Shigefumi Matsuyama

Outcomes of total arch replacement with stepwise distal anastomosis technique and modified perfusion strategy

OBJECTIVE Total arch replacement has been reported to present high morbidity and mortality. We have introduced a stepwise distal anastomosis technique and modified perfusion strategy, including selective antegrade cerebral perfusion, moderate hypothermia, and separate lower-body perfusion, to minimize organ ischemia and secondary morbidities. We report the operative outcomes of total arch replacement with our modified perfusion strategy. METHODS Between August 2006 and December 2008, 119 patients underwent total arch replacement with the current perfusion strategy. Of these patients, 56 (47%) underwent emergency operation for acute type A aortic dissection (n = 48) or ruptured thoracic aneurysm (n = 8). The mean age of patients was 68 years, and the mean follow-up period was 25 months. We analyzed operative mortality, morbidity, and 4-year survival of this patient group. RESULTS The mean operation, cardiopulmonary bypass, and circulatory arrest times were 313, 183, and 47 minutes, respectively. Operative mortality was 3.4%. Operative mortality of elective cases was 1.6%. The incidences of permanent neurologic deficit, paraparesis, and renal insufficiency were 5.0%, 1.7%, and 7.6%, respectively. Actuarial 4-year survival was 86.5%. CONCLUSIONS Total arch replacement with our modified perfusion strategy has demonstrated low operative mortality and morbidity.

Graft selection in elderly patients undergoing coronary artery bypass grafting

PurposeThis study aimed to assess the clinical and angiographic outcomes after coronary artery bypass grafting (CABG) in elderly patients (≥75 years).MethodsWe reviewed the records of 1021 patients who underwent CABG between September 2004 and December 2009. We divided these patients into two groups: ≥75 years (group E, n = 292) versus <75 years (group N, n = 729). We compared operative and postoperative variables and early and 1-year angiographic patency rates of grafts between the groups.ResultsThe rates of female sex (P < 0.01), unstable angina (P = 0.04), and history of congestive heart failure (P < 0.01) were higher in group E than in group N. More patients in group N had diabetes (P = 0.03) and hyperlipidemia (P < 0.01) than those in group E. Operative mortality (1.0% in group E vs. 0.3% in group N; P = 0.14) and the rate of major complications were not significantly different between the groups. The mean number of anastomoses per patient was similar in the groups. The rate of left internal thoracic artery use was not significantly different between the groups, although the use of other arterial grafts was significantly higher in group N than in group E. There were no significant differences in the early (98.5% vs. 97.2%, P = 0.08) or 1-year (91.6% vs. 89.3%, P = 0.28) patency rates of all grafts in the groups.ConclusionThe clinical and angiographic outcomes after CABG in elderly patients were almost identical to those in nonelderly patients.

Combination of Paeoniae Radix and Cnidii Rhizoma Prolonged Survival of Fully Mismatched Cardiac Allografts and Generated Regulatory Cells in Mice

In previous studies, we have demonstrated that Tokishakuyakusan (TJ-23) can prolong the survival of allogeneic cardiac grafts and induce regulatory T cells. In this study we investigated the effects of Paeoniae radix and Cnidii rhizoma, two components of TJ-23, on alloimmune responses in a murine cardiac transplantation model and whether the two agents have synergistic effect. CBA mice underwent transplantation of a C57BL/6 heart and received oral administration of 2 g/kg/day of Paeoniae radix, Cnidii rhizoma, or the mixture of two agents from the day of transplantation until 7 days afterward. Naïve CBA mice rejected C57BL/6 cardiac graft acutely (median survival time (MST): 7 days). Paeoniae radix and Cnidii rhizoma prolonged C57BL/6 allograft survival (MSTs: 13.5 and 15.5 days, resp.). However, the mixture of two agents prolonged C57BL/6 allograft survival indefinitely (MST > 100 days). Secondary CBA recipients given whole splenocytes from primary combination-treated CBA recipients with B6 cardiac allografts 30 days after grafting had prolonged survival of B6 hearts (MST: 33 days). Flow cytometry studies showed that the CD4+CD25+Foxp3+ regulatory cell population was increased in combination-treated recipients. Combination of Paeoniae radix and Cnidii rhizoma induced hyporesponsiveness to fully allogeneic cardiac allografts and may generate CD4+CD25+Foxp3+ regulatory cells in our model.

Surgical treatment of a huge hepatic artery aneurysm without revascularization—Case Report

Highlights • A huge hepatic artery aneurysm is a rare condition in aged patient.• Revascularization was not performed because of hepatic collateral circulation.• Postoperative liver function was preserved without revascularization.• Postoperative cholecystitis was observed despite hepatic collateral circulation.• Intraoperative ultrasound for hepatic collateral circulation may not be important.