Biomedical subjects

Kazuhiro Kurisu

Publications and source records attributed to Kazuhiro Kurisu.

10 recordsLinked to original sources

PubMed2006

Bilateral axillary arterial perfusion in surgery on thoracic aorta.

Bilateral axillary arterial cannulation for selective cerebral perfusion might minimize cerebral embolic complications during surgery on the ascending aorta and aortic arch. From March 2002 through February 2004, bilateral axillary arterial perfusion was applied in 12 consecutive patients (mean age, 61.3 years). Operative procedures were total arch replacement in 8 patients, hemiarch replacement in 1, and ascending aorta replacement in 3. Antegrade selective cerebral perfusion was established through vascular grafts anastomosed to the bilateral axillary arteries and a perfusion catheter placed directly into the left carotid artery. Bilateral axillary arterial perfusion through the grafts was successful in all patients. There were no early or late deaths and no incidence of neurologic deficit. There were no complications related to cannulation of the axillary arteries. Bleeding, temporary renal failure, acute respiratory distress syndrome, and graft infection occurred in one patient each; all recovered from these complications. Bilateral axillary arterial perfusion is feasible and effective for brain protection during surgery on the ascending aorta and aortic arch.

Adult↗

PubMed2005

A 10-year experience with the Carbomedics cardiac prosthesis.

BACKGROUND: There are few reports on the long-term results of Carbomedics prosthetic heart valves. METHODS: Five hundred five patients who underwent valve replacement with this prosthesis in the aortic or mitral position were chosen for this study. Patients' mean age was 57 years. There were 173 aortic (AVR), 253 mitral (MVR), and 79 double (DVR) valve implants. The mean follow-up was 5.1 years, and cumulative follow-up was 2,590 patient-years with an overall follow-up rate of 99.2%. RESULTS: The early mortality rate for the total population was 2.8% (AVR 1.2%, MVR 3.6%, DVR 3.8%). Actuarial freedom from thromboembolism at 10 years was 81.8% +/- 5.1%, 85.7% +/- 3.2%, and 88.8% +/- 6.8% for AVR, MVR, and DVR, respectively. At 10 years, 92.7% of AVR, 85.4% of MVR, and 94.7% of DVR patients were free of valve-related death. Overall survival rate at 10 years was 77.6% +/- 4.6%, 71.8% +/- 4.2%, and 81.3% +/- 5.8% for AVR, MVR, and DVR, respectively. The linearized rate of thromboembolism was 1.45%/patient-year, 1.78%/patient-year, 0.67%/patient-year; of major bleeding events, 0.52%/patient-year, 0.85%/patient-year, 0.45%/patient-year; of valve thrombosis, 0%/patient-year, 0.25%/patient-year, 0%/patient-year; of prosthetic valve endocarditis, 0.1%/patient-year, 0.25%/patient-year, 0.22%/patient-year; and of all reoperations, 0.31%/patient-year, 0.93%/patient-year, 1.1%/patient-year for AVR, MVR, and DVR, respectively. CONCLUSIONS: The Carbomedics prosthetic heart valves showed comparable or even better results than those of other mechanical valves with respect to morbidity and mortality. These results may justify the use of Carbomedics valves as one of the mechanical heart valves.

Adult↗

PubMed2004

Extended total arch replacement for type B aortic dissection with ascending aneurysm following healed aortic dissection.

We describe a case of type B aortic dissection with large ascending aortic aneurysm occurring 12.8 years after aortic root replacement (Cabrol procedure) in a non-Marfan patient with cystic medial necrosis of the aorta. We have successfully performed an extended total aortic arch replacement using a four-branched graft through the "L-incision" approach (a combination of a left anterior thoracotomy and upper half median sternotomy). Of note, a histological specimen from the aneurysmal ascending aortic wall revealed "healed aortic dissection" with fibrous tissue replacing the media and intima in addition to multiple foci of cystic medial necrosis.

Aged↗

PubMed2004

Coronary artery bypass grafting with absent right superior vena cava in visceroatrial situs solitus.

We report on a 63-year-old man with an absence of right superior vena cava in visceroatrial situs solitus who underwent coronary artery bypass grafting. Preoperative echocardiography showed a dilated coronary sinus, and venography confirmed an absent right and a persistent left superior vena cava. Perioperatively, placement of a pulmonary artery catheter, site of venous cannulation, and management of associated rhythm abnormalities were of great concern. The assessment of the right superior vena cava is advisable in carrying out the surgical procedure without any difficulties related to this anomaly when the persistent left superior vena cava is suspected.

Abnormalities, Multiple↗

PubMed2004

Coronary artery bypass grafting and aortic valve replacement in a patient with a tracheostoma.

We report a 67-year-old man with a tracheostoma who successfully underwent coronary artery bypass grafting and aortic valve replacement. He had received both a tracheostoma just above the sternal notch after total laryngectomy. As the standard full sternotomy might cause mediastinitis, we performed the operation through a lower half sternotomy with a limited skin incision. Postoperatively the wound was covered with a sterile plastic drape to prevent infection from the tracheostoma. The postoperative course was uneventful.

Aged↗

PubMed2003

Successful aortic valve replacement in severe pancytopenia related to myelodysplastic syndrome.

We report a 60-year-old man with myelodysplastic syndrome (MDS) whose aortic valve was replaced successfully. He suffered from dyspnea on exertion and was confirmed by echocardiography and cardiac catheterization to have severe aortic stenosis. A peripheral blood examination showed pancytopenia and a bone marrow examination showed MDS with a subtype of refractory anemia with excess blasts. His preoperative neutrophil count was 468/mm3, hemoglobin 9.8 g/dl, and platelet count 27,000/mm3. We conducted aortic valve replacement (AVR) using a bioprosthesis in July 2001. Pre- and postoperatively, we injected granulocyte colony-stimulating factor to keep the neutrophil count at 2,000/mm3 or more. We also transfused platelet concentrate and infused tranexamic acid. Despite potential risks of infection and bleeding, the AVR involved no significant complications. Careful preoperative planning thus plays an important role in managing such cases.

Aortic Valve↗

PubMed2003

Total aortic arch replacement through the L-incision approach.

BACKGROUND: Even though the median sternotomy is the standard approach for surgery involving the aortic arch, access to the site of distal anastomosis is problematic when the aortic pathology involves the distal arch. We recently developed an "L-incision" approach (a combination of a left anterior thoracotomy and upper half median sternotomy) for total arch replacement. METHODS: We reviewed our surgical technique and operative results for 11 patients who underwent total aortic arch replacement through the L-incision between July 1999 and July 2000. With a patient in a left anterolateral position, a left anterior thoracotomy was performed through the fourth to sixth intercostal space. An upper half median sternotomy followed. Operative exposure was enhanced with spring retractors. The proximal anastomosis (between the four branched graft and ascending aorta) was accomplished first. Upon completion of the proximal anastomosis, the heart was reperfused from one branch of the graft. The three arch vessels were subsequently reconstructed under deep hypothermia and retrograde cerebral perfusion. Antegrade cerebral perfusion was accomplished through the graft as the distal anastomosis (between the graft and descending thoracic aorta) was performed. RESULTS: No early operative deaths were observed. One patient sustained a permanent neurologic deficit. A transient recurrent laryngeal nerve palsy lasting 1 month occurred in 1 patient. No patient required reoperations for bleeding, nor did any patient develop a postoperative phrenic nerve palsy, aspiration pneumonia, or renal dysfunction. CONCLUSIONS: The L-incision allows extensive replacement of the aortic arch and is associated with a low incidence of postoperative bleeding and respiratory insufficiency.

Aged↗

PubMed2003

A modified valve-on-valve approach for aortic root replacement.

We describe an alternative surgical technique for aortic root replacement in a patient whose aortic valve was previously replaced with a bioprosthesis. It consists of resecting the leaflets of the original bioprosthesis in situ, amputating the struts, and suturing the skirt of a composite graft on the preserved annulus of the original bioprosthesis. Coronary circulation is reconstructed according to the Cabrol modification. This approach simplifies and shortens the procedure of aortic root replacement, minimizing the potential hazard of hemorrhage from the proximal suture line in these cases.

Aged↗

PubMed2002

Extensive use of polytetrafluoroethylene artificial grafts for prolapse of bilateral mitral leaflets.

OBJECTIVES: There are an increasing number of reports concerning mitral valve repair by reconstruction of the chordae tendinae with the use of expanded polytetrafluoroethylene (PTFE) sutures. However, little information is available about the extended application or results of this technique for extended prolapse of bilateral mitral leaflets, which is considered to be difficult to repair. METHODS: Between October 1993 and May 1998, 17 patients (age range 16-74 years) who had from moderate to severe mitral regurgitation as the result of a prolapse of bilateral leaflets underwent mitral valve repair by reconstruction of artificial chordae with CV-4 expanded PTFE sutures. Either bilateral or unilateral Kay's suture annuloplasty was also performed to correct annular dilatation in all patients. RESULTS: No operative death or late mortality was observed. Before discharge, immediate postoperative echocardiography showed less than moderate mitral regurgitation in 16 of 17 patients. The follow-up was completed in all cases by a clinical examination and serial echocardiograms, and the median follow-up period was 52 months (range 27-82 months). There was one failure that required re-operation because of worsening mitral regurgitation (elongation of the anchored side of papillary muscle). When the re-operated patient was excluded from the following data, the degree of mitral regurgitation, estimated by echocardiography performed at recent follow-up, was none in four patients, trivial in eight patients, and mild in four patients. The systolic and diastolic dimensions of the left ventricle decreased significantly (P<0.01). CONCLUSIONS: Because replacement of artificial chordae was not complicated and seemed to preserve fine relationships among leaflet tissues, chordae, and papillary muscles, we therefore suggest that the extensive use of PTFE artificial chordae appears to be a promising procedure for the repair of all kinds of mitral lesions causing mitral regurgitation.

Adolescent↗

PubMed2002

Off-pump CABG attenuates myocardial enzyme leakage but not postoperative brain natriuretic peptide secretion.

BACKGROUND: Off-pump coronary artery bypass surgery is considered to be less invasive compared with a conventional coronary artery bypass surgery, while objective assessment of its invasiveness has not been well established. The grade of invasiveness of off-pump CABG was evaluated by biochemical markers released from the myocardium. METHODS: Perioperative serial changes of myocardial enzyme leakage (creatine kinase-MB isoenzyme and troponin T) were evaluated in 217 patients who underwent coronary artery bypass surgery (28 off-pump CABG patients and 189 conventional CABG patients). Serial changes of atrial natriuretic peptide and brain natriuretic peptide secretion as markers of heart failure were also evaluated in 12 off-pump CABG patients and 49 conventional CABG patients. RESULTS: Myocardial enzyme leakage was significantly less in the off-pump CABG group, while increase of brain natriuretic peptides secretion were similar in both groups with its peak at the first postoperative day (246+/-46 pg/ml in the off-pump CABG group and 312+/-57 pg/dl in the conventional CABG group). CONCLUSIONS: Although off-pump CABG seems to be less invasive to the myocardial cells from the aspect of enzyme leakage, ischemic stress to the heart assessed by brain natriuretic peptide secretion was similar to that of conventional CABG. Careful monitoring and management throughout postoperative period is mandatory even in off-pump CABG procedure.

Aged↗