Kiyoyuki Eishi

Improved success rate of the maze procedure in mitral valve disease by new criteria for patients’ selection

OBJECTIVE We have carried out the maze procedure for atrial fibrillation (AF) as a combined operation with mitral valve surgery in a consecutive fashion until December 1994 (period 1). Therefore, the success rate in sinus rhythm conversion remained unsatisfactory. We have selected the patients according to arbitrarily decided new criteria since January 1995 (period 2), and examined the results prospectively. METHODS Between May 1992 and February 1997, we carried out the maze procedure in 220 patients as a combined operation with mitral valve surgery. During period 2, we carried out the maze procedure in 63 cases who satisfied all the new criteria (voltage of f-wave in V1 lead > 0.1 mV, cardiothoracic ratio (CTR) < 70%, LA dimension < 70 mm), and 37 patients out of these criteria. Success was defined as sinus rhythm restoration without sick sinus syndrome. RESULTS There were 4 hospital deaths (1.8%) and 4 late deaths (1.8%). Success rate was significantly (P = 0.0089) higher in period 2 (82%) than in period 1 (65%). Success rate was significantly higher in patients within criteria than out of criteria both in period 1, period 2, and total (77 versus 48%, P = 0.018; 90 versus 66%, P = 0.004, and 83 versus 55%, P = 0.0001). CONCLUSION The maze procedure is highly reliable when combined with mitral valve surgery if patients are selected properly.

Medium-term results after the modified Cox/Maze procedure combined with other cardiac surgery

OBJECTIVE Long-term results after the modified Cox/Maze III procedure combined with other cardiac procedure for the treatment of organic heart disease and chronic atrial fibrillation (AF) has not been clarified. This report describes our medium-term results after such operation. METHODS Between March 1993 and August 1995, 104 consecutive patients with chronic AF underwent the modified Cox/Maze III procedure combined with other cardiac procedure. There were 100 long-term survivors. There were 45 men and 55 women, with ages ranging from 21 to 77 years (mean 59.7). Patients were followed up and changes in rhythm, need for pacemaker implantation, and the incidence of CNS (central nervous system) complications were retrospectively studied. RESULTS The follow-up was complete in 103 patients and 99 long-term survivors (99%). The mean follow-up period was 44.6 +/- 1.1 months. In the immediate postoperative period, 73 patients regained sinus rhythm (SR group), 21 patients were in AF (AF group), and six patients underwent pacemaker implantation because of sick sinus syndrome (SSS). During the follow-up period, eight patients died. One- and 5-year survival rates (Kaplan-Meier) after surgery was 95.1 +/- 2.3 and 87.8 +/- 3.4% for the entire group. Preoperative NYHA class was 2.5 +/- 0.7 and medium-term NYHA class was 1.5 +/- 0.5. (P < 0.001) Changes in rhythm for the SR group were followed. Fifty-two patients of the SR group stayed in SR (72%), 16 patients converted back to AF (22%), and four patients had newly-developed SSS (6%) at follow-up period. Probability in SR maintenance for SR group at 1 year was 88.8 +/- 3.7% and at 5 years was 64.8 +/- 7.5%. Five patients experienced the CNS complication during the follow-up period. Two of the AF group and two of the SR group patients developed cerebral/cerebellar infarction. One of the SR group patients experienced small cerebral bleeding. CONCLUSIONS The medium-term results after the modified Cox/Maze III procedure concomitant with other cardiac procedure are good with improved functional status and good survival rate. However, there seems to be gradual but constant attrition in the rate of SR maintenance in SR group.

Clinical experience of mitral valve reconstruction with artificial chordae implantation

To expand the application of mitral valve reconstruction for pure mitral regurgitation due to diffuse leaflet prolapse, we have employed artificial chordae implantation using GPEP strips in 9 patients and 4-0 PTFE sutures in 20 patients since November 1986. The total number of GPEP strips implanted was 20 with a range from 1 to 4 (average 2.2 per patient) and 45 pairs of PTFE sutures with a range from 1 to 6 (average 2.3 per patient). There was one hospital death (3.4%). All other patients survived operation without valve-related complications except 1 patient who required reoperation for failure of mitral valve reconstruction. In 27 survivors free from reoperation, the amount of mitral regurgitation assessed postoperatively was none or trivial in 19 patients, mild in 7 and moderate in 1. All 27 patients improved to NYHA functional class I or II. So far, our results were no less acceptable than those with conventional procedures for mitral valve prolapse.

Mitral valve repair by Carpentier-Edwards Physio annuloplasty ring

A semi-flexible annuloplasty ring (Physio-ring) was clinically used in 30 cases of mitral valve insufficiency. The Physio-ring has the characteristics in which the anterior section is rigid and has a saddle-shaped curve, while the posterior section is flexible to allow for changes in size and shape of the anulus during ventricular contraction. The patients were aged from 23 to 73 years (mean 53.8 +/- 12.5). The cause of mitral valve insufficiency was degenerative (in 24 patients), rheumatic (2), ischemic (1), endocarditis (1), congenital + degenerative (1), and traumatic (1). On the 6-month post-implant echocardiogram, 96.6% had grade 0 or +1 regurgitation. The effective valve orifice area was 2.61 +/- 0.82 cm2 (n = 19). There was no late death. However, there was 1 (3.3%) hospital death after the patient had received a simultaneous coronary artery bypass grafting, and then developed low output syndrome after surgery. Although there was no device-related complication, hemolysis of undetermined cause was observed in 1 (3.3%) patient. The findings from this study indicated a low incidence of device-related complication, while excellent valvular function was maintained.

Annuloaortic Repair in the Treatment of Aortic Regurgitation and Aortic Root Pathology

Abstract We developed a new technique of aortic root repair which may be able to eliminate the potential problem of leaflet damage, resulting from the direct contact of the aortic leaflets with synthetic vascular grafts during systole. This report describes our technique of annuloaortic repair and the operative results. Between February 1995 and October 1998, 13 patients underwent annuloaortic repair. The patients included 8 males and 5 females (mean age 50 years). Four patients had grade IV/IV aortic regurgitation (AR), 5 had III/IV AR, 2 had II/IV AR, and 1 had no AR preoperatively. Regarding the preoperative functional status, 1 patient was classified as New York Heart Association class IV, 5 were class III, 6 class II, and 1 class I. Concomitant cardiovascular procedures were performed in 12 cases. Aortic valvuloplasty or annuloplasty was performed in 7 patients. Both operative and short-term postoperative results with pre- and postoperative echocardiographic findings were studied retrospectively. The mean total cardiopulmonary bypass time was 212 min. The mean aortic cross-clamp time was 130 min. Circulatory arrest was induced in 5 patients. Postoperatively, 7 patients had no AR. Three patients had grade I/IV AR and 3 had grade II/IV AR. Perioperative changes in aortic annulus, mid-sinus portion, and sinotubular junction diameters were determined echocardiographically in 5 patients. The preoperative diameters were 2.7 ± 0.4, 5.4 ± 0.5, and 4.7 ± 1.0 cm, respectively. The postoperative diameters were 2.3 ± 0.5, 4.2 ± 0.5, and 3.5 ± 0.5 cm, respectively. Ten patients were class I and 2 were class II. This technique of annuloaortic repair with or without aortic valvuloplasty is applicable to a certain subset of patients with aortic root disease and AR. Both the indications for this procedure and the long-term results should be confirmed.

Spiral suspension, a novel repair technique for severe functional tricuspid regurgitation

From the Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Sept 6, 2017; revisions received Dec 31, 2017; accepted for publication Jan 16, 2018; available ahead of print March 9, 2018. Address for reprints: Kikuko Obase, MD, Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan (E-mail: kobase@nagasaki-u.ac.jp). J Thorac Cardiovasc Surg 2018;156:649-52 0022-5223/

Liver Autotransplantation for an Inferior Vena Cava Tumor

36.00 Copyright 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.01.082

Serial Doppler echocardiographic evaluation of Carpentier-Edwards pericardial valve dysfunction: Comparison with Ionescu-Shiley valve

Title Liver Autotransplantation for an Inferior Vena Cava Tumor Author(s) Takatsuki, Mitsuhisa; Eguchi, Susumu; Hashizume, Koji; Soyama, Akihiko; Hidaka, Masaaki; Tanigawa, Kazuyoshi; Eishi, Kiyoyuki; Kuroki, Tamotsu Citation Transplantation, 98(12), pp.e91-e93; 2014 Issue Date 2014-12-27 URL http://hdl.handle.net/10069/35370 Right

Influence of Long-Term Support upon the Severely Failing Left Ventricle

BACKGROUND Doppler echocardiography is a valuable noninvasive method for evaluating of the occurrence and degree of either prosthetic valve stenosis or regurgitation. By using serial Doppler echocardiographic examination, we evaluated the incidence and the mode of the Carpentier-Edwards pericardial valve (CEPX) dysfunction compared with that of the Ionescu-Shiley valve (IS). METHODS AND RESULTS After aortic and/or mitral valve replacement, 80 patients with CEPX and 111 with IS underwent Doppler echocardiography at intervals of at least 2 years after surgery. The average durations of follow-up were 6.1 +/- 2.9 years for patients with CEPX and 7.2 +/- 3.0 years for those with IS. Bioprosthetic valve stenosis was defined as reduced excursion of the bioprosthetic valve leaflets and peak gradient > or =60 mm Hg after aortic valve replacement and mean gradient > or =7 mm Hg after mitral valve replacement. Bioprosthetic valve regurgitation caused by bioprosthetic valve dysfunction was defined as grade > or =3 transvalvular regurgitation. In the aortic position, although there was no significant difference in the actuarial rate of freedom from bioprosthetic valve stenosis between patients with IS and those with CEPX (10 years after surgery, 88% +/- 7% vs 90%, NS), bioprosthetic regurgitation caused by bioprosthetic valve dysfunction occurred less frequently in patients with CEPX than in those with IS (10 years after surgery, 86% vs 54% +/- 9%, p < 0.05). In the mitral position, bioprosthetic valve stenosis occurred more frequently in patients with CEPX than in those with IS (10 years after surgery, 54% +/- 11% vs 72% +/- 8%, p < 0.01). Although grade > or =3 transvalvular bioprosthetic regurgitation occurred later in patients with CEPX than in those with IS, there was no significant difference in the actuarial rate of freedom from that regurgitation between patients with CEPX and those with IS (10 years after surgery, 63% +/- 10% vs 54% +/- 7%, NS). CONCLUSIONS For aortic valve replacement, CEPX has good long-term durability because of the low incidence of bioprosthetic regurgitation. For mitral valve replacement, long-term durability of CEPX is poor, although medium-term durability is satisfactory.

Single lung retrieval from a donor supported by a left ventricular assist device

It is unclear how long-term support with a left ventricular assist system (LVAS) affects the severely failing left ventricle (LV). From 1994, we applied our LVAS to seven patients with profound heart failure. Of those, six patients were supported for more than 3 weeks. The etiologies of heart failure were valvular heart disease (VHD) in one, ischemic heart disease (IHD) in two, dilated phase hypertrophic cardiomyopathy (DHCM) in one, and dilated cardiomyopathy (DCM) in two. In one patient, biventricular assist was performed because of coexisting severe right heart failure. Each LVAS was installed between the left atrium and the ascending aorta and the pump was positioned paracorporeally. After stabilization of general condition, exercise was started. The natural heart size was examined and systolic heart function was evaluated by the systolic time interval (STI) under LVAS pumping by using echocardiography. This STI was calculated from the equation: ejection time divided by pre-ejection period measured from aortic valve movement. At the beginning of assistance, the STI was low ( 1 and their LVDd decreased to <70mm. Two of them (1CM, 1VHD) are doing well now 2 years after LVAS removal. From these data, the cardiac function of the patient with a severely failing LV may improve when LV dilatation decreases and STI increases through long-term LVAS support.