研究者詳細 - 中嶋　博之

Coronary artery bypass grafting (CABG) is advantageous for long-term clinical outcomes compared to percutaneous coronary intervention (PCI) in hemodialysis (HD) patients, as PCI has a lower short-term mortality but higher late revascularization risk. Therefore, CABG is very important for HD patients in current clinical practice. In HD patients, the presence of an arteriovenous fistula may lower the flow capacity of the ipsilateral internal thoracic artery (ITA) and induce flow steal, and concomitant microvascular disease (MVD) can cause myocardial ischemia and irreversible myocardial damage even after CABG. The use of the ipsilateral ITA as a free graft or the contralateral ITA as a graft to the left anterior descending artery can be reasonable options. MVD complicates the preoperative evaluation and could worsen clinical outcomes in HD patients. Graft selection and MVD in coronary and systemic circulation are mutually influential future concerns.

DOI CiNii Research

Reversal flow in the left anterior descending artery after internal thoracic artery grafting

Nakajima H.

Journal of Cardiothoracic Surgery ( Journal of Cardiothoracic Surgery ) 17 ( 1 ) 2022年12月

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Surgical outcomes of bridge-to-bridge therapy with extracorporeal left ventricular assist device for acute myocardial infarction in cardiogenic shock

Tokunaga C.

BMC Cardiovascular Disorders ( BMC Cardiovascular Disorders ) 22 ( 1 ) 2022年12月

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Validity of Ipsilateral Internal Mammary Coronary Artery Bypass Graft of Arteriovenous Fistula

Hayashi J.

Heart Lung and Circulation ( Heart Lung and Circulation ) 31 ( 10 ) 1399 - 1407 2022年10月

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Safety and arch complications after hemiarch versus total arch replacement with stented elephant trunk in acute type 1 dissection: Is a stent graft always beneficial?

Hayashi J.

JTCVS Open ( JTCVS Open ) 11 14 - 22 2022年09月

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Total arch replacement using frozen elephant trunk technique with Frozenix for distal aortic arch aneurysms

Tokunaga C.

Interactive Cardiovascular and Thoracic Surgery ( Interactive Cardiovascular and Thoracic Surgery ) 35 ( 1 ) 2022年07月

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JCS/JSCVS 2018 Guideline on Revascularization of Stable Coronary Artery Disease

Nakamura M.

Circulation Journal ( Circulation Journal ) 86 ( 3 ) 477 - 588 2022年

DOI PubMed CiNii Research

心臓移植待機期間の長期化は待機中死亡の増加と移植後成績の悪化につながる

木下修, 中嶋博之, 土屋美代子, 吉武明弘, 中埜信太郎

移植 ( 一般社団法人日本移植学会 ) 57 ( Supplement ) s200_1 - s200_1 2022年

2010年の臓器移植法改正まで心臓移植は年間0~11例だった。植込型VADの保険適応は2011年からである。待機患者は予後1年以内と見込まれる重症心不全患者であり、2009年以前は移植数の2倍以上の待機中死亡があった。　臓器移植法改正後、心臓移植数は年間50例以上にまで増えた。植込型VADの保険適応により年単位で移植待機できる患者が増えたことも加わり、待機中死亡は減少し2010～2015年は年間20人程度になった。心臓移植希望者は増加し、ここ数年は年間200人程度が新規登録されている。その結果、移植待機期間は長期化し続け、今や5年を超え、これから移植希望登録する患者は8年以上になると見込まれる。VAD治療が行えない患者はほとんど移植に至らず、移植を受けられるのはVAD装着患者ばかりである。日本の植込型VAD治療は4年生存率が8割程度で、8年生存率は6割程度になる可能性もあり、移植待機期間の長期化とともに待機中死亡が増えると思われる。実際ここ数年の待機中死亡は年間40人前後に増え、さらに増えることが懸念される。　心臓移植適応判定時には悪性腫瘍を含めた心臓以外の疾病が移植に不適当でないことを確認しているが、移植希望登録から8年以上も経過すると、適応判定時とは変わっている患者も出てくる。移植が不適当な状態が潜んでいても、気が付かずにそのまま移植が行われてしまえば移植後成績は悪化する。移植時年齢がより高齢になることも移植後成績に影響しうる。en-copyright=

DOI CiNii Research

ネイルガンによる穿通性心損傷および脳損傷の１例

小野寺康暉, 古峰弘之, 土屋亮輔, 栢原智道, 寺西亮雄, 武裕士郎, 吉武明弘, 中嶋博之, 根本学, 栗田浩樹

神経外傷 ( 一般社団法人日本脳神経外傷学会 ) 44 ( 2 ) 55 - 59 2021年12月

Nail gun injuries often occur in the extremities, but important organs such as the heart and brain can be damaged in some cases. Some of them result in several wounds and require urgent surgical interventions. Because injuries of multiple organs are extremely rare, the priority of surgical treatments is not established and should be considered according to each case. Herein, we report a case of penetrating heart and head injuries caused by a nail gun. A 44–year–old man was admitted to our institute after shooting himself using a nail gun the previous day. His consciousness was clear without the neurological deficit and his vital signs were stable despite the vital organ injuries. Chest Computed Tomography (CT) scan showed a nail penetrated his heart and head CT revealed the tips of 2 nails reached the right frontal lobe and the right temporal lobe respectively, but they did not indicate cardiac tamponade and intracranial hemorrhage. The other 4 nails around the occipital and cervical portion did not reach the intracranial and stopped in the subcutaneous tissue. After consultation with cardiovascular surgeons, we decided to perform surgery on his heart first, because the nail can get deeper and destroy his heart owing to its beat. It was performed using a cardio–pulmonary bypass under heparin administration. After measuring activated clotting time, we confirmed that the effect of heparin had disappeared, and started craniotomy. All the nails were successfully removed. The postoperative course was uneventful without neurological deficit and complications, and he was discharged on the 16th postoperative day. In the case of multiple organ injuries, rational strategy and earlier surgical interventions are indispensable for a good prognosis.

DOI CiNii Research

Early and mid-term results of transcatheter aortic valve implantation and valve durability assessment

Tochii M.

Heart and Vessels ( Heart and Vessels ) 36 ( 10 ) 1566 - 1573 2021年10月

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Premature Acute Myocardial Infarction in a Young Patient With Sitosterolemia

Yamada Y.

CJC Open ( CJC Open ) 3 ( 8 ) 1085 - 1088 2021年08月

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The change in the mitral-septal angle after surgery for atrial functional mitral regurgitation

Kaneyuki D.

General Thoracic and Cardiovascular Surgery ( General Thoracic and Cardiovascular Surgery ) 69 ( 1 ) 1 - 7 2021年01月

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Two-year results of the 17-mm avalus aortic valve in the PERIGON Japan trial

Okita Y.

Circulation Journal ( Circulation Journal ) 85 ( 7 ) 1035 - 1041 2021年

Background:The PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Japan Trial was developed to assess the safety and effectiveness of the 17-mm Avalus bioprosthesis (Medtronic, Minneapolis, MN, USA) in patients undergoing surgical aortic valve replacement.Methods and Results:The primary endpoint in the trial was the percentage of patients achieving the composite of at least 1 class improvement in New York Heart Association (NYHA) functional class at 1 year compared with baseline and effective orifice area index (EOAI) of 0.6 cm2/m2or greater at 1-year after implantation, compared with a performance goal of 60%. The present study reports outcomes through 2 years. Eleven patients were implanted (10 [91%] female, median age 78.3 years). From baseline to 1 year, 10 subjects (91%) showed an improvement in NYHA classification. At 1 year, mean (±SD) EOAI was 0.82±0.17 cm2/m2, with 10 patients (91%) having an EOAI ≥0.6 cm2/m2. As such, 9 of 11 patients (82%) successfully met the primary endpoint. One death occurred between the 1- and 2-year follow-up visits, unrelated to the valve. There were no valve reinterventions, explants, or device deficiencies through 2 years.Conclusions:The PERIGON Japan Trial met its primary endpoint. Surgical implantation of the 17-mm Avalus aortic bioprosthesis can be performed with an acceptable incidence of device-related adverse events, and the valve performs effectively based on echocardiographic findings.

DOI PubMed CiNii Research

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