Keiji Iwata

Influence of coronary artery disease on operative mortality and long-term survival after abdominal aortic aneurysm repair.

PurposeThis retrospective study was conducted to evaluate the effects of coronary artery disease (CAD) on short- and long-term survival after abdominal aortic aneurysm (AAA) repair.MethodsOne hundred consecutive patients underwent elective AAA repair between 1991 and 2002. Coronary angiography was performed in all patients, revealing significant coronary artery lesions in 47 (47%). Percutaneous transluminal coronary angioplasty (PTCA) was performed in 11 patients, 20 (median) days before the abdominal surgery. Abdominal aortic aneurysm repair was performed 60 (median) days after coronary artery bypass grafting (CABG) in five patients, and both procedures were performed simultaneously in two patients.ResultsThe in-hospital mortality rate for AAA repair was 1.0%, but there was no cardiac-related operative morbidity or mortality. The 96 patients discharged were followed up for a mean period of 2.9 years (range 3–143 months). The cumulative survival rates after 1, 2, 3, and 5 years were 98%, 95%, 88%, and 77%, respectively. Only one patient (1%) died of myocardial infarction. There was no significant difference in the long-term survival of the CAD and non-CAD patients.ConclusionsThese results emphasize the importance of routine coronary angiography and subsequent coronary revascularization to improve early and late survival rates after AAA repair.

Diabetes mellitus adversely affects mortality and recurrence after valve surgery for infective endocarditis

Background: Although diabetes mellitus (DM) increases the incidence of infective endocarditis (IE), little is known about the outcome of valve surgery for active IE in patients with DM. We evaluated the clinical outcomes of valve surgery for IE in patients with DM. Methods: Between 2009 and 2016, 470 patients underwent valve surgery for definitive left‐sided active IE at 12 affiliated hospitals. We compared the preoperative variables and clinical outcomes between patients without (n = 374) and with DM (n = 96). Results: Staphylococcus and chronic hemodialysis were more prevalent in patients with DM, and these patients had greater preoperative inflammation levels and worse renal function than patients without DM. In‐hospital mortality was 8% in patients without DM and 13% in patients with DM (P = .187). The overall survival rate at 1 and 5 years was 87% and 81% in patients without DM and 72% and 59% in patients with DM (P < .001). The incidence of infection‐related death was greater in patients with DM than in patients without DM (P < .001; hazard ratio 3.74 [1.78‐7.71]). Freedom from the recurrence of endocarditis at 1 and 5 years postoperatively was 98% and 95% in patients without DM, and 89% and 78% in patients with DM (P < .001), respectively. The Cox hazard analysis revealed that the presence of DM was the only independent risk for recurrence (hazard ratio 3.74 [1.45‐9.54], P = .007). Conclusions: The short‐ and mid‐term outcome after valve surgery for active IE in patients with DM is worse because of the greater prevalence of infection‐related death and IE recurrence.

Aortic arch surgery with a single centrifugal pump for selective cerebral perfusion and systemic circulation.

In aortic arch surgery, two pumps are required for systemic perfusion and selective cerebral perfusion (SCP). A new technique with a single centrifugal pump for systemic perfusion and SCP was developed and its efficacy and safety evaluated. This technique was adopted for total arch replacement in 22 consecutive patients with true aneurysms (13) and aortic dissection (nine) from January 2005 to January 2008. Cerebral perfusion lines branched from the main perfusion line. During SCP, right radial arterial pressure was maintained at 50 mm Hg and left common carotid arterial pressure at 60 mm Hg, and the regional cerebral oxygen saturation (rSO(2)) values were maintained at approximately >80% of the baseline value. Two operative deaths (9%) occurred due to pneumonia and hemorrhage in the left lung, respectively. Stroke occurred in one patient (5%). This simple circuit system can thus be easily and safely applied for aortic arch surgery.

Stent grafting simulation using a three-dimensional printed model for extensive aortic arch repair combined with coarctation

Stent grafting for complex aortic anatomy remains a challenge. In particular, stent graft collapse (i.e. infolding) is possible when an excessive oversized device is needed. We describe a case of preoperative stent grafting simulation using a three-dimensional (3D) printed model for extensive aortic arch repair in a 69-year-old woman with multiple aneurysms combined with coarctation. The patient was scheduled to undergo staged hybrid repair. A stent graft larger than 28 mm in diameter was needed to deploy into a coarctation of 15 mm in diameter during the 2nd stage of the operation. Preoperative, experimental stent grafting using a 3D printed model indicated that infolding would likely not occur. Therefore, we proceeded with surgery, which was successful. This technology could be a useful application for planning complicated stent grafting.

Successful Reconstructive Surgery for Isolated Mitral Insufficiency Associated with Williams Syndrome: Report of a Case

Isolated mitral insufficiency requiring surgical correction is extremely rare in Williams syndrome (WS). We report the case of a 25-year-old man with WS, who suffered congestive heart failure caused by severe mitral insufficiency and atrial fibrillation. We found extensive anterior leaflet prolapse, but no other cardiovascular disorders such as supra-aortic or pulmonary arterial stenosis. He underwent successful radical valve repair with a concomitant Cox-maze procedure. This reconstructive procedure was appropriate and effective surgical treatment for isolated mitral valve disease associated with WS.

Successful Surgical Treatment for Fungal Endocarditis of the Ascending Aorta after Aortic Valve Replacement

症例は69歳,女性.2001年4月人工弁(Freestyle弁)感染性心内膜炎,僧帽弁閉鎖不全症,陳旧性心筋梗塞に対し再大動脈弁置換術,僧帽弁形成術,冠血行再建術を施行した.2002年1月中旬から下痢,タール便を認め当院消化器科へ入院,絶飲食,高カロリー輸液を行っていた.1月下旬から発熱が持続,抗生剤投与を行い改善傾向にあったが,経食道心臓超音波検査にて上行大動脈に可動性を有する異常エコーを認め,β-Dグルカンの上昇,血液培養検査にてCandida parapsilosisを認め,真菌性心内膜炎の疑いにて4月5日手術を行った.大動脈を切開すると無冠洞近傍の大動脈壁に疣贅の付着を認め,機械弁による再々大動脈弁置換術,および疣贅とともに大動脈壁の一部を切除,大動脈壁欠損部の再建を行った.摘出標本からC.parapsilosisが検出され,抗真菌剤を経静脈的に8週間投与した.術後,意識覚醒遅延,一過性の左半身麻痺の合併を認めたが,術後133日目に脳梗塞後遺症なく退院,抗真菌剤内服を継続し,術後24ヵ月の時点で感染の再燃は認めていない.