Impact of Aortic Valve Replacement for Aortic Stenosis on Coexisting Mitral Stenosis.

Purpose:The course of coexisting mitral valve stenosis is not clear after aortic valve replacement (AVR) for aortic stenosis (AS). We investigated the effect of AVR for AS on coexisting mitral stenosis (MS).Methods:Between January 2002 and December 2019, 1338 consecutive patients underwent surgical AVR at Shiga University of Medical Science. Of them, 34 patients with moderate MS (mitral valve area [MVA]: 1.5–2.0 cm2) were included in the present study. We evaluated the postoperative clinical outcomes in these patients.Results:Mean MVA in our cohort significantly increased 1 week after operation compared with preoperative values, and the change was maintained for 5 years after surgery. Follow-up was completed in 94.1% (32/34) patients, and mean follow-up duration was 4.0 ± 3.0 years. No patients underwent mitral surgery for remaining MS after AVR during postoperative follow-up.Conclusion:AVR for AS resulted in increased MVA in patients with MS, and the change was maintained during follow-up

サイセンタン ノ サンジゲン イメージング システム : シンゾウ ケッカン ゲカ ニオケル Virtual Reality ギジュツ ノ ユウヨウセイ

滋賀医科大学心臓血管外科では医療用画像を三次元構築し、臓器を立体表示するVirtual Reality (VR) 技術を用いて心臓血管系の3D解析研究を進めている。VRでは臓器の内腔を可視化することができ、また3D構築した画像に直接介入し、従来の2D解析では評価困難であった複雑な構造も術者の視点で直観的に計測できるという利点がある。あらゆる医療画像データを三次元化し, かつ直感的な立体計測が可能なVR技術は, これまでの診断精度を上回る形態学的な情報を臨床医に提示し得ると考えられる。特に外科医にとって有用な手術支援VR画像は, 難易度が高い手術の治療成績を向上させる可能性が高い。Adequate preoperative planning may facilitate successful procedures in cardiovascular surgery. We have newly developed a system the Vesalius 3D suite, combining three-dimensional (3D) image-processing software with an optic-tracking spatial navigation, allowing quick, accessible 3D image interpretation for virtual reality (VR) exploration and measurement of complex anatomy. In this review, we present a novel method of virtual imaging analysis for preoperative planning and simulation in cardiovascular operation using this 3D-VR system. Based on unimodal or multimodal medical imaging data, DICOM data sets can be reconstructed for 3D visualization. Virtually reconstructed images can be viewed on stereoscopic 3D display, revealing each patient’s specific anatomy and the internal structures in exquisite detail. Highly accessible 3D interpretation promptly permits precise and intuitive measurements of repair-relevant anatomical parameters including geometrically complex shapes. This technology may promote understanding of form and function in the cardiovascular system, and facilitate operative procedures in more challenging cases. Furthermore, this system can be especially valuable for any surgeon to gain experience in practicing for rarely-performed procedures or uncommon patient-specific preoperative surgical simulations

Additional file 1 of Off-pump bilateral internal thoracic artery grafting in patients with left main coronary artery disease

Supplementary Material

Successful revascularization using a saphenous vein for a ruptured brachial artery aneurysm in a patient with neurofibromatosis type I

Vasculopathy in patients with type 1 neurofibromatosis is known. Brachial artery aneurysms in patients with type 1 neurofibromatosis are rare, but any rupture can be extremely serious. A 56-year-old woman presented to our hospital with sudden pain in her right upper arm. Computed tomography revealed a ruptured brachial artery aneurysm, and operative reconstruction using a saphenous vein graft was performed. This is one of the few case reports of such successful revascularization using saphenous vein. The pathologic findings suggest neurogenic tumor invasion, and end-to-side anastomosis was effective in avoiding hemorrhagic complications

Impact of vital capacity on outcome after total arch replacement.

Objectives: Although chronic obstructive pulmonary disease has been recognized as a significant risk factor for open-heart surgery, the relationship between vital capacity and postoperative outcomes remains unclear. Our objective was to analyze the effect of vital capacity on outcomes after total arch replacement.Methods: Between January 2003 and December 2018, 228 patients undergoing total arch replacement who were elective cases with preoperative spirometry records were retrospectively reviewed. Patients were divided into two groups, based on whether their preoperative vital capacity was less than or greater than 2.5 L. We compared perioperative data and long-term outcome after adjusting their backgrounds by propensity score matching analysis.Results: The lower vital capacity group had more tracheostomy patients (5.1% vs 0.0%; p = 0.045). The actuarial survival rate was 58.0% in the lower vital capacity group and 86.3% in the higher vital capacity group at 8 years. Log-rank analysis revealed a significant difference between the two groups (p = 0.011). In the multivariate Cox proportional hazard model, vital capacity < 2.5 L (p = 0.024) and estimated glomerular filtration rate < 30mL/minute/1.73 m2 (p = 0.012) showed a significant association with a higher risk of long-term mortality.Conclusions: Vital capacity should be considered an important risk factor for postoperative respiratory complications and long-term mortality in patients undergoing total arch replacement

Total arch replacement in octogenarians

Objectives:We investigated the effect of a preoperative age ≥80 years on postoperative outcomes in patients who underwent isolated elective total arch replacement using mild hypothermic lower body circulatory arrest with bilateral antegrade selective cerebral perfusion.Methods:A total of 140 patients who had undergone isolated elective total arch replacement between January 2007 and December 2020 were enrolled in the present study. We compared postoperative outcomes between 30 octogenarian patients (≥80 years old; Octogenarian group) and 110 non-octogenarian patients (≤79 years old; Non-Octogenarian group).Results:Overall 30-day mortality and hospital mortality were 0% in both groups, and there was no significant difference in overall survival between the 2 groups (log-rank test, P = 0.108). Univariable Cox proportional hazard analysis showed that age as continuous variable was only the predictor of mid-term all-cause death (hazard ratio 1.08, 95% confidence interval 1.01-1.16; P = 0.037), but not in the Octogenarians subgroup (P = 0.119).Conclusions:Preoperative age ≥80 years is not associated with worse outcomes postoperatively after isolated elective total arch replacement with mild hypothermic lower body circulatory arrest and bilateral antegrade selective cerebral perfusion

Bilateral Internal Thoracic Artery Grafting in Hemodialysis Patients.

Background:We compared postoperative outcomes in hemodialysis (HD) patients who underwent isolated coronary artery bypass grafting (CABG) for multivessel disease using either bilateral or single skeletonized internal thoracic artery.Methods and Results:Among 1,486 patients who underwent isolated CABG between 2002 and 2020, 145 HD patients were retrospectively analyzed. After inverse probability of treatment weighting, there were no significant differences in the preoperative characteristics. No significant differences in 30-day mortality (P=0.551) or postoperative deep sternal wound infection (P=0.778) were observed. However, the bilateral internal thoracic artery grafting group had a lower postoperative stroke rate (0% vs. 4.0%, P=0.019). No significant differences in freedom from all-cause death (P=0.760) and cardiac death (P=0.863) were found. In the multivariate Cox proportional hazards models, bilateral internal thoracic artery grafting was not associated with all-cause death (P=0.246) or cardiac death (P=0.435).Conclusions:Bilateral internal thoracic artery grafting in HD patients did not improve mid-term outcomes, but it was also not associated with worse postoperative outcomes. Use of the bilateral internal thoracic artery may be an important option in patients with limited conduits to prevent postoperative complications