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Featured researches published by Takashi Matsueda.


The Annals of Thoracic Surgery | 2015

Mid-Term Results of Valve-Sparing Aortic Root Replacement in Patients With Expanded Indications

Shunsuke Miyahara; Takashi Matsueda; Naoto Izawa; Katsuhiro Yamanaka; Toshihito Sakamoto; Yoshikatsu Nomura; Naoto Morimoto; Takeshi Inoue; Masamichi Matsumori; Kenji Okada; Yutaka Okita

BACKGROUND The mid-term results of valve-sparing aortic root reimplantation (VSRR) for various indications were investigated. METHODS From 2000 to 2013, 183 consecutive patients undergoing VSRR were enrolled. Expanded indications, defined as a patient on the marginal operative indication, included age 65 years or older (n = 33), age 15 years or younger (n = 4), acute type A aortic dissection (AAAD) (n = 21), aortitis (n = 8), reoperative root replacement (n = 11), cusp prolapse (n = 67), large aortoventricular junction of greater than 28 mm (AVJ) (n = 42), preoperative severe aortic regurgitation (AR) (n = 89), left ventricular ejection fraction 0.40 or less (n = 12), LV dilation (n = 66), New York Heart Association class III or greater (n = 5), need for total arch replacement (n = 29), and concomitant mitral valve repair (n = 12). RESULTS The overall survival at 5 years was 96.6%. Freedom from greater than mild AR and reoperation at 5 years was 85.8% and 92.9%, respectively. Cox proportional hazard model revealed that AAAD, cusp prolapse, AVJ 28 mm or greater, and operation before 2009 were at risk for late AR recurrence (p = 0.015, p = 0.0041, p = 0.032, and p = 0.014, respectively). After 2009, freedom from late AR in the cusp prolapse group improved (p = 0.055, versus control). Both freedom from recurrent AR and reoperation were worse as the number of expanded indications increased (log-rank trend p = 0.00017 and p = 0.00067, respectively). CONCLUSIONS Surgical outcomes of VSRR in these patient cohorts were satisfactory with some room for improvement in patients with cusp prolapse. Although the indications for VSRR are being expanded, a larger number of expanded indications were associated with poor outcomes in terms of longevity of valve function.


European Journal of Cardio-Thoracic Surgery | 2017

Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly

Yuki Ikeno; Yutaka Koide; Noriyuki Abe; Takashi Matsueda; Naoto Izawa; Takahiro Yamazato; Shunsuke Miyahara; Yoshikatsu Nomura; Shunsuke Sato; Hiroaki Takahashi; Takeshi Inoue; Masamichi Matsumori; Hiroshi Tanaka; Satoshi Ishihara; Shinichi Nakayama; Koji Sugimoto; Yutaka Okita

OBJECTIVES The purpose of this study was to identify the cut-off value of sarcopenia based on the psoas muscle area index and evaluate early and late outcomes following elective total arch replacement in the elderly. METHODS Sarcopenia was assessed by the psoas muscle area index [defined as the psoas muscle area at the L3 level on computed tomography (cm 2 )/body surface area (m 2 )]. The cut-off value for sarcopenia was defined as > 2 standard deviations below the mean psoas muscle area index value obtained from 464 normal control patients. Between October 1999 and July 2015, 266 patients who were ≥ 65 years and had undergone psoas muscle area index measurement underwent elective total arch replacement. These patients were classified into the sarcopenia (Group S, n  = 81) and non-sarcopenia (Group N, n  = 185) groups. RESULTS The mean age was 76.2 ± 5.6 years in Group S and 75.7 ± 5.7 years in Group N ( P  = 0.553). Hospital mortality was 3.7% (3/81) in Group S and 2.2% (4/185) in Group N ( P  = 0.483). Mean follow-up was 48.3 ± 38.7 months. Five-year survival was significantly worse in Group S (S: 63.2 ± 6.6% vs N: 88.7 ± 2.6%, P  < 0.001). A multivariable Cox proportional hazard analysis showed that sarcopenia significantly predicted poor survival (hazard ratio 2.59; 95% confidence interval 1.27-5.29; P  = 0.011). CONCLUSIONS Sarcopenia did not predict hospital death following total arch replacement, but it was negatively associated with overall survival. Sarcopenia can be an additional risk factor to estimate the outcomes of thoracic aortic surgery.


European Journal of Cardio-Thoracic Surgery | 2016

Impact of positional relationship of commissures on cusp function after valve-sparing root replacement for regurgitant bicuspid aortic valve.

Shunsuke Miyahara; Noriyuki Abe; Takashi Matsueda; Naoto Izawa; Takahiro Yamazato; Yoshikatsu Nomura; Aki Kitamura; Shunsuke Sato; Hiroaki Takahashi; Takeshi Inoue; Masamichi Matsumori; Yutaka Okita

OBJECTIVES The aim of this study is to investigate the longitudinal valve function after valve-sparing root replacement in patients with bicuspid aortic valves (BAVs), in terms of both transvalvular pressure gradient (TVPG) and freedom from aortic regurgitation. METHODS In this non-randomized retrospective study, two different approaches were chosen for correcting the circumferential orientation of commissures during aortic root reimplantation for Sievers type I BAV: (i) 180° orientation, in which both cusps occupy equal surface areas and (ii) preserving native commissural orientation. From 2005 to 2015, 41 consecutive patients with Sievers type I BAV undergoing valve-sparing root replacement were divided into two groups according to the techniques: native orientation group and 180° group. RESULTS The native orientation group included 22 patients (age, 45.1 ± 13.6 years) and the 180° group included 19 patients (age, 36.6 ± 13.7 years; P = 0.053). There was no significant difference in preoperative variables between the two groups. Postoperative and follow-up echocardiography revealed the following: the average TVPG at the time of discharge in the native orientation and the 180° groups was 17.3 ± 6.6 and 21.7 ± 11.1 mmHg (P = 0.16), respectively, at peak and 10.0 ± 3.7 and 11.7 ± 6.0 mmHg (P = 0.33), respectively, at mean; at follow-up, the corresponding values were 19.1 ± 6.6 and 22.9 ± 10.6 mmHg (P = 0.24) at peak and 9.9 ± 3.8 and 13.2 ± 7.2 mmHg (P = 0.12) at mean. Thus, there was a trend towards higher TVPG in the 180° group. The difference between the preoperative and postoperative commissural angles was correlated with higher postoperative peak and mean TVPG (r = 0.53, P = 0.041, 95% confidence interval, 0.029-0.82 at peak and r = 0.58, P = 0.024, 95% confidence interval, 0.092-0.84 at mean). CONCLUSIONS In terms of freedom from aortic regurgitation and valve function, similar outcomes were achieved in both despite different repair techniques used for fixation of commissures during valve-sparing aortic root replacement in BAV. However, attention should be paid to patients with 180° commissural reposition because of a trend towards higher TVPG.


The Journal of Thoracic and Cardiovascular Surgery | 2018

Surgical strategy for the treatment of aortoesophageal fistula

Takahiro Yamazato; Tetsu Nakamura; Noriyuki Abe; Koki Yokawa; Yuki Ikeno; Yojiro Koda; Soichiro Henmi; Hidekazu Nakai; Yasuko Gotake; Takashi Matsueda; Takeshi Inoue; Hiroshi Tanaka; Yoshihiro Kakeji; Yutaka Okita

Objective To present a surgical strategy for aortoesophageal fistula (AEF). Methods From October 1999 to May 2017, 27 patients with AEF were treated at Kobe University Hospital. After 9 patients with malignancies or fish bone penetration were excluded, 18 patients who had AEF secondary to aortic lesions were investigated. The mean age was 67.2 ± 10.4 years, and the male/female ratio was 16:2. Twelve patients had a nondissection thoracic aneurysm, and 6 patients had a chronic aortic dissection. Six patients were in shock. Seven patients had a previous thoracic endovascular aortic repair (TEVAR) in the descending aorta, 2 patients had descending aorta replacement, 1 had hemiarch replacement, and 2 had total arch replacement. As the first treatment for AEF, 3 patients underwent TEVAR as destination therapy, 3 patients had a bridge TEVAR to open surgery, 1 patient had an extra‐anatomical bypass from the ascending aorta to the abdominal aorta, and 11 patients had an in situ reconstruction of the descending aorta. The esophagus was resected in 16 patients, and an omental flap was installed in 16 patients. Additional procedures were extra‐anatomical bypass in 2 patients and in situ reconstruction of the aorta in 3 patients. Results Hospital mortality was noted in 4 patients (22.2% persistent sepsis, n = 3: pneumonia, n = 1). However, since 2007, only 1 of 13 patients has died (pneumonia). Late death occurred in 5 patients, due to pneumonia, cerebral bleeding, diarrhea, sudden death, and persistent infection. Actuarial survival was 42.4 ± 12.8% at 5 years and freedom from aorta‐related death was 59.4 ± 13.5% at 5 years. Nine patients achieved completed reconstruction of the esophagus 172 ± 57 days after initial surgery. Conclusions Although a comparative study was not performed, 1‐stage surgery consisting of resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta, and omental flap installation provided a better outcome in the treatment for AEF. Bridging TEVAR to the open surgery is a useful adjunct in patients with AEF with hemorrhagic shock. Later reconstruction of the esophagus can be performed in the survivors.


The Japanese Journal of Thoracic and Cardiovascular Surgery | 2018

A case of type A acute aortic dissection with a common carotid trunk

Yuki Ikeno; Masamichi Matsumori; Koki Yokawa; Soichiro Henmi; Hidekazu Nakai; Takashi Matsueda; Katsuhiro Yamanaka; Takeshi Inoue; Hiroshi Tanaka; Yutaka Okita

We present a rare case of common carotid artery with acute type A aortic dissection. A 72-year-old woman underwent emergent aortic arch repair using Antegrade selective cerebral protection. Bottom-tapped cannulae were inserted into three orifices of arch vessels, however, regional cerebral oxygen saturation decreased after rewarming. We found that arch branches were in order from front to back, right subclavian artery, common carotid trunk, and left subcravian artery. The patient complicated stroke in the right middle cerebral artery.


Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques | 2018

Optimal reconstruction of left ventricular outflow tract obstruction before surgical myectomy in a case with hypertrophic obstructive cardiomyopathy

Hiroyuki Toh; Shumpei Mori; Shinsuke Shimoyama; Yu Izawa; Shun Yokota; Yuto Shinkura; Ryo Takeshige; Akira Nagasawa; Fumitaka Soga; Hidekazu Tanaka; Toshiro Shinke; Koki Yokawa; Takashi Matsueda; Yutaka Okita; Ken-ichi Hirata

We present optimally reconstructed three‐dimensional computed tomography images of left ventricular outflow obstruction, comprehensive left ventriculography, and comparable intraoperative transesophageal echocardiography, as well as serial operative pictures, to facilitate the understanding of live‐heart anatomy of hypertrophic obstructive cardiomyopathy. As shown in this case, detailed morphological analysis around the left ventricular outflow tract using preoperative computed tomography would be feasible and useful. The present case highlights the importance of obtaining complete three‐dimensional information present in the acquired computed tomography dataset because computed tomography is not entirely noninvasive or free of radiation exposure and contrast material.


European Journal of Cardio-Thoracic Surgery | 2017

Which technique of cusp repair is durable in reimplantation procedure

Hiroshi Tanaka; Hiroaki Takahashi; Takeshi Inoue; Takashi Matsueda; Tatsuya Oda; Noriyuki Abe; Yoshikatsu Nomura; Yasuko Gotake; Yutaka Okita

OBJECTIVES We aimed to ascertain the durability of cusp repair techniques used in reimplantation procedures. METHODS Between 2000 and 2015, 249 patients (mean age, 49 ± 17 years) with aortic insufficiency underwent the reimplantation procedure. The pathology was acute aortic dissection in 24 and non-dissection in 225 patients. Preoperative aortic regurgitation (AR) was absent in 9, 1+ in 19, 2+ in 20, 3+ in 71 and 4+ in 120 patients. The mean aortic root and ascending aortic diameters were 47 ± 9 mm and 38 ± 7 mm, respectively. The following techniques of cusp repair were used: none (83), central plication (130), free margin reinforcement (57) and patch repair (19). Annual echocardiography was performed. Freedom from moderate aortic insufficiency and aortic valve reoperation were calculated by the Kaplan-Meier method. Factors influencing the freedom from moderate or severe AR were calculated by proportional hazard analysis. RESULTS Mean follow-up period was 56  ±  44 months. Freedom from moderate or severe AR was 82%±3% and 77% ± 4% at 5 and 8 years, respectively, whereas freedom from aortic valve reoperation was 93%±8% and 87% ± 3% at 5 and 8 years, respectively. Recurrent AR and infection were causes of reoperation in 13 and 3 patients, respectively. Preoperative cusp prolapse, technique of free margin reinforcement used and patch repair were significant factors for recurrent AR by proportional hazard analysis. Central plication was not a significant factor for recurrent AR. CONCLUSIONS Preoperative cusp prolapse was a risk factor, whereas central plication was not a risk factor for recurrent AR. Free margin reinforcement had a positive effect, whereas patch repair had a negative effect on aortic valve durability.


The Journal of Thoracic and Cardiovascular Surgery | 2018

Long-term Outcomes of Total Arch Replacement using 4-branched Graft

Yuki Ikeno; Koki Yokawa; Takashi Matsueda; Katsuhiro Yamanaka; Takeshi Inoue; Hiroshi Tanaka; Yutaka Okita

Objective: Our study evaluated the long‐term outcomes of total arch replacement using a 4‐branched graft. Methods: From October 1999 to December 2016, 655 patients underwent total arch replacement using a 4‐branched graft (pathology in the 655 patients was distributed as 399 no dissection, 149 acute dissection, and 107 chronic dissection). Two hundred nine patients (31.9%) underwent nonelective surgery. Mean follow‐up term was 5.0 ± 4.1 years and follow‐up rate was 97.1%. Results: Of 655 patients who underwent total arch replacement using a 4‐branched graft, operative mortality occurred in 34 patients (5.2%) and permanent neurologic deficit occurred in 24 patients (3.7%). One hundred ninety late deaths occurred, with 20 aortic event‐related deaths. Overall survival was 73.1% ± 1.9% at 5 years and 54.8% ± 2.7% at 10 years. Multivariate Cox‐hazard regression analysis demonstrated that older age, lower estimated glomerular filtration rate, concurrent procedures, permanent neurologic deficit, tracheostomy, and renal failure were significant risk factors for late death. Freedom from repeat operation on the aorta was 98.0% ± 0.7% at 5 years and 93.9% ± 1.8% at 10 years and freedom from additional aortic operation was 87.2% ± 1.5% at 5 years and 77.3% ± 2.7% at 10 years. The incidence of pseudoaneursym was 2.2%. Conclusions: The long‐term outcomes for patients undergoing total arch replacement using 4‐branched graft are favorable. However, even in the late phase, periodic follow‐up is necessary to address subsequent aorta‐related events.


The Japanese Journal of Thoracic and Cardiovascular Surgery | 2018

Successful hybrid treatment of a rare case of blunt traumatic rupture of the left atrial basal appendage and aortic arch

Yuki Ikeno; Yoshikatsu Nomura; Masamichi Matsumori; Yasuko Gotake; Hidekazu Nakai; Takashi Matsueda; Katsuhiro Yamanaka; Takeshi Inoue; Hiroshi Tanaka; Yutaka Okita

Despite advances in emergency care and the emergent transportation system, cardiac and aortic ruptures after blunt trauma are associated with high mortality and morbidity. We present a rare case of a 70-year-old man with a ruptured left atrial basal appendage and distal aortic arch after sustaining blunt trauma to the chest during a motor vehicle accident. The patient was transported to our hospital in a state of shock and taken directly to the operating room. Hybrid treatment was performed, including surgical repair of the left atrium under cardiopulmonary bypass and thoracic endovascular aortic repair, was performed. The patient fully recovered without any complications.


Interactive Cardiovascular and Thoracic Surgery | 2018

Early and long-term outcomes of open surgery after thoracic endovascular aortic repair†

Yuki Ikeno; Shunsuke Miyahara; Yojiro Koda; Koki Yokawa; Yasuko Gotake; Soichiro Henmi; Hidekazu Nakai; Takashi Matsueda; Takeshi Inoue; Hiroshi Tanaka; Yutaka Okita

OBJECTIVES This study evaluated the early and long-term outcomes of open surgery after thoracic endovascular aortic repair. METHODS We conducted a retrospective review of 41 patients who underwent open surgery following thoracic endovascular aortic repair between October 1999 and July 2017. The mean interval from primary intervention to open surgery was 3.1 ± 3.7 years. Indications for open repair were endoleak in 14 patients, graft infection in 10 patients, false lumen dilatation in 9 patients, retrograde dissection in 5 patients, migration in 1 patient and additional aneurysm in 2 patients. Eight patients underwent emergent surgical conversions. The mean follow-up period was 4.2 ± 4.0 years. RESULTS Descending aortic replacement was performed in 15 patients; thoraco-abdominal aortic repair, in 14 patients; extensive arch to descending aortic replacement, in 5 patients; and total arch replacement, in 7 patients. Six (14.6%) patients died in the hospital. The 5-year survival rate was 73.7 ± 7.2%, and freedom from reintervention was 88.5 ± 6.4%. CONCLUSIONS Early outcomes of open surgical procedures after thoracic endovascular aortic repair were still suboptimal. However, hospital survivors had excellent long-term outcomes.

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