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Ryohei Yozu

Publications and source records attributed to Ryohei Yozu.

At least 19 recordsLinked to original sources
PubMed2006

Chondromodulin-I maintains cardiac valvular function by preventing angiogenesis.

The avascularity of cardiac valves is abrogated in several valvular heart diseases (VHDs). This study investigated the molecular mechanisms underlying valvular avascularity and its correlation with VHD. Chondromodulin-I, an antiangiogenic factor isolated from cartilage, is abundantly expressed in cardiac valves. Gene targeting of chondromodulin-I resulted in enhanced Vegf-A expression, angiogenesis, lipid deposition and calcification in the cardiac valves of aged mice. Echocardiography showed aortic valve thickening, calcification and turbulent flow, indicative of early changes in aortic stenosis. Conditioned medium obtained from cultured valvular interstitial cells strongly inhibited tube formation and mobilization of endothelial cells and induced their apoptosis; these effects were partially inhibited by chondromodulin-I small interfering RNA. In human VHD, including cases associated with infective endocarditis, rheumatic heart disease and atherosclerosis, VEGF-A expression, neovascularization and calcification were observed in areas of chondromodulin-I downregulation. These findings provide evidence that chondromodulin-I has a pivotal role in maintaining valvular normal function by preventing angiogenesis that may lead to VHD.

Aged↗
PubMed2006

Use of hemoglobin vesicles during cardiopulmonary bypass priming prevents neurocognitive decline in rats.

BACKGROUND: Homologous blood use is considered to be the gold standard for cardiopulmonary bypass (CPB) priming in infants despite exposure of the patient to potential cellular and humoral antigens. However, the use of hemoglobin vesicles (HbVs), artificial oxygen carriers that encapsulate a concentrated hemoglobin solution within phospholipid bilayer membranes, for CPB priming may prevent neurocognitive decline in infants. The goal of this study was to determine whether HbV use offsets hemodilution caused by patient/priming volume-mismatched CPB and thereby prevents the development of postoperative neurocognitive deficits. METHODS AND RESULTS: CPB was established in 28 male Sprague-Dawley rats (age, 14 to 16 weeks; weight, 450 grams) after cannulation of the tail artery and right atrium. The animals were randomly assigned to 1 of 3 groups: sham surgery (n=9), HbV (-) prime (n=10), or HbV (+) prime (n=9). CPB was conducted for 90 minutes at 200 mL/kg per minute. The hematocrit during CPB was 10.0+/-1.2% in the HbV (+) prime group and 9.9+/-1.3% in the HbV (-) prime group (P=not significant). Learning and memory function were evaluated using 2 different maze tests (Maze-1 and Maze-2, in which the arrival times to the target were measured on the first, third, fifth, and seventh postoperative days). Learning and memory function were significantly better in the HbV (+) prime group than in the HbV (-) prime group (Maze-1, P=0.012; Maze-2, P=0.042); there was no difference between the HbV (+) prime and the sham surgery group. CONCLUSIONS: The use of HbV for CPB priming may serve as a substitute for homologous blood to prevent the unacceptable hemodilution and contribute to maintenance of intact neurocognitive function.

Animals↗
PubMed2006

Total cavopulmonary connection: open anastomosis of an extracardiac conduit with vacuum-assisted venous drainage.

Insertion of a tube conduit for total cavopulmonary connection is sometimes technically demanding due to the crumpled stump of the inferior vena cava caused by a tourniquet of the inferior vena cava near the division line. Herein we describe an alternative in which the anastomosis is completed during removal of the tourniquet with the application of vacuum-assisted venous drainage. This new technique may alleviate, if not completely eliminate, a concern associated with total cavopulmonary connection with extracardiac conduit in small patients.

Anastomosis, Surgical↗
PubMed2006

[Minimally invasive cardiac surgery using port-access method].

From October 1997 to January 2006, we operated on 209 patients with port-access cardiac surgery. The patients were 116 with atrial septal defect (ASD), 85 with mitral valve disease, 2 with coronary artery bypass grafting (CABG), 10 with other (ventricular septal defect, partial endocardial fusion defect, myxoma). The average of postoperative hospital stay is 7 (shortest: 3) days. None of these patient have been readmitted, however, there was 1 mortality. The operative technique for ASD is established in this series. On the other hand, for mitral valve disease, a modification point such as prevention of a complication and shortening of cardiopulmonary bypass time were recognized. It seemed that careful determination of operative indication and establishment of security were important. Improvement and development of operative technology of port-access method will enable future safe total endoscopic or robotic cardiac surgery. In this paper, we report the latest surgical technique of port-access cardiac surgery.

Cardiac Surgical Procedures↗
PubMed2005

Serum C-reactive protein elevation predicts poor clinical outcome in patients with distal type acute aortic dissection: association with the occurrence of oxygenation impairment.

BACKGROUND: Acute aortic dissection (AAD) is sometimes complicated by respiratory failure due to severe lung oxygenation impairment. Systemic activation of inflammatory system after aortic injury may play some roles in the development of this complication. The aim of this study was to determine the significance of serum C-reactive protein (CRP) elevation in the development of oxygenation impairment and clinical outcome with distal type AAD. METHODS AND RESULTS: A total of 61 patients, who were admitted with distal type AAD within 24 h from the onset, were examined. Serum CRP levels, white blood cell (WBC) counts and body temperature were measured serially for at least 4 days. Oxygenation impairment, defined as the lowest PaO2/FIO2 ratio < or = 200 mmHg, was noted in 31 patients (51%). In patients with oxygenation impairment, peak CRP levels (20.7+/-7.9 vs. 12.7+/-3.8 mg/dl, P < 0.001), peak WBC counts (14,600+/-3600 vs. 11,800+/-4300/mm3, P = 0.008) and body temperature (38.4+/-0.5 vs. 38.0+/-0.6 degrees C, P = 0.004) were significantly higher than those without. Peak CRP level was inversely correlated with the lowest PaO2/FIO2 (P < 0.001). Patients who underwent urgent surgical treatment and/or died in the hospital had higher peak CRP levels (25.1+/-12.3 vs. 16.1+/-7.4 mg/dl, P = 0.010) than those who did not. Multivariate analysis revealed that a peak CRP level > or = 15 mg/dl (relative risk = 12.6, P < 0.001) was an independent determinant of the development of oxygenation impairment. CONCLUSION: The greater serum CRP elevation after distal type AAD was associated with a higher incidence of oxygenation impairment and poor clinical outcome. Systemic activation of the inflammatory system after aortic injury may play an important role in the development of oxygenation impairment.

Acute Disease↗
PubMed2005

Japanese multicenter clinical evaluation of the HeartMate vented electric left ventricular assist system.

Implantable left ventricular assist device systems (LVAS) are increasingly being used to bridge patients to heart transplantation because of the limited number of available donor hearts. This prospective, multicenter trial was designed to evaluate the usefulness of the HeartMate vented electric (VE) LVAS as a bridge to transplantation in Japan. Between November 2001 and June 2003, six patients with end-stage heart failure [New York Heart Association (NYHA) class IV] were supported with the LVAS and five of the six were able to implement the evaluation (one dropped out). The five were men with an average age of 38.6 years and were supported for 2390 cumulative days (6.6 years). Average preimplant cardiac index improved from 1.93 l/min/m(2) to a 3.79 l/min/m(2) VAD flow index at the end of the clinical trial. All five patients improved to NYHA class I or II, survived more than 1 year, and one patient was discharged from the hospital. Mean LVAS support duration was 478 days (range 390-575 days) and four patients remain supported. One patient died from cardiac failure and sepsis. Device-related complications included: infections (four patients), thromboembolism (one patient), hemolysis (two patients), and repeat operation for bleeding (two patients). There was one case of inflow valve incompetence and two pump motor malfunctions. We conclude that the LVAS can effectively support patients as they await cardiac transplantation and offers improvement to the patient's quality of life.

Adult↗
PubMed2005

Pseudoaneurysm of the brachiocephalic artery.

Pseudoaneurym of the brachiocephalic artery is uncommon. A 62-year-old male patient with a mediastinal tumor underwent tumor resection at the Department of Thoracic Surgery in our hospital. Urgent transverse aorta-right common carotid artery bypass with an 8-mm prosthetic graft was performed intraoperatively, due to uncontrolled bleeding from the brachiocephalic artery where severe adhesion between the anterolateral aspect of the brachiocephalic artery and the tumor was encountered. After surgical removal of the tumor, frozen-section analysis revealed no malignant cells in the tumor, which instead comprised hematoma with organized changes and no evidence of malignancy. Based on pathological results, the resected tumor was diagnosed as a pseudoaneurysm of the brachiocephalic artery. Postoperative course was uneventful. Cause of the pseudoaneurysm was considered iatrogenic, as the aneurysmal wall displayed no atherosclerotic degeneration, and although no history of blunt trauma to the chest or central venous puncture was present, the patient had undergone cerebral artery angiography via the right brachial artery following right thalamic hemorrhage 2 years earlier.

Aneurysm, False↗
PubMed2005

Effect of the free radical scavenger MCI-186 on spinal cord reperfusion after transient ischemia in the rabbit.

OBJECTIVE: Paraplegia remains a serious complication of aortic operations. The production of free radicals during reperfusion after transient ischemia is believed to induce secondary spinal neuronal injury, resulting in paraplegia. The aim of the present study was to clarify the protective effect and method of administration of antioxidants on the neurological and histological outcome in the animal model for reperfusion injury after transient spinal cord ischemia. METHODS: New Zealand white rabbits underwent surgical exposure of the abdominal aorta that was clamped for 15 minutes to achieve spinal cord ischemia. Group A animals received two 10 mg/kg doses of 3-methyl-1-phenyl-2-pyrazolin-5-one (MCI-186) at the time of release of the aortic clamp and 30 minutes later. In group B, MCI-186, 5 mg/kg, was given three times, at the time of aorta clamp release, 30 minutes and 12 hours later. In group C (control group), one dose of vehicle was administered. Neurological status was assessed using modified Tarlov's score until 168 hours after operation. Spinal cord sections were examined microscopically to determine the extent of ischemic neuronal damage. RESULTS: Groups A and B animals had better neurological function than group C (p < 0.001). In contrast, group C animals exhibited paraplegia or paraparesis with marked neuronal necrosis. The number of surviving neurons within examined sections of the spinal cord was significantly greater in group B than in group C (p < 0.001). CONCLUSION: In a 15-minute ischemia-reperfusion model using rabbits, systemic repetitious administration of MCI-186, a free radical scavenger, was found to have a protective effect on the spinal cord neurons both neurologically and histologically. We postulate that the drug minimizes the delayed neuronal cell death for reperfusion injury after transient ischemia by reducing the free radical molecules. Moreover, it was thought that we could protect delayed neuronal cell death more effectively by administering MCI-186 12 hours later.

Animals↗
PubMed2005

An epidural cooling catheter protects the spinal cord against ischemic injury in pigs.

BACKGROUND: Using swine, we investigated whether epidural placement of a cooling catheter rather than infusing iced saline solution could protect the spinal cord from ischemia during aortic surgery. METHODS: We divided 14 domestic pigs into two groups of 7 each. Each underwent epidural catheter placement preceding 30 minutes of aortic cross-clamping distal to the origin of the left subclavian artery. In group 1, cold water was circulated continuously through the lumen of the catheter connected to an external unit. In group 2, animals received catheter placement without cooling. Spinal cord somatosensory evoked potentials were recorded. Neurologic status involving hind limbs was graded sequentially after surgery. RESULTS: At aortic cross-clamping, spinal temperature in group 1 (31.7 degrees +/- 0.6 degrees C) was significantly lower than in group 2 (37.8 degrees +/- 0.4 degrees C; p < 0.0001). No significant elevation of intrathecal pressure accompanied cooling with the catheter (group 1, 8.1 +/- 1.7 mm Hg; group 2, 8.0 +/- 1.5 mm Hg). Mean duration of total loss of potentials was significantly shorter in group 1 (7.4 +/- 3.8 minutes) than group 2 (19.7 +/- 7.3 minutes; p = 0.0002). Pigs in group 1 exhibited better hind limb function recovery (mean Tarlov score, 4.7 +/- 0.5) than group 2 (0.6 +/- 0.8; p = 0.0017). Group 1 showed normal histologic characteristics, whereas group 2 showed loss of motor neurons in the ventral horns. CONCLUSIONS: Epidural cooling catheter without iced saline infusion can cool the spinal cord without elevating intrathecal pressure, protecting the cord against ischemia.

Animals↗
PubMed2005

Protective use of N-methyl-D-aspartate receptor antagonists as a spinoplegia against excitatory amino acid neurotoxicity.

OBJECTIVE: Paraplegia remains a serious complication of thoracic and thoracoabdominal aortic operations. To avoid this dreadful complication, N-methyl-D-aspartate (NMDA) receptor antagonists have been examined in the ischemic or excitotoxic neuronal injury model. In the present study, we evaluated the protective efficacy of NMDA receptor antagonists that were infused segmentally after aortic clamping, as a spinoplegia, to reduce aspartate neurotoxicity in the spinal cord. METHODS: Infrarenal aortic isolation was performed in New Zealand white rabbits. Group A animals (n = 7) were pretreated with the segmental infusion of MK-801, a noncompetitive NMDA receptor antagonist, followed by segmental aspartate (50 mmol) infusion for 10 minutes. Group B animals (n = 6) received pretreatment with CGS19755, a competitive NMDA receptor antagonist, followed by the same aspartate infusion as group A. Group C animals (n = 7) received vehicle only, followed by aspartate infusion as a control group. In addition, group D animals (n = 6) were pretreated with MK-801 that was administrated intravenously 1 hour before aspartate infusion. Neurologic status was assessed at 12, 24, and 48 hours after operation by using the Tarlov score. The spinal cords were procured at 48 hours for histopathologic analysis to determine the extent of excitotoxic neuronal injury. RESULTS: Most of the animals in groups A and D revealed full recovery or mild motor disturbance. Group B and C animals exhibited paraplegia or paraparesis with marked neuronal necrosis. In the Tarlov score at 48 hours, group A animals represented better neurologic function than group C (P < .01) and similar motor function to group D animals. Severe histopathologic change was not observed in groups A and D. Animals in groups A and D showed a greater number of motor neurons than animals in groups B and C (P < .01). The difference could be due to chance between group A and D animals (P = .08). CONCLUSIONS: These results showed that the segmental infusion of noncompetitive NMDA receptor antagonist as an intraoperative spinoplegia could have a protective effect on the spinal cord neurons against excitotoxic neuronal injury in vivo. On the other hand, efficacy of the use of competitive antagonist was suggested to be limited in this model, probably because of the insurmountable obstacle of the blood-brain barrier. CLINICAL RELEVANCE: Paraplegia is a devastating complication during surgical repair of the thoracic and thoracoabdominal aortas. Excitatory amino acids neurotoxicity through the N-methyl-D-aspartate (NMDA) receptor is no doubt the pathologic hallmark of ischemic and postischemic spinal cord injury. Systemic administration of either a competitive or noncompetitive NMDA antagonist has been reported to have neuroprotective effect, in terms of preoperative treatment, with dose-related central sympathomimetic and sedative effects. Local administration, particularly of a noncompetitive NMDA antagonist, infused segmentally after aortic clamping could therefore be a potent intraoperative pharmacologic strategy to minimize the effective dose that retains NMDA antagonism without undesirable adverse effects. Our ability to reproduce this model could facilitate pharmacologic prevention or provide a new surgical technique as a spinoplegia for NMDA receptor-mediated neuronal injury.

Animals↗
PubMed2004

Changes in left ventricular volume and predictors of cardiac events after endoventricular circular patch plasty.

OBJECTIVE: The aim of this study was to identify predictors of cardiac events after endoventricular circular patch plasty (Dor operation) by analyzing our experience with Dor operation. METHODS: Thirty patients with left ventricular aneurysm and/or ischemic cardiomyopathy who underwent Dor operation were included in this study. Hemodynamic and clinical results were analyzed, and the predictors of cardiac events were examined. RESULTS: Hospital mortality was 3.3%. Postoperative clinical status and left ventricular (LV) function in all survivors significantly improved. The survival rates at 1, 3, and 5 years after operation were 93%, 89% and 89%. The corresponding cardiac event-free rates were 75%, 67% and 49%. Pre- and postoperative LV function and volume did not differ significantly between patients with or without cardiac events. However, the proportion of reduced end-diastolic volume index (EDVI) (preoperative EDVI-postoperative EDVI) to preoperative EDVI was significantly higher in patients with cardiac events than in cardiac event-free patients. Postoperative LV volume re-increased in the cases with cardiac events during follow-up. Cox regression analysis confirmed that preoperative clinical premature ventricular contraction and end-systolic volume index (ESVI), postoperative EDVI, ESVI, and ejection fraction were independent predictors of late cardiac events. There was a significant positive correlation between preoperative ESVI and postoperative EDVI. CONCLUSION: Though LV function significantly improved after Dor operation, LV reconstruction with excessive reduction can cause restarting LV remodeling and increasing mortality and morbidity. Therefore, LV reconstruction of appropriate sizes and shapes, considering the function of residual myocardium, has a significant effect on prognosis. It is highly reasonable to expect that preoperative ESVI can predict the optimal size of reconstructed left ventricle.

Aged↗
PubMed2004

Effect of delayed induction of postischemic hypothermia on spinal cord damage induced by transient ischemic insult in rabbits.

OBJECTIVE: This study was performed to determine the effect of delayed induction of mild hypothermia after transient spinal cord ischemia in rabbits. METHODS: Abdominal aortic occlusion was performed for 15 minutes to induce spinal cord ischemia at a rectal temperature of 37.3 +/- 0.3 degrees C. Four groups of rabbits were investigated: Group 1 (n = 8) was subjected to ischemia and reperfused at the same temperature for 7 hours; Group 2 (n = 8) was subjected to ischemia and reperfused at the same temperature for 1 hour, followed by 6 hours of systemic hypothermia (32.5 +/- 0.5 degrees C); Group 3 (n = 8) was subjected to ischemia, reperfusion at the same temperature for 3 hours and then 6 hours of systemic hypothermia (32.5 +/- 0.5 degrees C); and Group 4 (n = 8) comprised non-ischemic controls. Neurological status of all rabbits in Groups 1-3 was recorded and animals were sacrificed 1 week after ischemic injury. Spinal cord sections were examined microscopically to determine the extent of ischemic neuronal damage. RESULTS: Mean modified Tarlov's score at 1 week after ischemic insult was 0.5 +/- 0.8 in Group 1, compared to 43 +/- 1.5 in Group 2 and 2.9 +/- 1.8 in Group 3. Mean total number of surviving neurons within examined sections of spinal cord was significantly greater for Groups 2 and 3 compared with Group 1 (Group 1, 81 +/- 66.1; Group 2, 293.4 +/- 110.9; Group 3, 227.1 +/- 105.5; p < 0.001). CONCLUSIONS: Delayed postischemic hypothermia induced within 3 hours after reperfusion significantly reduces ischemia-induced spinal cord neuronal damage in rabbits.

Animals↗
PubMed2004

Active distal coronary perfusion to prevent regional myocardial ischemia in off-pump coronary artery bypass grafting.

Regional myocardial ischemia during anastomosis in off-pump coronary artery bypass (OPCAB) can occasionally cause hemodynamic instability. To prevent regional myocardial ischemia and stabilize the hemodynamics during the procedure, perfusion of the distal coronary artery to the anastomotic site is necessary as the only reliable method. We have applied an active coronary perfusion method using a servo-controlled pump in selected patients in place of conventional passive perfusion methods (intraluminal shunt and external shunt). We present a case in which the active perfusion method proved useful in avoiding regional myocardial ischemia. A 74-year-old male patient with triple-vessel coronary disease underwent OPCAB for unstable angina. During revascularization of the main right coronary artery, the hemodynamics collapsed due to regional myocardial ischemia. As soon as the distal coronary artery was perfused at a high flow rate around 80 ml/min, the hemodynamics stabilized and the operation was completed successfully. This active coronary perfusion method in OPCAB is particularly useful in cases in which regional myocardial ischemia cause hemodynamic instability.

Aged↗
PubMed2004

Resection of giant right atrial lymphoma using vacuum-assisted cardiopulmonary bypass without snaring the inferior vena cava.

A 53-year-old man sustained hemodynamic collapse due to a huge right atrial tumor and was transferred to our hospital and underwent a life-saving emergency operation. The tumor arose from the inferolateral wall of the right atrium, occupying almost the whole right atrial cavity and obstructing not only the inflow of the right ventricle but also the orifice of the inferior vena cava. Venous cannulation via the right atrial wall and placing a snare around the inferior vena cava were impossible. With a cardiopulmonary bypass using vacuum-assisted venous drainage, the tumor was successfully resected and the tricuspid valve was replaced with a bioprosthetic valve without snaring the inferior vena cava. Postoperative histological examination demonstrated the tumor to be a large B-cell non-Hodgkin type malignant lymphoma. When the tumor is large and it is difficult to establish total cardiopulmonary bypass, the vacuum-assisted cardiopulmonary bypass is a useful option. This can achieve a bloodless operative field and is not blocked by the incoming air, due to the venous drainage being continually pressure-regulated.

Cardiopulmonary Bypass↗
PubMed2003

The limitation of staged repair in the surgical management of congenital complex heart anomalies with aortic arch obstruction.

OBJECTIVE: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. METHODS: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. RESULTS: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 +/- 7.3 years). There were 20 postoperative hospital deaths (27%) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3% +/- 4.5% at 1 month, 68.0% +/- 5.4% at 1 year, 65.0% +/- 5.5% at 5 years, 63.1% +/- 5.7% at 10 years, 63.1% +/- 5.7% at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95% confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5%). The Kaplan-Meier estimate of the reintervention-free rate was 91.3% +/- 4.2% at 5 years, 85.5% +/- 5.6% at 10 years, 75.6% +/- 8.2% at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95% confidence interval: 3.2-80.2]). CONCLUSIONS: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch.

Abnormalities, Multiple↗
PubMed2003

Comparison of early postoperative quality of life in minimally invasive versus conventional valve surgery.

PURPOSE: Minimally invasive cardiac surgery (MICS), an approach in which full sternotomy is avoided and the surgical incision is minimal, has been shown to produce less postoperative discomfort and to enable earlier mobilization and discharge than conventional cardiac surgery (CCS). This study was performed to retrospectively evaluate quality of life following MICS in comparison with CCS valve surgery. METHODS: Sixty-six patients scheduled for MICS and 50 patients scheduled for CCS for isolated aortic or mitral valve surgery from January 1999 to June 2001 were enrolled in the study. The clinical records for the two groups were compared across intraoperative parameters and those associated with postoperative quality of life. RESULTS: The aortic clamp and cardiopulmonary bypass times in the MICS group were longer than those in the CCS group (144 +/- 42 and 224 +/- 58min vs 112 +/- 21 and 179 +/- 27min, P < 0.001). Postoperative pain medication (rectal buprenorphine and intramuscular pethidine) was administered to 18 of the 66 MICS patients (27%), as compared with 26 of the 50 CCS patients (52%, P = 0.007). Postoperative delirium was less frequent in the MICS group than the CCS group (26% vs 44%, P = 0.039). Initial postoperative food intake and urine catheter removal were possible earlier in the MICS than in the CCS group. MICS patients had shorter stays in the intensive care unit than CCS patients (37.4 +/- 7.3 vs 45.9 +/- 8.7h, P < 0.001). CONCLUSION: Although longer aortic clamp and cardiopulmonary bypass times remain a problem in MICS procedures, our results suggest that MICS, as compared with CCS, facilitates earlier recovery of daily activities and provides improved quality of life in the early postoperative period.

Female↗
PubMed2003

A case in which biventricular assist device support was required after aortic valve replacement with a bioprosthetic valve.

We report the case of a 45-year-old man with severe aortic regurgitation. The patient underwent aortic valve replacement with a bioprosthetic valve, but was unable to be weaned from cardiopulmonary bypass (CPB). Intraoperative coronary angiography revealed stenosis of the right coronary orifice, so an intra-aortic balloon pump was inserted and coronary artery bypass grafting to the right coronary artery was conducted; however, weaning from CPB again failed. Left ventricular assist using a Gyro centrifugal pump was performed between the left atrium and left femoral artery, along with right ventricular assist using a Nikkiso centrifugal pump between the right atrium and pulmonary artery. Flow rates averaged from 2.0 to 2.8 l/min for the left-side ventricular assist device (VAD) and 2.1-3.8 l/min for the right-side VAD. The bypass rate reached approximately 70% at maximum. No thromboembolic events were documented during VAD support. The patient underwent explantation of VADs on postoperative day 4. No thrombus was identified on the bioprosthetic aortic valve by transesophageal echocardiography. The left-side pump displayed no thrombus, while the right-side pump had a small thrombus at the shaft. The patient was discharged from the hospital and was alive as of 2 year postoperatively. To the best of our knowledge, no clinical study has yet compared the antithrombotic properties of two centrifugal pumps in one patient where mechanical support was performed for the same duration and flow rate.

Aortic Valve↗