Kazuhisa Sakamoto

Genetic Ablation of MicroRNA-33 Attenuates Inflammation and Abdominal Aortic Aneurysm Formation via Several Anti-Inflammatory Pathways

Objective— Abdominal aortic aneurysm (AAA) is an increasingly prevalent and ultimately fatal disease with no effective pharmacological treatment. Because matrix degradation induced by vascular inflammation is the major pathophysiology of AAA, attenuation of this inflammation may improve its outcome. Previous studies suggested that miR-33 (microRNA-33) inhibition and genetic ablation of miR-33 increased serum high-density lipoprotein cholesterol and attenuated atherosclerosis. Approach and Results— MiR-33a-5p expression in central zone of human AAA was higher than marginal zone. MiR-33 deletion attenuated AAA formation in both mouse models of angiotensin II– and calcium chloride–induced AAA. Reduced macrophage accumulation and monocyte chemotactic protein-1 expression were observed in calcium chloride–induced AAA walls in miR-33−/− mice. In vitro experiments revealed that peritoneal macrophages from miR-33−/− mice showed reduced matrix metalloproteinase 9 expression levels via c-Jun N-terminal kinase inactivation. Primary aortic vascular smooth muscle cells from miR-33−/− mice showed reduced monocyte chemotactic protein-1 expression by p38 mitogen-activated protein kinase attenuation. Both of the inactivation of c-Jun N-terminal kinase and p38 mitogen-activated protein kinase were possibly because of the increase of ATP-binding cassette transporter A1 that is a well-known target of miR-33. Moreover, high-density lipoprotein cholesterol derived from miR-33−/− mice reduced expression of matrix metalloproteinase 9 in macrophages and monocyte chemotactic protein-1 in vascular smooth muscle cells. Bone marrow transplantation experiments indicated that miR-33–deficient bone marrow cells ameliorated AAA formation in wild-type recipients. MiR-33 deficiency in recipient mice was also shown to contribute the inhibition of AAA formation. Conclusions— These data strongly suggest that inhibition of miR-33 will be effective as a novel strategy for treating AAA.

Comparison of endovascular repair with branched stent graft and open repair for aortic arch aneurysm

OBJECTIVES Although conventional open repair is our preference for patients with aortic arch aneurysms, we have often chosen thoracic endovascular aneurysm repair (TEVAR) with a handmade branched stent graft (bTEVAR) in high-risk patients. The aim of this study was to compare the midterm clinical outcomes of our bTEVAR technique to those of the open repair. METHODS Between January 2007 and December 2014, we treated 129 patients with aortic arch aneurysm by means of either conventional open repair (OPEN, n = 61) or bTEVAR (n = 68) at our institution. RESULTS The mean ages were 70.5 ± 12.7 years in the OPEN group and 72.7 ± 12.5 years in the bTEVAR group (P = 0.32). The aetiologies included true aneurysm in 101 patients (78.3%) and chronic dissection in 26 (20.1%). There were 2 (3.3%) in-hospital deaths in the OPEN group and 3 (4.4%) in the bTEVAR group. The mean follow-up duration was 3.0 ± 2.1 years (2.4 ± 1.9 years in the OPEN group and 3.6 ± 2.3 years in the bTEVAR group). There was no difference in 5-year aneurysm-related mortality between groups (10.7% in OPEN vs 12.8% in bTEVAR, P = 0.50). In terms of late additional procedures, however, none were required in the OPEN group, whereas 10 (15.4%) additional endovascular repairs and 4 (6.2%) open repairs were required in the bTEVAR group. CONCLUSIONS Our bTEVAR could be performed with low early mortality, and it yielded similar midterm aneurysm-related mortality to that of conventional open repair. However, these patients undergoing this technique required more late additional procedures than those undergoing conventional open repair.

Lung autotransplantation technique for postpneumonectomy-like syndrome

From the Departments of Thoracic Surgery and Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication April 25, 2015; revisions received June 7, 2015; accepted for publication June 14, 2015; available ahead of print July 26, 2015. Address for reprints: Hiroshi Date, MD, Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan (E-mail: hdate@kuhp.kyoto-u.ac.jp). J Thorac Cardiovasc Surg 2015;150:e45-7 0022-5223/

A Case of Successful Reopening of Left Main Coronary Artery Occlusion After Transcatheter Aortic Valve Replacement

36.00 Copyright 2015 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2015.06.048

On-pump beating CABG concomitant with bilateral living-donor lobar lung transplantation

An 86-year-old woman with severe aortic stenosis was referred for transcatheter aortic valve replacement (TAVR). The transfemoral TAVR procedure was conducted under general anesthesia. Aortography during pre-dilatation with a 20-mm balloon demonstrated reduced blood flow through the left main

A Case of Penetrating Atherosclerotic Ulcer Treated With Thoracic Endovascular Aortic Repair.

Comorbidities in patients were previously considered to be a relative contraindication for lung transplantation. Coronary artery disease (CAD), especially, was recognized a serious surgical risk. Because the number of lung transplantations has been increasing, patients with many comobities including CAD, may be candidates for this treatment. Several reports described acceptable outcomes of preoperative or combined treatment for CAD in patients who are in need of lung transplantation. These results suggest that patients with CAD need not be excluded as candidates for lung transplantation.

Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement

Penetrating atherosclerotic ulcer (PAU) is defined as ulceration of an aortic atherosclerotic plaque penetrating through the internal elastic lamina into the media.1–3 PAU accounts for 2% to 7% of all acute aortic syndrome.4 PAU is at risk of intramural hematoma, pseudoaneurysm, aortic rupture, or an acute aortic dissection.5 Symptomatic PAU has to be assumed to indicate an emergency because the adventitia is reached and aortic rupture is expected.5 The rupture rate of symptomatic PAU has been reported to be as high as …