Toshihiro Ohata

Comparison of durability of bioprostheses in tricuspid and mitral positions.

BACKGROUND Few reports have assessed differences in the durability of mitral and tricuspid bioprostheses after simultaneous implantation of the same bioprosthesis in both positions. We investigated the long-term outcome after simultaneous mitral valve replacement (MVR) and tricuspid valve supraannular implantation (TVSI) with the Carpentier-Edwards bioprostheses in patients with severe tricuspid regurgitation and advanced mitral valve disease. METHODS Between 1982 and 1998, 37 patients in our hospital underwent MVR and TVSI with Carpentier-Edwards bioprostheses. The mean age of the patients was 55+/-11 years. The average postoperative follow-up was 7.9+/-4.5 years after surgery (range 0 to 14.6 years, 315.1 patient-years). The follow-up rate was 100%. We evaluated the actuarial survival rate, the actuarial freedom from structural valve deterioration (SVD) and reoperation, and postoperative complications. RESULTS The overall actuarial survival rate at 13 years after the operation was 69%+/-31%. The actuarial freedom from SVD and reoperation in the mitral and tricuspid positions were 78+/-22 and 100% and 70+/-30 and 90%+/-10% (p = 0.03), respectively. No patient had systemic or pulmonary thromboembolism, or complications associated with fatal arrhythmia. CONCLUSIONS These results suggest that the bioprostheses in the tricuspid position yield significantly better long-term results than those in the mitral position after simultaneous MVR and TVSI.

Tricuspid valve supra-annular implantation in adult patients with Ebstein's anomaly

BACKGROUND Tricuspid valve supra-annular implantation (TVSI) has been performed for adult patients with Ebsteins anomaly at our hospital for several decades. TVSI is characterized by reliable reduction of tricuspid annulus size without affecting the conduction system; by prevention of residual tricuspid regurgitation (RTR) through preservation of the native tricuspid valve; and by implantation of the bioprosthesis at a supra-annular site. METHODS Ten adult patients with Ebsteins anomaly underwent TVSI. The right ventricular diameter and residual tricuspid regurgitation were evaluated by echocardiography preoperatively, at discharge, 1 year after the operation, and over the long term (12.4 +/- 5.5 years). Actuarial survival rate, actuarial freedom from structural valve deterioration rate, and postoperative occurrence of arrhythmia were also evaluated. RESULTS The actuarial survival rate at 19 years was 76 +/- 15%. Tricuspid regurgitation disappeared in 8 patients just after operation. Right ventricular diameter was significantly smaller at discharge than preoperatively (63 +/- 11 vs 37 +/- 9, p < 0.01), and there were no significant differences between values at discharge and at follow-up. The actuarial freedom from structural valve deterioration rate and the reoperation rate were both 100%. There were no fatal complications related to arrhythmia or thromboembolism. CONCLUSIONS TVSI is useful for adult patients with Ebsteins anomaly. The absence of complications related to fatal arrhythmia and thromboembolism, good durability of the bioprosthesis, and a simple operative procedure are merits of this therapy.

Hemodynamic Alterations during Laparoscopic Cholecystectomy

Serial changes of hemodynamic parameters were investigated using a Swan-Ganz catheter in 14 patients undergoing laparoscopic cholecystectomy (LAP) and 12 patients undergoing mini-laparotomy cholecyste

Respiratory Movement of the Membranous Part of the Trachea after Thoracic Esophagectomy

Respiratory movement of the membranous part of the trachea was investigated using cineradiography 3 days and 1 month after operation in 10 patients who underwent thoracic esophagectomy through a right

Difference in Structural Change in the Carpentier-Edwards Pericardial Valves Implanted in the Mitral and Tricuspid Positions

We report a 29-year-old patient with prosthetic valve dysfunction with severe calcific stenosis in the mitral position but no structural change in the tricuspid position after mitral valve replacement and tricuspid valve supra-annular implantation with same bioprostheses at the seven years before. The difference in structural change between the mitral position and the tricuspid position might be due mainly to the effect of mechanical stress on the cusps, rather than to any difference in serum calcium levels. However, some hormonal effect other than that of the parathyroid hormone on the systemic and pulmonary circulation might be related to the early progression in cusp calcification in the systemic circulation.