研究者業績
基本情報
研究分野
1論文
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Journal of cardiothoracic surgery 19(1) 635-635 2024年11月22日As the current guidelines on myocardial revascularization recommend, transit-time flow measurement (TTFM) is increasingly used for intraoperative graft flow analysis during coronary artery bypass grafting (CABG) as a less invasive, more highly reproducible, and less time-consuming method. In addition to the morphological assessment using color Doppler, mean graft flow (Qm) > 15 ml/min, pulsatility index (PI) < 5.0, diastolic filling (DF) > 50%, and systolic reverse flow (SRF) < 4% have been reported to predict patent CABG grafts. However, it is difficult to determine the clear-cut cut-off value of these parameters, because they varies with the hemodynamic characters, including fractional flow reserve (FFR) of the target coronary artery. In addition to these parameters, we focused on fast Fourier transform (FFT) analysis, because the TTFM waveform morphology may be more important than Qm itself. FFT analysis is based on the principle that any periodic waveforms can be broken down into a series of pure sine waves or harmonics. Herein we review FFT analysis of the intraoperative TTFM waveforms for quality assessment of CABG grafts.
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Journal of clinical medicine 13(18) 2024年9月14日Background: We have employed a conservative management approach, including intensive control of both blood pressure and heart rate, in patients with aortic intramural hematoma (AIMH) and retrograde thrombosed type A acute aortic dissection (RT-TAAAD), sharing common clinical and imaging characteristics. Methods: To evaluate the outcomes of our conservative management approach, we retrospectively reviewed the clinical records of 98 patients diagnosed with AIMH or RT-TAAAD from January 2008 to March 2023. A conservative management approach was applied, except for those patients with an aortic diameter ≥ 55 mm, false lumen expansion, or cardiac tamponade, who underwent emergency aortic repair. Results: Besides 2 patients, who declined surgery and subsequently died from aortic rupture, 18 patients underwent urgent aortic surgery, while 78 did not. Multivariable logistic regression analysis identified the extrusion type of ulcer-like projections (ULPs) on admission and a maximum aortic diameter ≥ 45 mm on Day 1 as risk factors for acute aortic surgery. Among the 78 patients who were discharged, 9 (12%) underwent aortic surgery, while 69 (88%) did not, with a median follow-up of 44 months. The overall actuarial aortic surgery-free rates were 78% at 1 year and 72% at 5 years, respectively. A Cox proportional hazards analysis identified ULPs and an aortic diameter ≥ 45 mm at discharge as risk factors for late aortic surgery. Conclusions: The early and late outcomes of our conservative strategy for AIMH and RT-TAAAD demonstrate favorable surgery-free rates. The extrusion type of ULPs on admission and an aortic diameter ≥ 45 mm on Day 1 are predictors of acute aortic surgery, while ULPs and an aortic diameter ≥ 45 mm at discharge are predictors of late surgery.
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Circulation Journal 87(11) 1672-1679 2023年10月25日
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Journal of cardiology cases 27(6) 251-253 2023年6月UNLABELLED: We report a case of surgically repaired symptomatic mitral valve regurgitation (MR) in a 61-year-old woman with anomalous unilateral single pulmonary vein. A two-staged surgery was scheduled; first a catheter embolization of anomalous vessel to avoid recirculation of the blood into the left atrium during cardiopulmonary bypass, and second a mitral valve repair via right lateral thoracotomy. LEARNING OBJECTIVE: Scimitar sign is a horn-like shape on plain chest radiograph. One of the possible diagnoses is partial anomalous pulmonary venous return (APVR), which often requires surgical interventions due to comorbidities of congenital heart disease and recurrent pneumonia [1-3]. Another is anomalous unilateral single pulmonary vein (AUSPV), which is generally asymptomatic, and therefore, requires no medical interventions. This case addresses the advantage of multidetector computed tomography (CT) and the safety of two-staged strategy.
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Interactive cardiovascular and thoracic surgery 35(3) 2022年8月3日OBJECTIVES: Patients with cardiovascular disease are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Although SARS-CoV2 vaccination may be effective, its impact on surgical patients is not well studied. We investigated the effects of cardiovascular surgery, especially under cardiopulmonary bypass (CPB), on the antibody titres after SARS-CoV2 vaccination. METHODS: A prospective observational study was designed for patients undergoing surgery between July and November 2021. The immunoglobulin G against the receptor-binding domain was measured and antibody preserved rate (APR) was calculated from perioperative titres comparison. RESULTS: Enrolled 63 study patients were divided into 39 undergoing surgery with CPB (Group CPB) and 24 without CPB (Group None). Preoperative vaccines were BNT162b2 (Pfizer/BioNTech) (n = 58, 92%) and mRNA-1273 (Moderna) (n = 5, 8%). While immunoglobulin G against the receptor-binding domain titres did not significantly decrease after surgery in Group None, they decreased significantly in Group CPB from 21.80 [11.15, 37.85] to 11.95 [6.80, 18.18] U/ml (P < 0.001) a day after surgery, 11.40 [7.85, 22.65] U/ml (P < 0.001) 14 days after surgery and 7.60 [4.80, 17.60] U/ml (P < 0.001) a month after surgery. The APRs a day after the surgery were significantly lower in Group CPB (0.46 [0.41, 0.60]) than in Group None (0.80 [0.68, 0.87]) (P < 0.001). CONCLUSIONS: The SARS-CoV2 antibody titres significantly decreased with lower APRs immediately after surgery under CPB. Based on our informative results, careful considerations of vaccination schedule might be required for surgery under CPB.
MISC
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日本外科学会雑誌 114(2) 253-253 2013年3月5日
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日本外科学会雑誌 111(2) 51-51 2010年3月5日
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Ann Vasc Dis 3(3) 215-221 2010年 査読有り
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SURGERY TODAY 39(7) 603-605 2009年7月 査読有りThis report presents an extremely rare case of paraplegia following emergency surgery for a nonruptured symptomatic abdominal aortic aneurysm. A 62-year-old man underwent an emergency surgical repair for a symptomatic nonruptured infrarenal abdominal aortic aneurysm. On postoperative day 2 paraplegia following spinal cord ischemia occurred at the T8 level. The site of the ischemia was situated too high for clamping to have caused this condition, unless the patient had a congenital anomaly in the blood supply to the spinal cord or it had been caused by the previously occluded great radicular artery, which was maintained by the collateral blood supply from the iliac circulation.
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Left axillary arterial perfusion for cerebrospinal protection in proximal descending aortic aneurysmGeneral Thoracic and Cardiovascular Surgery 56(12) 589-591 2008年12月 査読有りA 73-year-old man presented with DeBakey type IIIa chronic aortic dissection. The aneurysm of the descending aorta was replaced using an open proximal technique with hypothermic circulatory arrest. For cerebrospinal protection, the left axillary artery was cannulated, which perfuses the vertebral artery and affects the Willis arterial circle, the anterior spinal artery, and the collateral blood supply to the spinal cord. Cannulation of the left axillary artery was a safe and effective surgical option for antegrade cerebral perfusion and spinal protection. © 2008 The Japanese Association for Thoracic Surgery.
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Circulation journal : official journal of the Japanese Circulation Society 72 1084-1084 2008年10月20日
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オペナーシング 23 138-147 2008年
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General Thoracic and Cardiovascular Surgery 56(1) 22-24 2008年1月 査読有りAberrant right subclavian artery is a rare condition with a prevalence of 0.5%-2.0% of the population. We report a case of distal aortic arch aneurysm with right subclavian artery. A 75-year-old man who was asymptomatic was referred to our hospital for a thoracic aortic aneurysm. Computed tomography showed a 55-mm fusiform aneurysm of the distal arch and an aberrant right subclavian artery. Total arch replacement was performed via median sternotomy with antegrade selective cerebral perfusion and hypothermic circulatory arrest. We reconstructed the aberrant right subclavian artery in the normal position to avoid compression of the esophagus and trachea caused by future aneurysmal dilatation of the orifice of the aberrant right subclavian artery and potential high risk for rupture. © 2008 The Japanese Association for Thoracic Surgery.
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CIRCULATION JOURNAL 71(11) 1669-1677 2007年11月 査読有りBackground Restenosis still occurs, even with the sirolimus-eluting stent (SES), and the precise mechanisms and the impact of stent fracture on restensosis have not yet been elucidated. Methods and Results Intravascular ultrasound (IVUS)-guided SES implantation was performed in 184 lesions in 151 patients with stable and unstable angina. Serial (pre-, post- and follow-up) quantitative coronary angiography analysis was obtained in 169 lesions in 138 patients (angiographic follow-up rate: 91%) and 12-month clinical follow-up was done in all patients. Restenosis occurred in 13 (7.7%) of 169 lesions. Stent fracture occurred in 4 (2.4%) of 169 lesions at follow-up. Of the 13 restenotic lesions, 8 had intimal hyperplasia, 4 had stent fracture, and 1 had late stent thrombosis at 7 months. Although multivariate logistic regression analysis revealed that minimal lumen area (min-LA) post (p=0.027), total stent length (p=0.003) and diabetes (p=0.032) were significant independent predictors of restenosis, univariate analysis showed that stent fracture was more common in the restenosis than in the non-restenosis groups (p=0.001). Conclusions Although min-LA post by IVUS, total stent length by QCA and diabetes are independent predictors for angiographic restenosis, stent fracture occurred in 4 lesions (2.4%) and all of them resulted in restenosis (31% of the restenosis). The impact of stent fracture and its potential role in the development of restenosis deserves further study.
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Surgery today : the Japanese journal of surgery 37(10) 893-896 2007年10月1日
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日本血管外科学会雑誌 16(2) 49-54 2007年閉塞性動脈硬化症に対する血管内治療は,腸骨動脈領域では良好な成績が示されており,TASC(TransAtlantic Inter-Society Consensus)の治療指針においてもTASC C,D病変を除き手術的治療に代わる方法として位置づけられている.しかし,大腿・下腿動脈領域においてはその適応・成績に関していまだ一定の見解は得られておらず,施設や術者の方針にゆだねられているところが多い.今回われわれは,透析や糖尿病を合併したハイリスク症例や重症虚血肢に対して積極的に血管内治療を行い,比較的良好な成績が得られたので報告する.2005年 2 月から2006年 9 月の間に血管内治療を行った29症例,37肢,44病変を対象とした.内訳は男性23例,女性 6 例,平均年齢は71歳であった.病変部位は浅大腿動脈23病変,膝窩動脈13病変,下腿動脈 8 病変であった.浅大腿病変はステント留置術を行い,膝下膝窩動脈・下腿動脈病変はバルーン拡張術を行った.治療の初期成功率はいずれも100%で,合併症は膝窩動脈血腫 1 例のみで死亡はなかった.浅大腿動脈病変の一次開存率は 3 カ月で94%,6 カ月で75%,12カ月で66%であり,一次補助開存率はそれぞれ100%,75%,66%であった.救肢率はそれぞれ96%,96%,85%であった.生存率は 3 カ月で100%,6 カ月で93%,12カ月で93%であった.膝下膝窩動脈・下腿動脈病変の一次開存率は 3 カ月で89%,6 カ月で67%であり,一次補助開存率はそれぞれ89%,89%であった.救肢率は 3 カ月,6 カ月で100%であった.生存率は 3 カ月で86%,6 カ月で86%であった.鼠径部以下の病変に対する血管内治療はバイパス手術と比較して長期の開存率は劣るが,低侵襲で早期社会復帰が可能であり,合併症や死亡が少ないなどの点から,重症虚血肢やハイリスク症例に対する治療の選択肢になりうると考えられた.
書籍等出版物
6共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 2023年4月 - 2026年3月
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日本学術振興会 科学研究費助成事業 2020年4月 - 2023年3月
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日本学術振興会 科学研究費助成事業 2014年4月 - 2018年3月
教育内容・方法の工夫(授業評価等を含む)
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件名-概要循環器系の講義は、動画やEBMを主体とした内容の講義。
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件名-概要ポリクリの教育には、手術だけでなく術前・術後管理に関しての知識を伝え、循環器系および外科系の知識や魅力を伝える。
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件名-概要特定看護師養成コースの教育は、今後の臨床の質や効率の向上を目指す。
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件名-概要大学院生に対する研究指導は、臨床研究だけでなく医療科学部との連携や循環器内科と共同することにより、より高度な内容の臨床研究と、研究範囲の拡大を目指す。
教育方法・教育実践に関する発表、講演等
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件名-終了年月日2013/11/30概要(教育講演) 心臓血管外科Up-To-Date(特定看護師はどうかわるか). 第2回日本NP協議会研究会. 東京
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件名-終了年月日2012/03/03概要(特別講演)高木 靖、櫻井祐輔、天野健太郎、樋口義郎、近藤弘史、秋田淳年、石田理子、金子 完、石川 寛、渡邊 孝、安藤太三. 特別企画1 冠動脈外科におけるチームワークの重要性 冠動脈外科における特定看護師の役割. 第17回日本冠動脈外科学会学術大会; 東京.
その他教育活動上特記すべき事項
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件名-終了年月日2014/03/07概要第2回藤田保健衛生大学心臓血管外科セミナー 大動脈弁形成術
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件名-終了年月日2013/10/01概要第1回藤田保健衛生大学心臓血管外科セミナー 大動脈弁形成術
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件名-終了年月日2013/08/18概要医学部教育ワークショップ:卒業時、および臨床実習終了時アウトカム(学習成果)の設定
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件名-終了年月日2011/08/27概要医学教育ワークショップ:多肢選択問題、臨床長文問題、計算問題ブラッシュアップ