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Ko Bando

Publications and source records attributed to Ko Bando.

At least 37 records · Page 2Linked to original sources
PubMed2004

Rationale for off-pump coronary revascularization to small branches--angiographic study of 1,283 anastomoses in 408 patients.

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) has gained wide acceptance in tandem with the development of the stabilizer and associated operative techniques. However bypass grafting to the small branches of a beating heart is technically demanding and remains controversial. In the present study we evaluated the graft patency and quality of anastomoses to small coronary arteries by early postoperative angiography. METHODS: Between March 2000 and December 2002 a total of 1,328 anastomosed sites to coronary branches were studied angiographically in 404 patients representing 88.6% of all cases who underwent OPCAB in this period. The coronary artery branches were categorized as large (>1.5 mm, group L: 1,028 anastomoses sites) or small (< 1.5 mm, group S: 300 sites) by intraoperative measurement. As in situ grafts the internal thoracic artery (ITA) and the gastroepiploic artery (GEA) were used at 504 and 28 distal anastomosis sites respectively. The radial artery (RA) was used as a composite graft for 739 distal anastomosis sites. Sequential bypass grafting was performed at 388 anastomosis sites in side-to-side fashion. Arterial grafts were used in 96.1% of total bypass grafting. RESULTS: The percentage of male gender was 78.3% in group S and 87.2% in group L (p = 0.025). The ITA was used in 43.7% of group L and 18.3% of group S (p < 0.0001). The RA was used in 49.4% of group L and 77% of group S (p < 0.0001). The overall patency and stenosis free rates (FitzGibbon Type A) were 97.2% and 96.2%. Graft patency and stenosis free rates in group S (96.7% and 93.3%) were as good as those in group L (97.5% and 97.1%). In group S, the patency and stenosis free rates of SV grafts were 71.4% and 57.1%. On the other hand, those of ITA grafts were 100% and 98.3% (p = 0.53 vs. saphenous vein graft [SVG]) and RA grafts were 95.8% and 92.1% (p = 0.61 vs. SVG) respectively. In group S, the graft patency and stenosis free rates of bypass to the obtuse marginal (OM) (93.7% and 87.5%) were slightly lower than those to other implantation sites left anterior descending (LAD: 100% and 97.3%; PL: 96.5% and 92.3%; DI: 98.0% and 96%; PDA: 97.0% and 97.0%; right coronary artery [RCA]: 100% and 100%) although there was no statistical significance. The graft patency and stenosis free rates were slightly better with side-to-side anastomosis than with end-to-side anastomosis (side-to-side: 98.1% and 95.8% vs. end-to-side 96.3% and 86.3%) in group S. CONCLUSIONS: OPCAB to small coronary artery branches with arterial grafts provided satisfactory graft patency and stenosis free rates.

Anastomosis, Surgical↗
PubMed2004

Competitive flow in arterial composite grafts and effect of graft arrangement in Off-Pump coronary revascularization.

BACKGROUND: We sought to investigate the incidence of competitive flow in arterial composite grafts and to delineate the effect of the location of moderately stenotic branch, the extent of the revascularized territories and the arrangement of in situ and free arterial grafts in off-pump coronary artery bypass grafting (OPCAB). METHODS: Three hundred eighteen patients who underwent OPCAB with aorta no-touch technique using the composite graft with totally arterial materials between December 2000 and March 2003 were studied. A total of 362 composite grafts were used. We reviewed their coronary angiography before and early after operation. Competitive flow was defined as the phenomenon that at least one of the distal anastomotic sites of the composite graft was not opacified in in situ graft angiography, but clearly opacified in native coronary angiography. The number of distal anastomoses was 3.47 +/- 0.93 per patient and 2.87 +/- 0.81 per composite graft. RESULTS: Early patency rate of the distal anastomotic sites of composite grafts was 98.7%. Competitive flow was found in 53/362 (14.6%) composite grafts, and graft occlusion occurred in 13/362 (3.6%) composite grafts. In the multivariate analysis of 362 composite grafts, 75% stenosis in right coronary artery (RCA) territory (p < 0.0001) and the number of distal anastomoses (p = 0.004) were significant predictors of competitive flow and graft occlusion. Multivariate analysis of 318 patients demonstrated that 75% stenosis in RCA territory (p < 0.0001) and the total number of distal anastomoses (p = 0.003) were statistically significant predictors of competitive flow and graft occlusion. The use of more than two in situ grafts and the shape of composite graft (branched or straight) did not have significant correlation with the outcome. CONCLUSIONS: Coronary artery revascularization using composite arterial grafts provided satisfactory early patency rates with an acceptable incidence of competitive flow. Because the implication of competitive flow in an arterial composite graft may differ from that in conventional bypass grafts unpredictably, long-term follow-up is mandatory.

Aged↗
PubMed2004

Total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system: clinical outcome and angiographic evaluation.

BACKGROUND: We assessed the clinical outcome and conducted an angiographic study of total arterial off-pump coronary artery bypass grafting for revascularization of the total coronary system. METHODS: Of 382 consecutive patients who underwent off-pump coronary artery bypass between April 2000 and December 2002, 235 patients (193 men and 42 women, mean age 66 +/- 9 years) with three-vessel disease underwent off-pump coronary artery bypass with all arterial grafts. A total of 872 vessels were bypassed (average number of grafts 3.7 +/- 0.8). The internal thoracic arteries, radial arteries, and gastroepiploic arteries were used for revascularization of 306, 542, and 24 coronary arteries, respectively. Two hundred twenty-five patients underwent revascularization with composite grafts that were connected to the in situ internal thoracic artery (Y configuration 181, I configuration 55, K configuration 27, X configuration 3, T configuration 1); 10 patients underwent revascularization with all in situ grafts. RESULTS: Three (1.3%) hospital deaths and 1 late death occurred. There were no occurrences of clinical underperfusion syndrome or new intraaortic balloon pump insertion. Cerebral infarction occurred in 2 patients (0.8%). Early postoperative angiography was performed on 833 grafts in 223 patients (95%); the overall patency rate was 98%. Stratified by coronary distribution, the patency rate was 99% (218/221) in the left anterior descending artery, 97% (84/87) in the diagonal artery, 99% (70/71) in the obtuse marginal artery, 98% (262/268) in the posterolateral artery, 98% (167/170) in the posterior descending artery, and 100% (16/16) in the right coronary artery. CONCLUSIONS: Total arterial off-pump coronary artery bypass yielded good clinical results and an excellent patency rate of revascularization for the total coronary system.

Adult↗
PubMed2004

Consequence of atrial fibrillation and the risk of embolism after percutaneous mitral commissurotomy: the necessity of the maze procedure.

BACKGROUND: We sought to investigate the incidence and risk of embolism after percutaneous balloon mitral commissurotomy (PMC) and delineated the necessity of the maze procedure in patients with atrial fibrillation (AF). METHODS: Clinical records of 326 patients, who underwent PMC between April 1988 and March 2003, and 162 patients, who underwent mitral valve surgery (MVS) combined with the maze procedure (MVS/maze) in the same period, were reviewed. We examined the consequence of cardiac rhythm and the incidence and risk of embolism after PMC. Next our current criteria for indication of the maze procedure, which included duration of AF less than 10 years, voltage of f wave on electrocardiography greater than 0.1 mV, cardiothoracic ratio less than 70%, and left atrial dimension less than 70 mm, were applied to all patients. These criteria were satisfied by 190 patients of PMC (PMC group) and 114 patients of MVS/maze (MVS/maze group) and the early and late results of the two groups were compared. RESULTS: Thirty-eight patients suffered from embolic complications after PMC. Of these 33 patients experienced AF before intervention. The actuarial embolism-free rate at 10 years was 81.9% in patients with AF before PMC and 92.9% in patients with sinus rhythm before PMC (p = 0.01). Univariate predictors of embolism after PMC included previous embolic history (p = 0.01), AF (p = 0.01), pressure gradient (p = 0.01), age (p = 0.03), and mitral valve area (p = 0.04). Multivariate analysis identified AF as the independent predictor of embolism in the late follow-up period (p = 0.03). In a comparative study of the selected patients the actuarial AF-free rates after MVS/maze were 89.9% at 1 year and 85.7% at 5 years and were significantly higher than those of 17.3% at 1 year and 4.2% at 5 years after PMC (p < 0.0001). The actuarial embolism-free rate in the MVS/maze group was 98.0% at 5 years and was significantly higher than that of 84.8% at 5 years and 82.4% at 10 years in the PMC group (p = 0.01). CONCLUSIONS: PMC alone is not sufficient with regard to sinus rhythm recovery and prevention of embolism. Surgical treatment concomitant with the maze procedure may be beneficial for patients with AF.

Atrial Fibrillation↗
PubMed2004

Should the transverse aortic arch be replaced simultaneously with aortic root replacement for annuloaortic ectasia in Marfan syndrome?

OBJECTIVE: The purpose of this study was to determine, on the basis of the late fate of the intact aortic arch with abnormal tissue after aortic root replacement, whether the intact aortic arch should be replaced prophylactically at the time of aortic root replacement for annuloaortic ectasia in Marfan syndrome. METHODS: A retrospective review was performed in 85 patients with Marfan syndrome who underwent aortic root replacement for annuloaortic ectasia with or without aortic dissection (mean age 37 years, range 19-61 years). These 85 patients were divided into four groups according to the postoperative condition of the residual aorta. In group I (n = 47), the patients underwent aortic root replacement for annuloaortic ectasia with or without localized dissection in the ascending aorta. In these patients the residual aorta, including the aortic arch, was therefore intact. In group II (n = 10), the aortic arch was intact, although the descending thoracic aorta was dissected because of the preoperative type B dissection. In groups III and IV, the patients had type A dissection involving the transverse arch associated with annuloaortic ectasia. In group III (n = 13), residual dissection existed in the descending thoracic aorta after concomitant total arch replacement. In group IV (n = 15), the aortic arch and the descending thoracic aorta were dissected. RESULTS: There were 5 early deaths (3 in group I, 1 in group II, and 1 in group III). Subsequent operations were required in 10, 5, 6, and 7 cases in groups I, II, III, and IV, respectively. Regarding the aortic arch, only 2 of 53 survivors of the initial hospitalization with an intact aortic arch (groups I and II) underwent subsequent total arch replacement for the onset of dissection in the aortic arch, and 4 of 14 survivors of the initial hospitalization with a residual dissecting arch (group III) needed subsequent total arch replacement. Actuarial freedom from arch repair among patients with an intact aortic arch (91% at 15 years) was significantly higher than that among patients with a residual dissecting arch (49% at 15 years, P =.0078). CONCLUSIONS: The incidence of new dissection in the residual intact arch after aortic root replacement was extremely low. Therefore prophylactic replacement of the intact arch does not appear to be necessary at aortic root replacement for annuloaortic ectasia in Marfan syndrome.

Actuarial Analysis↗
PubMed2003

Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve.

BACKGROUND: Patients with bicuspid aortic valve (BAV) have been frequently complicated with ascending aortic dilation possibly because of hemodynamic burdens by aortic stenosis (AS) or regurgitation (AR) or congenital fragility of the aortic wall. METHODS AND RESULTS: To clarify if the aortic dilation could be prevented by aortic valve replacement (AVR) in BAV patients, we studied 13 BAV (8 AR dominant, 5 AS dominant) and 14 tricuspid aortic valve (TAV) patients (7 AR, 7 AS) by echocardiography before and after AVR (9.7+/-4.8 years). We also studied 18 BAV (11 AR, 7 AS) without AVR. Diameters of the sinuses of Valsalva, sinotubular junction and the proximal aorta were measured. The annual dilation rate was calculated by dividing changes of diameters during the follow-up period by the body surface area and the observation interval. We found that aortic dilation in BAV patients tended to be faster than that in TAV patients, although a significant difference was found only at the proximal aorta (0.18+/-0.08 versus -0.08+/-0.08 mm/(m2/year), P=0.03). BAV patients with and without AVR showed similar progressive dilation. AR dominant group showed tendency of more progressive dilation than AS dominant group in BAV, although it did not reach statistical significance. TAV patients did not show further aortic dilation after AVR. CONCLUSIONS: AVR could not prevent progressive aortic dilation in BAV. Since the aorta did not dilate in TAV, progressive aortic dilation in BAV seems mainly due to the fragility of the aortic wall rather than hemodynamic factors.

Adult↗
PubMed2003

Early results of complete off-pump coronary revascularization using left internal thoracic artery with composite radial artery.

OBJECTIVE: Off-pump coronary artery bypass (OPCAB) using the left internal thoracic artery (LITA) with a composite radial artery (RA) was employed for arterial revascularization in order to minimize neurological complication. METHODS: Sixty-one patients underwent OPCAB using the LITA with a composite RA. Angiography was performed in all patients at two weeks postoperatively. RESULTS: The mean number of distal anastomoses was 3.2 +/- 0.4. A Y-composite graft was used in 55 patients, and K-composite graft was used in the other 6 patients. There was no hospital death, no neurological complication nor deep sternal infection. Furthermore, there was no episode of perioperative myocardial infarction nor hypoperfusion syndrome. Patients have been angina-free during a mean follow-up period of 1 year. The graft patency of the LITA to the left anterior descending artery (LAD) was 100% (61/61 anastomoses). The RA became occluded in 4 patients, and the patency rate was 95.6% (130/136 anastomoses). String or coronary-coronary bypass resulting from flow competition was observed in the LITA of 6 patients and in the RA of 13 patients. The string of the LITA occurred in the segment distal from the anastomosis with the composite RA. The string or coronary-coronary bypass was observed more often in cases in which the recipient coronary artery had less than 75% stenosis. CONCLUSION: OPCAB using only the LITA with a composite RA can be successfully and safely performed in patients with multivessel disease. Late postoperative follow-up of the flow competition is necessary to delineate the significance of flow competition.

Aged↗
PubMed2003

Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement.

BACKGROUND: The purpose of this study was to evaluate morbidity and mortality after double valve replacement (DVR) and aortic valve replacement with mitral valve repair (AVR + MVP). METHODS: From 1977 to 2000, 379 patients underwent DVR (n = 299) or AVR + MVP (n = 80). Actuarial survival and freedom from reoperation were determined by the Kaplan-Meier method. Potential predictors of mortality and reoperation were entered into a Cox multiple regression model. Propensity score was introduced for the multivariable regression modeling for adjustment of a selection bias. RESULTS: Survival 15 years after surgery was similar between the groups (DVR, 81% +/- 3%; AVR + MVP, 79% +/- 7%; p = 0.44). Freedom from thromboembolic event at 15 years was similar between the groups (p = 0.25). Freedom from mitral valve reoperation at 15 years was significantly better for the DVR group (54% +/- 5%) as compared with the AVR + MVP group (15% +/- 6%; p = 0.0006), primarily due to progression of mitral valve pathology and early structural deterioration of bioprosthetic aortic valve used for patients with AVR + MVP. After AVR + MVP, freedom from mitral reoperation at 15 years was 63% +/- 16% for nonrheumatic heart diseases, and 5% +/- 5% for rheumatic disease (p = 0.04). CONCLUSIONS: Although both DVR and AVR + MVP provided excellent survival, DVR with mechanical valves should be the procedure of choice for the majority of patients because of lower incidence of valve failure and similar rate of thromboembolic complications compared with AVR + MVP. MVP should not be performed in patients with rheumatic disease because of higher incidence of late failure.

Actuarial Analysis↗
PubMed2003

Early and late stroke after mitral valve replacement with a mechanical prosthesis: risk factor analysis of a 24-year experience.

OBJECTIVE: We evaluated risk factors for mortality and stroke after mechanical mitral valve replacement between May 1977 and December 2001. METHODS: Early and late mortality and stroke were assessed. Potential predictors of mortality and stroke were entered into a Cox proportional hazards model. Actuarial survival and freedom from stroke were determined by a log-rank test. RESULTS: Mitral valve replacement was performed in 812 patients. Concomitant procedures included left atrial appendage closure in 493 (61%) patients, tricuspid annuloplasty-replacement in 348 (43%) patients, maze procedure in 185 (23%) patients, plication of the left atrium in 148 (18%) patients, and other procedures in 151 (19%) patients. Five-year actuarial survival was 91.1% +/- 2.3%. Freedom from stroke at 8 years was significantly better in patients with sinus rhythm versus atrial fibrillation (P <.001). Ninety-nine percent of patients with mitral valve replacement combined with a maze procedure were free from stroke, whereas only 89% of patients with mitral valve replacement alone were free from stroke at 8 years after surgical intervention. Seventy-two patients had late stroke; sixty-five patients (90%) were in atrial fibrillation, and 47 (65%) patients had the left atrial appendage closed. Multivariate analysis showed that late atrial fibrillation (odds ratio, 3.39; 95% confidence interval, 1.72-6.67; P =.0001) and omission of the maze procedure (odds ratio, 3.40; 95% confidence interval, 1.14-10.14; P =.003) were the significant risk factors for late stroke. CONCLUSIONS: Persistent atrial fibrillation was the most significant risk factor for late stroke after mechanical mitral valve replacement. Restoration of sinus rhythm with a maze procedure nearly eliminated the risk of late stroke, whereas neither closure of the left atrial appendage nor therapeutic anticoagulation prevented this complication.

Adolescent↗
PubMed2003

Early adaptation of the left internal thoracic artery as a blood source of y-composite radial artery grafts in off-pump coronary artery bypass grafting.

OBJECTIVE: Y-composite grafting with the radial artery (RA) is often used in off-pump coronary artery bypass grafting (OPCAB). However, the early flow reserve of the left internal thoracic artery (LITA) as a blood source of the Y-composite RA graft has not been delineated. METHODS: The size of the LITA was examined angiographically in 42 patients who underwent OPCAB using LITA and Y-composite RA grafting between June 2000 and February 2002. In these patients, the LITA was used as a blood source of the Y-composite RA graft. The mean patient age +/- SD was 67 +/- 8 years. The average number of d i stal anastomoses was 3.2 +/- 0.7. Total coronary revascularization was carried out in 34 patients with only LITA and Y-composite RA grafting. RA grafting was used for revascularization of the circumflex artery alone in 5 patients, for the right coronary artery system (RCS) alone in 6 patients, and for both the circumflex and the RCS in 23 patients. The average number of distal anastomoses using the RA was 1.9 +/- 0.7. Flow measurements of the proximal LITA were achieved intraoperatively with a transit-time flowmeter. The diameters of the LITA before and after the operation were measured angiographically. Intraoperative flow volume was correlated with the ratio of the LITA diameters before and after the operation. RESULTS: The mean flow rate of the LITA was 61 +/- 35 mL/min (range, 9-196 mL/min). The mean diameters of the LITA before and after the operation were 1.97 +/- 0.36 mm and 2.74 +/- 0.60 mm, respectively. The mean ratio of the LITA diameter after the opera t ion to that before the operation was 1.43 +/- 0.27. The intraoperative flow volume was positively correlated with the ratio of LITA diameters (r = 0.414; P =.006). CONCLUSION: These results demonstrate the early adaptation of the LITA as a blood source of the Y-composite RA graft in OPCAB and the rationale for using the LITA as a single blood source for total coronary artery revascularization.

Aged↗
PubMed2002

The effect of cryo-maze procedure on early and intermediate term outcome in mitral valve disease: case matched study.

BACKGROUND: The maze procedure is an effective way to treat atrial fibrillation (AF) associated with mitral valve disease. In a last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, there has been no comparative study to delineate the feasibility of the use of cryoablation. METHODS AND RESULTS: We compared the early and intermediate-term results of the maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM) with our conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins. One hundred and 10 pairs of patients were matched in the age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation and concomitant aortic valve procedures. CM required significantly shorter cardiopulmonary bypass time (186+/-56 minute versus 214+/-47 minute, P=0.001) and aortic cross-clamp time (134+/-43 minute versus 144+/-37 minute, P=0.03) than KM with less chest tube drainage (590+/-353 mL versus 745+/-618 mL, P=0.02) for 12 hours after operation. The sinus rhythm restoration rate in CM group (85.4%) was comparable with KM group (86.4%) at discharge. In the late results, the actuarial freedom from recurrence of sustained AF at 3 years in CM group (97.7%) was not significantly (P=0.11) different from that in KM group (90.4%). The actuarial freedom from stroke at 3 years in CM group was 99.0%. CONCLUSION: The modification of the maze procedure including cryoablation for pulmonary venous isolation provided less aortic cross-clamp time and less amount of chest tube drainage with the comparable recovery and maintenance of sinus rhythm with KM. CM is a reliable and less invasive surgical option for the AF associated with mitral valve disease.

Atrial Fibrillation↗
PubMed2002

Plasma atrial natriuretic peptide concentration inversely correlates with left atrial collagen volume fraction in patients with atrial fibrillation: plasma ANP as a possible biochemical marker to predict the outcome of the maze procedure.

OBJECTIVES: We hypothesized that the plasma atrial natriuretic peptide (ANP) level reflects atrial degenerative change and may predict the outcome of the maze procedure. BACKGROUND: Although a larger preoperative left atrial dimension and longer duration of atrial fibrillation (AF) have been reported in patients with persistent AF than in those with sinus rhythm (SR), these individual factors were not enough to predict the outcome of the maze procedure. METHODS: Preoperative plasma ANP levels were measured in consecutive 62 patients who underwent the Kosakai's modified maze procedure. Moreover, we performed histological and molecular biological examinations in the resected left atrial tissues. RESULTS: The preoperative plasma ANP was lower in the AF group (n = 13) than it was in the SR group (n = 49) (p < 0.001). Multiple logistic regression analysis revealed that duration of AF and plasma ANP were independently associated with postoperative cardiac rhythm. Among 41 patients with a higher plasma ANP or shorter duration of AF than the median value, SR was restored in 95% of patients. In contrast, in 21 patients with a lower plasma ANP and a longer duration of AF than the median value, SR was restored only in 48% of patients. Histological examination revealed that the collagen volume in the left atrial tissue was higher in AF than it was in SR and inversely correlated with plasma ANP. In addition, the messenger RNA expressions of ANP, collagen type I and type III were lower in AF than they were in SR. CONCLUSIONS: These results suggest that a combination of plasma ANP and/or duration of AF may predict the success rate for the maze operation. Advanced atrial degenerative change may result in a decrease of atrial ANP secretion.

Aged↗
PubMed2002

Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease.

OBJECTIVE: We sought to determine whether the Cox maze procedure provides additional benefit to patients with atrial fibrillation undergoing mitral valve operations. METHODS: Between May 1992 and August 2000, we performed 258 Cox maze procedures with mitral valve replacement (n = 147) or mitral valve repair (n = 111). We compared the outcomes of these patients with those of 61 control patients with preoperative atrial fibrillation who underwent mitral valve replacement alone during the same interval. The three cohorts were similar in age, sex, and proportion of patients in preoperative New York Heart Association functional class 3 or 4. RESULTS: Although 5-year survivals were similar among the groups (94% for mitral valve replacement alone, 95% for mitral valve replacement plus maze, and 97% for mitral valve repair plus maze), freedoms from atrial fibrillation at 5 years were significantly higher in the mitral valve replacement plus maze group (78%) and the mitral valve repair plus maze group (81%) than in the mitral valve replacement group (6%, P <.0001). Freedoms from stroke at 5 years were 97% for the mitral valve replacement plus maze group, 97% for the mitral valve repair plus maze group, and only 79% for mitral valve replacement group (P <.0001). Multivariable analysis with Cox hazard model revealed that the most significant risk factor for late stroke was the omission of the Cox maze procedure (P =.003). CONCLUSIONS: The addition of the Cox maze procedure to mitral valve repair and replacement was safe and effective for selected patients. Elimination of atrial fibrillation significantly decreased the incidence of late stroke.

Aged↗
PubMed2002

Huge saccular aneurysm in a coronary-pulmonary fistula fed by the left and right coronary arteries.

A 62-year-old woman was referred because of an abnormal mediastinal shadow that had first been noted 4 years ago on the left cardiac border on plain chest roentgenogram and which had gradually increased in size since. A huge saccular aneurysm in coronary-pulmonary fistula into which both the left and right coronary arteries drained was revealed by computed tomography and coronary angiography. The patient underwent aneurysmal resection and ligation of the fistulas. Histological study of the aneurysmal wall did not reveal atherosclerotic change but instead cystic medial necrosis, although there was no other clinical manifestation associated with this.

Angiography, Digital Subtraction↗
PubMed2002

Perioperative advantages of off-pump coronary artery bypass grafting.

For the first time in Japan, off-pump coronary artery bypass grafting (OPCAB) was compared with the conventional on-pump technique, retrospectively examining the morbidity associated with coronary artery bypass grafting (CABG) and assessing the efficacy of OPCAB. In 2000, 158 patients underwent CABG: 95 patients (60%) had OPCAB (Group I) and 63 patients (40%) had conventional CABG (Group II). The operating time, length of intensive care unit (ICU) stay, ventilation time, postoperative bleeding, transfusion, postoperative renal function, occurrence of stroke, and early graft patency were examined in both groups. There were no hospital deaths in either group. The operating time, ICU stay, and ventilation time were significantly (p < 0.0001, p = 0.013, and p < 0.0001, respectively) shorter in Group I (351 +/- 85 min, 3.0 +/- 1.4 days, and 5.1 +/- 2.8h) than in Group II (449 +/- 112 min, 3.6 +/- 1.8 days, and 13.7 +/- 18.0 h). The postoperative blood loss within 12h and the transfusion volume were significantly (p = 0.0004 and p < 0.0001, respectively) smaller in Group I (480 +/- 210 ml and 300 +/- 490ml) than in Group II (720 +/- 430ml and 1,230 +/- 1,180 ml). Peak serum blood urea nitrogen and creatinine concentrations (excluding patients with preoperative chronic renal failure, ie a preoperative serum creatinine > 1.5 mg/dl) were significantly (p < 0.0001 and p < 0.0001, respectively) lower in Group I (16.2 +/- 15.2mg/dl and 0.81 +/- 0.72 mg/dl) than in Group II (19.2 +/- 7.6 mg/dl and 0.92 +/- 0.28 mg/dl). There were no perioperative strokes in Group I, but 6.4% of Group II patients suffered a stroke. There was no significant difference in graft patency between the groups (95.6% vs 94.9%). OPCAB reduced the mortality and morbidity of coronary revascularization, with a shorter operating time and more rapid recovery from surgery.

Aged↗
PubMed2002

Total arterial off-pump coronary revascularization with only internal thoracic artery and composite radial artery grafts.

OBJECTIVE: Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. METHODS: Between April 2000 and May 2002, 257 patients underwent OPCAB grafting with this technique. The range of ages at operation was 42 to 86 years (mean, 66.1 +/- 8.6 years). On average, 3.28 +/- 0.86 grafts per patient were completed. More than 4 distal anastomoses were performed in 88 patients (34%). For coronary revascularization, 289 ITA and 555 RA grafts were used. The RA was used as a Y graft in 211 patients, as an I graft (for ITA extension) in 52 patients, and as a K graft (the side of the RA attached to the side of the left ITA) in 28 patients. Sequential bypass grafting was performed with 190 RA and 7 ITA grafts. The sites of distal anastomoses were 256 left anterior descending arteries (30%), 236 posterolateral branches (28%), 144 posterior descending arteries (17%), 106 diagonal branches (13%), 82 obtuse marginal branches (10%), and 19 right coronary arteries (2%). RESULTS: There were 1 operative death (0.4%) due to cerebral hemorrhage and 2 episodes of stroke (0.8%) during postoperative angiography. There were no clinical underperfusion syndromes or new intra-aortic balloon pump insertions. Perioperative myocardial infarction occurred in 12 patients (4.7%), sternal dehiscence in 5 (1.9%), and early coronary intervention in 4 (1.6%). There was no deep wound infection, reexploration for bleeding, or hand ischemia. The actuarial survival rate and the cardiac event-free rate at 2 years were 98.6% +/- 2.4% and 94.2% +/- 0.8%, respectively. Early postoperative angiography revealed a 97.8% (264/270) graft patency of ITAs and 97.9% (512/523) graft patency of RAs in 238 patients. Flow competition of the RA graft was recognized in 22 patients and, as indicated by follow-up angiographic study, did not cause late graft occlusion. CONCLUSIONS: OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.

Adult↗
PubMed2002

Eight-year experience of combined valve repair for mitral regurgitation and maze procedure.

BACKGROUND AND AIMS OF THE STUDY: Although atrial fibrillation (AF) is often associated with severe mitral regurgitation (MR), a simultaneous maze procedure for AF associated with repair of MR remains controversial. In this study, mid-term results of combined mitral valve repair and the maze procedure were examined. METHODS: Between May 1992 and April 2001, 85 patients (61 males, 24 females) underwent valve repair for MR and the maze procedure. Mean age at surgery was 61.8+/-9.1 years; mean follow up was 4.7+/-2.3 years. Valve lesions were anterior in 26 patients (31%), posterior in 31 (36%), anterior + posterior in 23 (27%), and simple dilated annulus in five (6%). Chordal replacement with expanded PTFE sutures was performed in 40 patients (47%), and leaflet resection in 41 (48%). Ring annuloplasty was also applied in 61 patients (72%). Associated procedures were tricuspid valve annuloplasty in 33 (36%), coronary artery bypass grafting in four, atrial septal defect closure in two, aortic valve repair in one, and resection of abnormal septum in the left atrium in one. RESULTS: There was one hospital death (1%), and one late death (1%). Reopening the chest for bleeding was necessary in six cases (7%). One thromboembolic episode was detected during follow up (0.25%/patient-year). Reoperation for MR was performed in three patients (4%). Actuarial event-free survival rate was 90.0+/-6.4% at eight years. Sinus rhythm was regained in 68 patients (81%), and atrial A-wave was detected in 57 (68%) by pulsed Doppler study. Postoperative left ventricular diastolic and systolic dimensions were significantly (p = 0.001 and p = 0.017) smaller in patients who restored sinus rhythm than in those who did not (48.6+/-4.6 versus 54.6+/-4.7 mm, and 33.0+/-6.0 versus 38.1+/-6.9 mm). CONCLUSION: Combined mitral valve repair for MR and the maze procedure showed satisfactory midterm results. Postoperative sinus rhythm conversion by the maze procedure may reduce left ventricular size, and the incidence of thromboembolic episodes in mitral valve repair.

Adult↗