup placement. Following comprehensive enhanced CT and angiography tests, orthopedic surgery was performed in preparation for potential vascular damage, demonstrating the multidisciplinary approach to managing such cases.

A Case of Cerebral Arteriovenous Malformation and Malformation of the Lower Limbs.

Tomohiro Nakajima, Tsuyoshi Shibata, Yutaka Iba, Keitaro Nakanishi, Nobuyoshi Kawaharada

Cureus 16 ( 4 ) e58336 2024.04 [International journal]

The case involves a 37-year-old female who was diagnosed with undifferentiated immunodeficiency and protein-losing gastroenteropathy at the age of 26 and was under outpatient care in the gastroenterology department while taking Prednisolone 15mg. At the age of 37, she experienced loss of consciousness and was diagnosed with a right occipital lobe arteriovenous malformation upon investigation. Although initially managed conservatively, she presented the following month with a right-sided headache and vomiting and was urgently transported to our hospital. Imaging with contrast-enhanced CT revealed bleeding from the arteriovenous malformation. Emergency craniotomy was performed, followed by ventricular drainage. Two weeks later, she underwent transcatheter arterial embolization of the main feeder via the right femoral artery approach, followed by excision of the arteriovenous malformation the next day. Subsequently, she had an uneventful recovery. A confirmation CT angiography before discharge revealed severe stenosis of the right common femoral artery, leading to a referral to the cardiovascular surgery department. The stenosis was attributed to the Pro-Glide used for hemostasis during the embolization procedure. Repair surgery was performed, during which CT angiography revealed arteriovenous malformations in both the popliteal fossae and the foot.

Rare coronary artery anomaly: left anterior descending artery origin form right coronary cusp.

Tomohiro Nakajima, Keitaro Nakanishi, Tsuyoshi Shibata, Keishi Ogura, Nobuyoshi Kawaharada

Oxford medical case reports 2024 ( 3 ) omae015 2024.03 [International journal]

Huge, Infected Pancreatic Necrosis After Total Arch Replacement in a Patient With Immunoglobulin G4-Related Syndrome.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Ayaka Arihara, Nobuyoshi Kawaharada

Cureus 16 ( 3 ) e56805 2024.03 [International journal]

Mitral valve repair for infective endocarditis after esophageal reconstruction: a case report.

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

Surgical case reports 10 ( 1 ) 37 - 37 2024.02 [Domestic journal]

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.

Identification of a Dissection Site in the Internal Thoracic Artery Using Fluorescence Imaging: A Case Report.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Akihito Ohkawa, Nobuyoshi Kawaharada

Cureus 16 ( 2 ) e55199 2024.02 [International journal]

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.

SFA領域のEVTにおけるDevice選択再狭窄形態からDESをどう選ぶべきか REALDES study preliminary dateより

柴田豪, 伊庭裕, 新垣正美, 中西敬太郎, 山下修, 椿本恵則, 木村文昭, 畑田充俊, 笠島史成, 植野恭平, 中島智博, 仲澤順二, 三浦修平, 在原綾香, 川原田修義

日本血管外科学会雑誌 ( (NPO)日本血管外科学会 ) 33 ( Suppl. ) PD2 - 3 2024

Diaphragmatic paralysis following open-heart surgery in an adult.

Masayuki Akatsuka, Tomohiro Nakajima, Saori Miyagishima, Yutaka Iba, Yoshiki Masuda

Oxford medical case reports 2023 ( 12 ) omad140 2023.12 [Refereed] [International journal]

Coronary Artery Bypass Grafting Using the No-Touch Great Saphenous Vein Graft Harvesting Technique: A Retrospective Study.

Tomohiro Nakajima, Tsuyoshi Shibata, Shuhei Miura, Kei Mukawa, Takakimi Mizuno, Keitaro Nakanishi, Ayaka Arihara, Junji Nakazawa, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 15 ( 12 ) e50777 2023.12 [International journal]

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.

A Case of Massive Retroperitoneal Hematoma After High-Energy Trauma.

Tomohiro Nakajima, Keitaro Nakanishi, Keisuke Harada, Eichi Narimatsu, Nobuyoshi Kawaharada

Cureus 15 ( 12 ) e51080 2023.12 [International journal]

A 66-year-old female suffered from high-energy trauma due to a traffic accident, resulting in injuries to the iliac artery and the superior mesenteric artery. She underwent endovascular embolization for vascular occlusion and an open surgical procedure to control bleeding from the superior mesenteric artery. A substantial retroperitoneal hematoma was observed on the right side, making primary closure challenging. A hematoma evacuation procedure was performed using a right retroperitoneal approach, successfully relieving the compression from the posterior aspect.

Pathological Characteristics of the Vascular Septum in Chronic Aortic Dissection: A Case Report.

Tomohiro Nakajima, Ayaka Arihara, Kei Mukawa, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 15 ( 11 ) e48910 2023.11 [International journal]

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.

Mitral Valve Infective Endocarditis Associated With Prednisolone-Induced Immunosuppression: A Case Report.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Akihito Ohkawa, Nobuyoshi Kawaharada

Cureus 15 ( 11 ) e48474 2023.11 [International journal]

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.

Partial arch replacement of type A aortic dissection after thoracic endovascular aortic repair for type B dissection.

Tomohiro Nakajima, Yutaka Iba, Keishi Ogura, Nobuyoshi Kawaharada

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology 75 ( 1 ) 81 - 81 2023.10 [International journal]

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.

A case of multiple median sternotomy for infection and expanding hematoma in 10 years.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Nobuyoshi Kawaharada

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology 75 ( 1 ) 80 - 80 2023.10 [International journal]

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.

The impact of postoperative cerebrospinal fluid drainage on neurological improvement following thoracic aortic and thoracoabdominal aortic surgery.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Shingo Tsushima, Ayaka Arihara, Itaru Hosaka, Akihito Okawa, Junji Nakazawa, Nobuyoshi Kawaharada

Journal of thoracic disease 15 ( 9 ) 4787 - 4794 2023.09 [International journal]

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.

A Case of Takotsubo Cardiomyopathy After Mitral Valvuloplasty.

Tomohiro Nakajima, Yutaka Iba, Tsuyoshi Shibata, Nobuyoshi Kawaharada

Cureus 15 ( 8 ) e43175 2023.08 [International journal]

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.

Outcomes of Vascular Surgery Performed Jointly With Other Departments.

Tomohiro Nakajima, Tsuyoshi Shibata, Kei Mukawa, Keitaro Nakanishi, Takakimi Mizuno, Ayaka Arihara, Shuhei Miura, Junji Nakazawa, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 15 ( 8 ) e43833 2023.08 [International journal]

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.

A Case of a Giant Hemangioma of a Primary Cardiac Tumor.

Tomohiro Nakajima, Tsuyoshi Shibata, Keishi Ogura, Yutaka Iba, Nobuyoshi Kawaharada

Cureus 15 ( 8 ) e43818 2023.08 [International journal]

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.

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 2023.07 [International journal]

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 32 ( 2 ) 15266028231179861 - 15266028231179861 2023.06 [International journal]

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.

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 32 ( 1 ) 15266028231169183 - 15266028231169183 2023.04 [International journal]

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.

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 ) 2023.01 [International journal]

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.

REALDES studyZilver PTXとEluviaの実臨床における多施設前向き研究の一年次結果

柴田豪, 伊庭裕, 新垣正美, 中西敬太郎, 山下修, 椿本恵則, 木村文昭, 畑田充俊, 笠島史成, 植野恭平, 中島智博, 仲澤順二, 大川陽史, 保坂到, 川原田修義

日本血管外科学会雑誌 ( (NPO)日本血管外科学会 ) 32 ( Suppl. ) EA - 4 2023

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 2022.09 [International journal]

Improvement of predicted hematocrit values after the initiation of cardiopulmonary bypass in cardiovascular surgery.

Takeo Hasegawa, Yutaka Iba, Shuichi Naraoka, Tomohiro Nakajima, Syuichi Hashimoto, Takao Murohashi, Riko Umeta, Itaru Hosaka, Akihito Ohkawa, Naomi Yasuda, Tsuyoshi Shibata, Nobuyoshi Kawaharada

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 25 ( 2 ) 117 - 124 2022.06 [Domestic journal]

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.

Scattered Media Elastic Fibers from the Aortic Root to the Ascending Aorta in a 30-Year-Old Marfan Syndrome Patient.

Tomohiro Nakajima, Yutaka Iba, Syuichi Naraoka, Tsuyoshi Shibata, Shintaro Sugita, Nobuyoshi Kawaharada

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 30 ( 1 ) 2022.05 [Domestic journal]

腹部大動脈瘤治療をマスターする:Short neckに対する治療戦略 Short neckに対するphysician modified inner branchの有用性

柴田豪, 梅田璃子, 保坂到, 大川陽史, 安田尚美, 中島智博, 伊庭裕, 川原田修義

日本心臓血管外科学会学術総会抄録集 ( (NPO)日本心臓血管外科学会 ) 52回 PD9 - 5 2022.03

A case of a giant pulmonary artery aneurysm due to an atrial septal defect with left main coronary artery occlusion.

Takuma Mikami, Syuichi Naraoka, Akiyoshi Hashimoto, Hirosato Doi, Keitaro Nakanishi, Tsuyoshi Shibata, Tomohiro Nakajima, Ryo Harada, Takeshi Kamada, Nobuyoshi Kawaharada

General thoracic and cardiovascular surgery 69 ( 9 ) 1338 - 1343 2021.09 [Domestic journal]

Cases of coronary artery occlusion due to the exclusion of pulmonary artery aneurysm are extremely rare, and there are few reports of surgical treatment. A 60-year-old woman with pulmonary hypertension due to an atrial septal defect and obstruction of the left main coronary trunk due to the exclusion of a giant pulmonary artery aneurysm underwent surgery. The surgery included atrial septal defect closure, tricuspid annulus plasty, pulmonary artery aneurysmorrhaphy, and coronary artery bypass grafting. One and a half years after the surgery, no re-expansion of the pulmonary artery was observed, and the symptoms of heart failure had improved. There are no reports of improvement in pulmonary valve regurgitation by aneurysmorrhaphy in pulmonary artery aneurysm. Surgery for pulmonary artery aneurysm with the exclusion of other organs was effective, and aneurysmorrhaphy for pulmonary artery aneurysm was acceptable.

Descending thoracic aorta-abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report.

Takuma Mikami, Takeshi Kamada, Toshiyuki Yano, Tomohiro Nakajima, Naomi Yasuda, Tsuyoshi Shibata, Keitaro Nakanishi, Ryo Harada, Syuichi Naraoka, Kojiro Toda, Nobutaka Nagano, Atsuko Muranaka, Nobuyoshi Kawaharada

Journal of cardiothoracic surgery 16 ( 1 ) 219 - 219 2021.08 [International journal]

BACKGROUND: There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta. CASE PRESENTATION: A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu's arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%. CONCLUSION: In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.

Acute kidney injury post-heart transplant: An analysis of peri-operative risk factors.

Brandon M Jocher, Joel D Schilling, Irene Fischer, Tomohiro Nakajima, Fei Wan, Yuki Tanaka, Gregory A Ewald, Kunal Kutkar, Muhammad Masood, Akinobu Itoh

Clinical transplantation 35 ( 6 ) e14296 2021.06 [International journal]

Acute kidney injury is a common complication following heart transplantation, and the factors contributing to acute kidney injury are not well understood. We conducted a retrospective cohort study evaluating patients who underwent heart transplantation between 2009 and 2016 at a single institution. The primary endpoint was incidence of acute kidney injury as defined by Kidney Disease Improving Global Outcomes criteria. Secondary endpoints included 30-day hospital readmission, 30-day mortality, and 1-year mortality. A total of 228 heart transplant patients were included in the study for analysis. In total, 145 (64%) developed acute kidney injury, where 43 (30%) were classified as stage I, 28 (19%) as stage II, and 74 (51%) as stage III. Risk factors found to be associated with the presence of acute kidney injury included increased use of vasopressors and inotropes post-transplant. Protective factors included cardiopulmonary bypass time <170 min. Acute kidney injury was found to be associated with increased 30-day and 1-year mortality.

Extracorporeal Life Support for Cardiogenic Shock With Either a Percutaneous Ventricular Assist Device or an Intra-Aortic Balloon Pump.

Tomohiro Nakajima, Yuki Tanaka, Irene Fischer, Kunal Kotkar, Ralph J Damiano Jr, Marc R Moon, Muhammad F Masood, Akinobu Itoh

ASAIO journal (American Society for Artificial Internal Organs : 1992) 67 ( 1 ) 25 - 31 2021.01 [International journal]

Extracorporeal life support (ECLS) can result in complications due to increased left ventricular (LV) afterload. The percutaneous ventricular assist device (PVAD) and intra-aortic balloon pump (IABP) are both considered to be effective means of LV unloading. This study describes the efficacy of LV unloading and related outcomes with PVAD or IABP during ECLS. From January 2010 to April 2018, all cardiogenic shock patients who underwent ECLS plus simultaneous PVAD or IABP were analyzed. Forty-nine patients received ECLS + PVAD, while 91 received ECLS + IABP. At 48 hours, mean pulmonary artery pressure was significantly reduced in both groups [34 mm Hg to 22, p < 0.01; 32 mm Hg to 21, p < 0.01; ECLS + PVAD and ECLS + IABP group, respectively]. The two groups had similar 30 day survival rates [19 patients (39%) vs. 35 (39%), p = 0.56]. The ECLS + PVAD group had higher incidences of bleeding at the insertion site [11 (22%) vs. 0, p < 0.01] and major hemolysis [9 (18%) vs. 0, p < 0.01]. Both groups had improvement in LV end-diastolic dimension (61 ± 12 mm to 54 ± 12, p = 0.03; 60 ± 12 mm to 47 ± 10, p < 0.01), and LV ejection fraction (16 ± 7% to 22 ± 10, p < 0.01; 22 ± 12% to 29 ± 15, p = 0.01). Both ECLS + PVAD and ECLS + IABP effectively reduced pulmonary artery pressure and improved LV function. Bleeding at the PVAD or IABP insertion site occurred more frequently in the ECLS + PVAD group than the ECLS + IABP group (p < 0.01). Nine patients (18%) in the ECLS + PVAD group experienced major hemolysis, while there was no hemolysis in the ECLS + IABP group (p < 0.01). Careful considerations are required before selecting an additional support to ECLS.

The impact of uncorrected mild aortic insufficiency at the time of left ventricular assist device implantation.

Yuki Tanaka, Tomohiro Nakajima, Irene Fischer, Fei Wan, Kunal Kotkar, Marc R Moon, Ralph J Damiano Jr, Muhammad F Masood, Akinobu Itoh

The Journal of thoracic and cardiovascular surgery 160 ( 6 ) 1490 - 1500 2020.12 [International journal]

OBJECTIVE: The study objective was to investigate the progression of uncorrected mild aortic insufficiency and its impact on survival and functional status after left ventricular assist device implantation. METHODS: We retrospectively reviewed 694 consecutive patients who underwent implantation of a continuous-flow left ventricular assist device between January 2006 and March 2018. Pre-left ventricular assist device transthoracic echocardiography identified 111 patients with mild aortic insufficiency and 493 patients with trace or no aortic insufficiency. To adjust for differences in preoperative factors, propensity score matching was used, resulting in 101 matched patients in each of the mild aortic insufficiency and no aortic insufficiency groups. RESULTS: Although both groups showed similar survival (P = .58), the mild aortic insufficiency group experienced higher incidence of readmission caused by heart failure (hazard ratio, 2.62; 95% confidence interval, 1.42-4.69; P < .01). By using the mixed effect model, pre-left ventricular assist device mild aortic insufficiency was a significant risk factor for both moderate or greater aortic insufficiency and worsening New York Heart Association functional status (P < .01). CONCLUSIONS: Patients with uncorrected mild aortic insufficiency had a higher risk of progression to moderate or greater aortic insufficiency after left ventricular assist device implantation with worse functional status and higher incidence of readmission caused by heart failure compared with patients without aortic insufficiency. Further investigations into the safety and efficacy of concomitant aortic valve procedures for mild aortic insufficiency at the time of left ventricular assist device implant are warranted to improve patients' quality of life, considering the longer left ventricular assist device use as destination therapy and bridge to transplant with the new US heart allocation system.

Surgery of giant right coronary artery aneurysm complicated with coronary artery fistula to left ventricle.

Takeshi Uzuka, Masanori Nakamura, Tomohiro Nakajima, Noriyasu Watanabe, Yuichiro Fukazawa

Journal of cardiac surgery 33 ( 2 ) 95 - 96 2018.02 [International journal]

Absent left circumflex artery detected by computed tomography-angiography.

Ryo Harada, Tomohiro Nakajima, Nobuyoshi Kawaharda

Asian cardiovascular & thoracic annals 25 ( 5 ) 401 - 401 2017.06 [International journal]

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

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

The Journal of thoracic and cardiovascular surgery 151 ( 6 ) 1704 - 8 2016.06 [International journal]

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

Idiopathic bronchial hemorrhage: a rare but catastrophic complication in cardiac surgery.

Takeshi Uzuka, Masanori Nakamura, Tomohiro Nakajima, Shinichi Kusudoh, Hiroaki Usubuchi, Akihiko Tanaka, Noriyasu Watanabe

Journal of cardiothoracic surgery 11 ( 1 ) 78 - 78 2016.05 [International journal]

BACKGROUND: Hemoptysis is a common complication in all kinds of surgery. However, it is rarely critical because it resolves with or without intervention. CASE PRESENTATION: Here the authors present what is believed to be an unprecedented report of a case involving a fatal idiopathic bronchial hemorrhage complication during cardiac surgery. Eighty-five-year-old female with severe aorticvalve stenosis had elective aortic valve replacement. Subsequently, she developed diffuse bilateral severe idiopathic bronchial hemorrhage which required maximum intervention such as external bronchial ligation, V-A ECMO, coil embolization of bronchial artery and internal airway blockage by spigot. CONCLUSIONS: Airway bleeding is not a rare complication in cardiac surgery, but this case should increase awareness of this potentially life threatening perioperative complication.

Acute dilatation of the ascending aorta and aortic valve regurgitation in Loeys-Dietz syndrome.

Tomohiro Nakajima, Kazutoshi Tachibana, Yasuko Miyaki, Nobuyuki Takagi, Takayuki Morisaki, Tetsuya Higami

The Annals of thoracic surgery 97 ( 6 ) 2188 - 90 2014.06 [International journal]

Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder caused by mutations of the transforming growth factor (TGF)-β receptors. It is an autosomal dominant syndrome characterized by the triad of arterial tortuosity and aneurysms, hypertelorism, and bifid uvula or cleft palate. We treated an 18-year-old woman with a 100-mm-diameter aortic root aneurysm and severe aortic valve regurgitation. She underwent urgent aortic root replacement and bioprosthetic valve implantation. LDS was diagnosed by postoperative genetic screening results. Histopathologic examination of the aortic wall showed diffuse degeneration and elastin fragmentation in the media.

[Henoch-Schönlein Purpura with lung abscess].

Junji Nakazawa, Atsushi Watanabe, Tomohiro Nakajima, Taijiro Mishina, Masahiro Miyajima, Tetsuya Higami

Kyobu geka. The Japanese journal of thoracic surgery 66 ( 10 ) 886 - 9 2013.09 [Domestic journal]

A 72-year-old man had underwent left lower lobectomy for squamous cell carcinoma in our hospital in 2008. Postoperative stage was I A (T1N0M0). In 2010, follow-up chest computed tomography (CT) images showed similar cavitary nodules in segments 2 and 8 of the right lung with positive uptake on fluorodeoxyglucose-positron emission tomography (FDG-PET) images. Physical examination, blood tests, and levels of serum tumor markers showed no abnormality. Transbronchial lung biopsy revealed the absence of malignant cells. Segment 8 of the right lower lobe with the nodule was partially resected, and pathological examination demonstrated lung abscess. He was discharged but was hospitalized in another hospital for purpuric rash, fever, and arthralgia. Microscopic albuminuria was noted, and renal biopsy revealed nephritis with immunoglobulin A( IgA)deposition. He was made a diagnosis of Henoch-Schönlein purpura. Oral steroid therapy( prednisolone 60 mg/d) was initiated, resulting in the improvement of symptoms and disapearance of the cavitary nodule in the right lung segment 2.

[Aortic valve surgery in a patient with cold agglutinin disease; effectiveness of continuous retrograde cardioplegia].

Yasuko Miyaki, Nobuyuki Takagi, Takeo Hasegawa, Naomi Yasuda, Tomohiro Nakajima, Kazutoshi Tachibana, Tetsuya Higami

Kyobu geka. The Japanese journal of thoracic surgery 66 ( 3 ) 187 - 9 2013.03 [Domestic journal]

A 76-year-old female was hospitalized because of congestive heart failure and anemia. A thorough examination led to a diagnosis of severe aortic stenosis and cold agglutinin disease. The critical temperature for hemagglutination was 27 °C, which caused particular problems with regard to the myocardial protection temperature during surgery. Aortic valve replacement was performed safely by increasing the normal myocardial protection temperature from 15 °C to 32 °C and using 3 times the normal volume of cardioplagic fluid. As a result of strict perioperative thermal management, the operation was completed without any complications.

Transmanubrial approach with video-assisted thoracoscopic surgery for left superior sulcus tumour with dense adhesion after replacement of descending thoracic aorta.

Tomohiro Nakajima, Atsushi Watanabe, Jyunji Nakazawa, Tetsuya Higami

Interactive cardiovascular and thoracic surgery 14 ( 6 ) 906 - 8 2012.06 [International journal]

There are various surgical approaches to superior sulcus tumours according to the location of the tumour. The chief difficulties in the operation are broadening of the operative field and adhesiolysis. This study presents the case of surgical treatment of superior sulcus tumour following chemoradiation therapy with dense pleural adhesion due to a history of graft replacement of the descending thoracic aorta. The patient underwent left upper lobectomy via a transmanubrial osteomuscular-sparing approach combined with video-assisted thoracoscopic surgery (VATS). Transmanubrial approach combined with VATS offered a good overview during local tumour dissection.

[Aneurysm of the aortic cusp; report of a case].

Shuichi Naraoka, Satomi Inoue, Tomohiro Nakajima, Yukihiro Niida

Kyobu geka. The Japanese journal of thoracic surgery 63 ( 13 ) 1164 - 7 2010.12 [Domestic journal]

We performed surgical therapy to the rare case of the perforation of an aneurysm of the aortic cusp which had caused the congestive heart failure. 71-year-old man having developed coughing was diagnosed as a severe aortic regurgitation and came to our hospital for surgery. The non coronary cusp was dilated and perforated. The aortic valves were removed and replaced with a bioprosthetic valve. The pathological examination of the valves showed healed infective endocarditis. The patient discharged home uneventfully.

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