Biomedical subjects

Manabu Sakurai

Publications and source records attributed to Manabu Sakurai.

7 recordsLinked to original sources

PubMed2006

Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting.

OBJECTIVE: It has been observed that a systemic inflammatory response after on-pump coronary artery bypass grafting (CABG) participates in the pathogenesis of postoperative atrial fibrillation (AF). In patients undergoing off-pump CABG, it is plausible that inflammation is associated with the development of postoperative AF. The present study examined relation of proinflammatory cytokines, which play an important role in the upstream of inflammatory cascade, to the development of AF after off-pump CABG. METHODS: The present study included 39 patients undergoing off-pump CABG. Tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-8, were measured by enzyme-linked immunosorbent assay, on anesthetic induction, after sternotomy before anastomoses, at the completion of anastomoses, 3 and 6h thereafter, and on postoperative days (POD) 1-4. C-reactive protein (CRP) was also measured by turbidimetric immunoassay, preoperatively, and on POD 1, 2, 3, 6, 9, and 13. RESULTS: Eleven patients (28%) developed postoperative AF. Patients with postoperative AF were older (70+/-6.4 years vs 60+/-8.8 years, P=0.001); however, there was no difference in other pre- and perioperative variables. TNF-alpha level did not change during the study period. However, IL-8 and CRP levels significantly increased after the surgery, although there was no significant difference between the two groups. IL-6 level also increased after the surgery with its peak at 6h after the completion of anastomoses. IL-6 levels of 3 and 6h after anastomoses were significantly higher in patients with postoperative AF (360+/-143 pg/ml vs 230+/-94 pg/ml, P=0.0047, 435+/-175 pg/ml vs 247+/-102 pg/ml, P=0.0005, respectively). Logistic regression analysis indicated that the highest quartile of IL-6 level immediately after the surgery (odds ratio 7.63; 95% CI, 1.06-54.9; P=0.04) and age (odds ratio 1.18; 95% CI, 1.01-1.39; P=0.04) independently predict postoperative AF. Furthermore, the maximum level of IL-6 immediately after the surgery significantly correlated to age and intraoperative blood loss (r=0.04, P=0.01, and r=0.47, P=0.04, respectively). CONCLUSIONS: Advanced age was a major risk factor for postoperative AF. Furthermore, inflammatory response induced by surgical trauma was also associated with the development of AF after off-pump CABG.

Age Factors↗

PubMed2006

Ascending aortic aneurysm following aortico-ventricular tunnel repair.

Aortico-left ventricular tunnel is a very rare congenital anomaly. An 18-year-old boy had undergone tunnel closure at 3 years of age. A moderate degree of aortic regurgitation remained postoperatively. Seven years later, aortic valve replacement for aortic regurgitation was performed. Eight years later, the ascending aortic aneurysm had grown to 63 mm in diameter. This dilatation became an operative indication. Ascending aortic replacement was performed with a Dacron graft. Pathological examination of the resected aortic wall revealed cystic medial degeneration. We report a rare case of ascending aortic aneurysm following surgical repair of the aortico-left ventricular tunnel and aortic valve replacement.

Adolescent↗

PubMed2006

A case complicated with Horner's syndrome after off-pump coronary artery bypass.

In the present report, a case complicated with Horner's syndrome after off-pump coronary artery bypass (OPCAB) was presented. This case showed ptosis and miosis in the left eye promptly after OPCAB. No abnormal neurological findings other than Horner's syndrome were observed in postoperative examinations including head magnetic resonance imaging (MRI), and this case was thought to have Horner's syndrome as a complication after cardiac surgery through median sternotomy.

Aged↗

PubMed2006

Late-term regression of stenosis at the kink site in the internal thoracic artery in two cases.

A kink in the internal thoracic artery (ITA) is a rare postoperative complication after coronary artery bypass surgery. The kink can be accompanied by significant stenosis and has been observed after the ITAs are harvested by the skeletonization method. In this report, we present two cases in which early postoperative angiography showed the kink accompanied by significant stenosis, and late angiography revealed regression of stenosis at the kink site. Immediate intervention is not always necessary even when the kink, accompanied by significant stenosis was observed on early postoperative angiography.

Aged↗

PubMed2005

Cognitive dysfunction following cardiovascular surgery.

OBJECTIVE: The aim of this study was the evaluation of perioperative cognitive dysfunction in patients undergoing cardiovascular surgery with or without cardiopulmonary bypass (CPB) and identification of the risk factors. SUBJECTS AND METHODS: Between July 2001 and October 2003, we performed cognitive examinations in 192 patients (mean age 65.5 +/- 7.6 years) who underwent elective cardiovascular surgery with or without CPB. The cognitive examinations (Hasegawa dementia scale) were done both pre- and postoperatively. Forty-six patients who had developed cognitive dysfunction postoperatively were included in Group A. The remaining 146 patients were placed in the control group (Group B). RESULTS: The patients in Group A were noted to be significantly older than those in Group B (69.8 +/- 7.4 vs. 64.1 +/- 7.2, p < 0.05). The number of patients who at risk for cerebrovascular disease was significantly higher in Group A than in Group B (p < 0.05). Among intraoperative variables, there were no significant differences between the two groups concerning the presence or absence of CPB, CPB duration, and operation duration. The length of postoperative hospitalization of the Group A patients was greater. Age was identified as the only predictor of postoperative cognitive dysfunction in multivariate analysis. CONCLUSION: In the present study, it is possible that CPB did not play a significant role in the genesis of cognitive dysfunction after cardiovascular surgery. Age appears to be the only significant predictor of postoperative cognitive dysfunction.

Age Factors↗

PubMed2003

Total aortic arch grafting via median sternotomy using integrated antegrade cerebral perfusion.

BACKGROUND: In aortic arch grafting, antegrade cerebral perfusion prolongs the safe time of arch exclusion. However, there are the problems of cerebral embolism and distribution of the cerebral perfusion. We describe and analyze mortality and cerebral complications in patients undergoing total arch grafting using our refined technique. METHODS: Between June 1994 and March 2002, 100 consecutive patients underwent total arch grafting through median sternotomy. There were 49 atherosclerotic aneurysms and 51 aortic dissections. Fifty-four patients were operated on an emergency basis because of rupture or acute type A dissection. We conducted total arch grafting using hypothermic antegrade cerebral perfusion from every cervical vessel. Carbon dioxide gas was added to the cerebral perfusion in order to inhibit the increase in the cerebral vascular resistance during hypothermic cerebral perfusion. RESULTS: Hospital mortality was 4%. The causes of death were dysarrhythmia (n = 1), mesenteric necrosis (n = 1), and preoperative cardiac arrest (n = 2). On univariate analysis, preoperative shock and concomitant cardiac procedures were risk factors for hospital death. The rate of postoperative neurologic damage was 5%. Two patients suffered from cerebral infarction. Temporary neurologic dysfunction occurred in 3 patients. On univariate analysis, emergency surgery was a risk factor for postoperative neurologic damage. On multivariate analysis, there was no significant independent predictor of hospital mortality and neurologic damage. Actuarial survival at 96 months was 66.4 +/- 9.1%, and freedom from aortic accidents (reoperation, rupture, and cholesterol embolism) was 74.9 +/- 7.9%. CONCLUSIONS: The early- and long-term results of total arch grafting using integrated antegrade cerebral perfusion were found to be satisfactory.

Aged↗

PubMed2002

Total aortic arch grafting for acute type A dissection: analysis of residual false lumen.

BACKGROUND: In surgery for acute type A dissection, an unresected dissection and residual false lumina are causes of the progression of aneurysms and ruptures. We grafted the ascending aorta and total arch, the maximum grafting possible through a median sternotomy alone, in all patients with type A dissection extending to the descending aorta, wherever initial tears existed in the arch. METHODS: A total of 37 consecutive patients with acute type A dissection underwent ascending and total arch grafting between August 1994 and December 2000. Cerebral protection was achieved by selective cerebral perfusion. The distal anastomosis was conducted using the "Elephant Trunk" technique. Patent false lumina were evaluated using computed tomography 3 months after the operation. RESULTS: The hospital mortality was 8.1%. No major cerebral complications were observed. The incidence of residual thoracic patent false lumina was 26.5%. Univariate analyses showed Marfan syndrome and preoperative extension of false lumina to be statistically significant determinants of residual thoracic false lumina. On multivariate analysis, no other significant independent predictor of residual false lumina in the thoracic aorta was found. CONCLUSIONS: Outcomes of our strategy were satisfactory. However, residual thoracic false lumina could not be prevented in 26.5% of the patients. Thus, this extended operation is indicated in patients with initial tears in the aortic arch or distal arch, those with Marfan syndrome, and young patients with preoperative patent false lumina extending to the abdominal aorta.

Adult↗