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Hitoshi Hirose

Publications and source records attributed to Hitoshi Hirose.

48 records · Page 3Linked to original sources
PubMed2002

Coronary artery bypass grafting in patients on chronic hemodialysis: diabetic nephropathy versus nondiabetic nephropathy.

Patients with both end-stage renal disease and diabetes mellitus carry an increased risk of coronary atherosclerosis. This study was performed to evaluate the perioperative and remote outcome of diabetic nephropathy patients on hemodialysis undergoing coronary artery bypass grafting (CABG). We retrospectively analyzed the results of CABG performed between September 1, 1993 and August 31, 2001. Preoperative, perioperative, and follow-up data of patients with hemodialysis primarily due to diabetic nephropathy (Group D, n = 31, 22 males and 9 females with a mean age of 60.1 +/- 6.6) were collected and compared to patients with hemodialysis primarily due to nondiabetic nephropathy (group N, n = 21, 17 males and 4 females with a mean age of 60.9 +/- 11.2). Preoperative risk factors between the 2 groups were not significantly different. The mean number of distal anastomoses was 2.5 +/- 1.2 in Group D and 2.5 +/- 1.0 in Group N (p = not significant [NS]). All patients received at least 1 internal mammary artery graft. There was 1 in-hospital death in each group. Postoperative recovery, mortality, and morbidity were not significantly different between the two groups. At the mean follow-up of 2.7 years, the actuarial 3 year survival rate was 72.8% in Group D and 78.7% in Group N (p = NS). The actuarial 3 year cardiac event-free rate was 79.7% in Group D and 74.7% in Group N (p = NS). CABG for hemodialysis patients can be performed with acceptable risks. Diabetic nephropathy has no impact on early or remote patient outcomes among patients on hemodialysis.

Adult↗
PubMed2002

Off-pump coronary artery bypass grafting for patients with three-vessel disease.

BACKGROUND: Off-pump coronary artery bypass grafting (CABG) has been performed since 1996 in our institute, and its application has recently been expanded to patients with three-vessel disease. A study was performed to clarify the benefit of off-pump CABG for patients with three-vessel disease. METHODS: Between June 1, 1991 and September 30, 2001, a total of 1089 patients with three-vessel disease (832 men and 257 women; mean age, 64.0 +/- 9.1 years) underwent on-pump CABG. After 1997, a total of 310 patients with three-vessel disease (223 men and 87 women; mean age, 68.8 +/- 8.6 years) underwent off-pump CABG. Data of the historical cohort of on-pump CABG and the concurrent cohort of off-pump CABG were analyzed retrospectively. RESULTS: The 2 groups were age and gender matched. Significant comorbidities were more often observed in the off-pump group than in the on-pump group. The mean number of bypass grafts in the off-pump versus on-pump CABG was 3.3 vs 3.7, P <.0001. The mean intubation period, intensive care unit stay, and postoperative hospital stay were 7.9 vs 11.7 hours, 2.2 vs 3.0 days, and 14.5 vs 17.5 days, respectively (P <.0001). In-hospital mortality rate (0.6% vs 1.2%, respectively) and morbidity rates (10.3% vs 12.9%, respectively) were not significantly different. After surgery, calculated event-free rates at 2 years were 93.3% vs 91.9%, respectively; P = not significant. CONCLUSIONS: In patients with multivessel disease, off-pump CABG provided early recovery, and its complication rates and early follow-up results were equivalent to on-pump CABG.

Adult↗
PubMed2002

On-pump versus off-pump coronary artery bypass using quadruple arterial grafts.

The optimal combination of arterial grafts for quadruple coronary artery bypass is the bilateral internal mammary artery, the radial artery, and the gastroepiploic artery. Patients who underwent quadruple bypass in our hospital group between December 1995 and March 2001 were retrospectively analyzed to determine whether off-pump surgery (n = 27) provides better outcomes than conventional on-pump surgery (n = 51). Preoperative risk factors as well as the mean number of distal anastomoses (4.5 in the off-pump versus 4.8 in the on-pump patients) were not significantly different between the 2 groups. Postoperative recovery was significantly faster in the off-pump group than in the on-pump group (intubation time, 6.4 versus 16 hours; stay in intensive care unit, 2 versus 3 days; and postoperative hospital stay, 12.3 versus 15.8 days). Early stenosis-free graft patency rates did not differ significantly (90.3% versus 89.3%). No late cardiac events were observed in the off-pump group, while 4 occurred in the on-pump group. Quadruple arterial bypass without cardiopulmonary bypass is safe, and it allows faster recovery. The follow-up results of off-pump patients so far have been satisfactory.

Adult↗
PubMed2002

Triple arterial coronary revascularization using the radial artery and bilateral internal mammary arteries versus the gastroepiploic artery and bilateral internal mammary arteries.

Arterial grafts are frequently used in modern coronary artery bypass grafting (CABG) and the benefit of the 2 internal mammary arteries (IMA) has already been established. However, the choice of the third arterial conduit, in addition to the IMA, is controversial. We have retrospectively analized perioperative and the follow-up results of patients who underwent CABG with triple arterial bypass using either the radial artery (RA) or the gastroepiploic artery (GEA) in conjunction with the bilateral IMA (BIMA). Between December 1995 and June 2001, 1,516 consecutive isolated CABG operations were performed at Shin-Tokyo Hospital. Among them the RA and BIMA were used in 96 patients (78 males, 18 females; mean age, 63.2+/-6.7 years, group R), and the GEA and BIMA in 123 patients (101 males, 22 females; mean age, 61.0+/-11.6 years, group G). Their perioperative and follow-up data were studied. The preoperative risk factors were similar between the 2 groups, except that there were significantly fewer patients with renal dysfunction in group R. The surgical results did not differ between the 2 groups; however, the GEA was more commonly used for revascularization of the right coronary artery, while the RA was used for the diagonal, circumflex or right coronary arteries. Surgical mortality and morbidity rates were not significantly different. During the follow-up period of 2.3+/-1.6 years, the event-free rates as well as the survival rates were not significantly different. CABG with either the RA or the GEA in conjunction with the BIMA can be performed safely. The surgical results as well as the follow-up results were acceptable and no significant differences between the 2 groups were observed.

Aged↗
PubMed2002

Side clamp used during off-pump coronary artery bypass does not increase the risk of stroke.

BACKGROUND: The purpose of this study was to investigate whether the incidence of stroke after off-pump AC bypass was lower than that after on-pump AC bypass. MATERIAL/METHODS: A prospective study was performed with consecutive patients who underwent isolated AC bypass in the Shin-Tokyo Hospital Group between July 1, 1996 and December 31, 2001 AC bypass was defined as coronary artery bypass requiring proximal anastomoses onto the ascending aorta. The patients were divided into two groups, depending on the use of cardiopulmonary bypass: on-pump and off-pump groups. Perioperative data were prospectively collected and the risk factors for postoperative stroke were investigated. RESULTS: Preoperative comorbidities were more frequent in the off-pump group. The number of distal anastomoses was not significantly different but the number of proximal anastomoses was significantly greater in the on-pump group than in the off-pump group. The incidence of postoperative stroke was 0.3% in the off-pump group and 2.0% in the on-pump group. Significant risk factors influencing the occurrence of postoperative stroke included: use of cardiopulmonary bypass, age over 75, peripheral vascular disease, saphenous vein use, and postoperative atrial fibrillation. Multivariate analysis demonstrated that the use of cardiopulmonary bypass, age over 75, and peripheral vascular disease were isolated predictors of postoperative stroke. CONCLUSIONS: The incidence of postoperative stroke was lower in the off-pump group than in the on-pump group, even though the side clamp was applied to the ascending aorta for aortocoronary bypass. The use of side clamping for off-pump AC bypass does not increase the risk of postoperative stroke.

Age Factors↗
PubMed2002

Concomitant cholecystectomy and coronary artery bypass.

INTRODUCTION AND METHODS: Cholelithiasis is a common disorder which may be present with coronary artery disease. Concomitant cholecystectomy and coronary artery bypass grafting (CABG) was performed in selected patients and retrospective study was performed to verify the safety of the concomitant surgery. RESULTS: A total of 55 patients (41 males and 14 females, mean age 64.6 8.7 years) underwent concomitant cholecystectomy and CABG between 1992 and 2001 at the Shin-Tokyo Hospital Group. Exclusion from concomitant surgery was choledocholithiasis and/or acute cholecystitis. Cholecystectomy was performed via an upper abdominal incision extending the mid-sternal incision. In 48 patients (87.3%), the gastroepiploic artery (GEA) was used for coronary revascularization. The mean number of bypass grafts was 3.6 1.2. The mean operative time, intubation period, ICU stay, and postoperative hospital stay were 376 minutes, 15.6 hours, 3.9 days, and 23.0 days, respectively. Postoperative feeding was resumed 1 day after extubation. No intra-abdominal complications, delays in feeding, abdominal wound complications or postoperative bowel obstruction were observed. CONCLUSIONS: Concomitant surgery of cholecystectomy and CABG did not increase the postoperative complications, and it is a feasible procedure of choice.

Aged↗
PubMedDate not supplied

Bypass to the distal right coronary artery using in situ gastroepiploic artery.

OBJECTIVE: We investigated the clinical outcomes after coronary artery bypass grafting (CABG) using the in situ gastroepiploic artery (GEA) exclusively bypassing to the distal right coronary artery (RCA). METHODS: Between, 1991 and 2002, 1020 consecutive patients (788 male and 232 female with a mean age of 63.6 +/- 9.7) underwent CABG to the distal coronary artery using in situ GEA in the Shin-Tokyo Hospital Group. Their perioperative and follow-up data were retrospectively analyzed. RESULTS: The in-hospital morbidity rate was 15.1% and the mortality rate was 0.6%. Postoperative myocardial infarction associated with GEA graft failure occurred in two cases. Among the survivors, follow-up was completed in all patients with a mean period of 4.7 +/- 2.4 years. Actuarial 3- and 5-year angina or intervention-free rates were 93.6% and 89.9%, respectively. Actuarial 3- and 5-year survival rates were 95.8% and 91.6%, respectively. Postoperative angiography was performed on 482 patients within 1 year, 115 patients with 3 years, and in 87 patients more than 4 year after surgery. The GEA patency rates at 1, 3, and 5-year were 95.7%, 90.2%, and 85.7%, respectively. These patency rates were compared with other graft materials (the saphenous vein n = 291, radial artery n = 186, and right internal thoracic artery n = 23) used for bypass to the distal RCA, and we found no significant differences (p = 0.29). CONCLUSION: The perioperative and clinical remote results of GEA grafting were satisfactory. The angiographic patency rates of GEA to the distal RCA was not inferior to the saphenous vein graft in this study.

Adult↗
PubMedDate not supplied

Stroke rate of off-pump coronary artery bypass; aortocoronary bypass versus in-situ bypass.

Off-pump coronary artery bypass (OPCAB) using in-situ grafts does not require aortic manipulation, and it is theoretically free from the risk of stroke. Because of the limited availability of in-situ grafts, aortocoronary bypass has been conducted in addition to in-situ grafting. In this paper, the authors prospectively investigated whether or not on aortocoronary bypass increases the incidence of stroke after off-pump bypass. Perioperative data were collected prospectively from patients who underwent isolated off-pump bypass at their hospital group between March 1997 and February 2002. The patients were divided into 2 groups; group AC (patients with at least 1 aortocoronary bypass, n = 280) and group IS (patients with all in-situ grafts, n = 234). Patients with 3-vessel disease more frequently underwent aortocoronary bypass and patients with a history of stroke, calcified ascending aorta, or renal failure more often underwent in-situ graft. The number of distal anastomoses was greater in group AC (3.5 +/- 1.0) than in group IS (2.7 +/- 1.1), p < 0.0001. Patient recovery and complication rates were similar, including the occurrence of postoperative stroke: 3.0% (7/234) in group IS vs 0.7% (2/280) in group AC, p = 0.051, NS. The graft patency and remote results were not significantly different between the 2 groups. Side clamping of the aorta used in off-pump aortocoronary bypass does not increase the risk of postoperative strokes compared to in-situ bypass. Postoperative stroke after OPCAB may depend on the patient's preoperative comorbidities.

Adolescent↗
PubMedDate not supplied

Routine reoperative off-pump coronary artery bypass grafting via midline sternotomy: is it feasible?

Multivessel off-pump coronary artery bypass (OPCAB) has been conducted safely; however, the clinical outcomes of reoperative OPCAB have not been reported clearly. Currently OPCAB is being performed systematically in this institution including reoperative surgeries. Between September 1, 1999, and December 31, 2003, reoperative OPCAB via midline sternotomy was planned for nonemergent patients with normal left ventricular function without valvular disease. The perioperative results of patients who underwent reoperative OPCAB were analyzed. Thirty-five patients were scheduled for OPCAB. Of these, OPCAB was performed in 27 patients, giving OPCAB success rate of 77.1%. Failure of OPCAB was due to graft injury in 2, ischemic EKG change in 1, and dense adhesion and difficulty of dissection in 5 patients. The mean number of grafts with completed OPCAB was 3.0 +/- 1.5. There were no hospital deaths, strokes, or respiratory or renal failures. One patient (3.7%) developed perioperative myocardial infarction. Postoperative angiography was obtained in 12 patients (26 distal anastomoses), and all anastomoses were perfect except for 1 distal anastomosis stenosis, giving an overall stenosis-free patency rate of 95.1%. During a follow-up period (mean 2.5 +/- 0.6 years), all patients survived without cardiac event, except 1 patient who underwent catheter intervention. Cardiopulmonary bypass may be required during cardiac dissection to decompress the heart and to facilitate dissection. However, once lysis of the adhesion is completed, reoperative OPCAB can be performed without increasing surgical risks. Midterm results were satisfactory.

Aged↗
PubMedDate not supplied

Coronary artery bypass grafting for patients with aortoiliac occlusive disease.

Harvest of the internal thoracic artery (ITA) in patients with aortoocclusive disease carries a risk of leg ischemia. Staged revascularization of the lower extremities and coronary artery in patients with aortoiliac occlusive disease with collateral vessels to the lower extremities via the ITA is reported. Revascularization of the aortoiliac occlusion prior to coronary artery bypass grafting can be performed in stable patients with appropriate perioperative coronary precautions. In patients with unstable angina and aortoiliac occlusion with collateral vessels to the leg via the ITA, coronary artery bypass grafting should be performed without using the ITA.

Aged↗