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Shuichiro Takanashi

Publications and source records attributed to Shuichiro Takanashi.

17 recordsLinked to original sources
PubMed2007

Early and midterm results of off-pump coronary artery bypass grafting.

BACKGROUND: Early outcomes of off-pump coronary artery bypass grafting have been documented by numerous studies. However, there have been few reports concerning midterm outcomes after off-pump coronary artery bypass grafting. METHODS: We retrospectively reviewed the records of 602 consecutive patients (24.8% female) who underwent isolated off-pump coronary artery bypass grafting between April 2001 and July 2004. Mean age was 66.7 +/- 9.3 years. Mean Canadian Cardiovascular Society score was 2.5 +/- 0.9. Early postoperative angiograms were evaluated during the same period of hospitalization. Midterm outcomes, including overall patient survival, freedom from cardiac death, and freedom from the combined endpoint of cardiac events, were evaluated. RESULTS: The average number of distal anastomoses per patient was 3.6 +/- 1.4. The average operation time was 286.1 +/- 72.1 minutes. Long segmental reconstruction of the left anterior descending coronary artery was performed in 218 patients (36.2%). Total arterial grafting was performed in 466 patients (77.4%). Thirty-day mortality was 0.5%. Overall patency rate for all grafts and anastomoses was 97.5% and 97.6%, respectively. Mean follow-up time was 2.9 +/- 1.0 years. Cumulative patient survival at 5 years was 87.9% +/- 2.4%. Freedom from cardiac death was 97.7% +/- 0.6% at 5 years. Freedom from the combined endpoint of cardiac events was 83.8% +/- 2.3% at 5 years. CONCLUSIONS: Early and midterm outcomes after off-pump coronary artery bypass grafting have acceptable mortality and cardiac events rates, with favorable early graft patency rates.

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PubMed2006

Surgical treatment for Kommerell's diverticulum.

OBJECTIVE: Kommerell's diverticulum, which is a rare condition, is a congenital abnormality of the aortic arch. The strategy of surgical treatment for Kommerell's diverticulum has not been established. METHODS: Between 1994 and 2004, 6 patients underwent surgery for Kommerell's diverticulum at our institute. Diagnoses included right aortic arch with aberrant left subclavian artery in 4 patients and left aortic arch with aberrant right subclavian artery in 2 patients. Indications for surgery were dilatation of Kommerell's aneurysm (n = 4) and dysphagia (n = 2). One patient underwent total arch replacement through the median sternotomy plus right thoracotomy. Five patients underwent replacement of the descending aorta and reconstruction in situ (n = 4) or ligation (n = 1) of the stenotic aberrant subclavian artery through the right (n = 3) or left (n = 2) thoracotomy. RESULTS: There were no patient deaths or patients who required rehospitalization. Mediastinitis occurred in 1 patient. This patient required mediastinal drainage and an omentopexy. Two patients who had dysphagia became asymptomatic. Postoperative angiographies in all patients were satisfactory. The patient whose aberrant subclavian artery was ligated had no ischemic symptom of the arm. At the midterm outcomes (mean follow-up length was 55.6 +/- 42.2 months, ranging 10-114 months), all patients resumed normal activities without any complications. CONCLUSIONS: Kommerell's diverticulum can be repaired safely with graft replacement concomitant with in situ reconstruction of the aberrant subclavian artery through thoracotomy.

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PubMed2006

[Off-pump coronary artery bypass with endarterectomy].

The diffusely diseased left anterior descending coronary artery (LAD) remains a challenge for both interventional cardiologists and cardiac surgeons. We assessed the surgical outcomes obtained from off-pump coronary artery reconstruction, with or without endarterectomy, for a diffusely diseased LAD. One hundred and eighteen patients were treated with an extended LAD reconstruction, with or without endarterectomy. The left internal thoracic artery (LITA) was used to reconstruct the LAD in all patients. Coronary artery reconstruction was performed without endarterectomy in 63 patients and with endarterectomy in 55 patients. The operative mortality was 0.8%. Perioperative myocardial infarction was observed in 14.4% of the patients. The mean LAD incision length was 5.6 +/- 1.4 cm. The patency rate of the LITA to LAD was 96.2% by early angiographic examination. Coronary artery reconstruction, with or without endarterectomy, using the LITA for a diffusely diseased LAD can be performed with acceptable results.

Coronary Artery Bypass, Off-Pump↗
PubMed2005

Coronary artery and graft spasm after off-pump coronary artery bypass grafting.

We report a case of a 52-year-old man with severe coronary artery and graft spasm after triple-vessel off-pump coronary artery bypass grafting. Emergent coronary angiography was performed to identify the location and severity of the spasm. Intracoronary injections of several vasodilators failed to relieve the spasm. Observational treatments including intra-aortic balloon pump and inotropic drugs to increase coronary flow were performed until the spasm resolved. The patient recovered and was discharged. A follow-up coronary angiography revealed patent native coronary artery and bypass grafts without evidence of residual spasm.

Coronary Artery Bypass, Off-Pump↗
PubMed2005

Optimal method of coronary endarterectomy for diffusely diseased coronary arteries.

BACKGROUND: Although several techniques for coronary artery bypass grafting have been introduced that incorporate coronary endarterectomy (CE), there is little information about late patency among the various CE methods. To clarify the quality of CE, we assessed clinical and angiographic results of our experience with this procedure on 127 patients who had diffusely diseased coronary arteries. METHODS: Between January 1994 and December 2002, 127 patients underwent coronary artery bypass grafting with CE. Sixty-eight patients undergoing CE with long arteriotomies and on-lay patch bypass grafting (group O) were compared with 59 patients undergoing CE with the conventional pull-out method (group P). RESULTS: Thirty-day mortality was 2.9% in group O and 6.8% in group P. The early angiographic results of 115 patients revealed a patency rate of 92.1% (grade A: 79.4%) in group O and 88.6% (grade A: 68.6%) in group P. Actuarial survival at 5 years was 90.7% in group O and 74.0% in group P (p = 0.1). Angiograms performed on 78 patients after a mean period of 21 +/- 16 months showed a patency rate of 89.1% (grade A:76.1%) in group O and 81.0% (grade A: 38.1%) in group P (grade A: p < 0.001). CONCLUSIONS: The midterm angiographic results of CE with long arteriotomies and on-lay patch bypass grafting were better than the results obtained with the conventional pull-out method. This procedure was found to be safe and effective for complete revascularization in patients with a severely and diffusely diseased coronary artery.

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PubMed2005

Coronary endarterectomy and stent removal in patients with in-stent restenosis.

BACKGROUND: In-stent restenosis (ISR) remains the major limitation of coronary stent implantation. Controversies exist regarding optional treatment for ISR. Recently, we developed aggressive surgical options, coronary endarterectomy and stent removal, in this complex setting. METHODS: Between April 2001 and March 2004, 11 consecutive patients who presented with angina and angiographically severe ISR were treated with coronary endarterectomy and stent removal with concomitant multivessel coronary bypass grafting. There were 10 men and 1 woman. The age ranged from 43 to 75 years old (mean 64.1 +/- 9.6 years). The mean number of target vessel interventions was 1.6 +/- 0.7. Data were analyzed retrospectively. RESULTS: The target vessel was the left anterior descending artery (LAD) in all patients. The mean interval from the last intervention was 4.8 +/- 1.9 months. The mean number of target vessel interventions was 1.6 +/- 0.7. The mean LAD incision length was 57.3 +/- 11.0 mm. The left internal mammary artery (LIMA) was grafted in situ, as an on-lay patch. Procedural success without in-hospital complications was achieved in all cases, except one patient with low output syndrome. Postprocedure angiography demonstrated that all LIMA patches and LAD arteries were patent and left ventricular functions were preserved. CONCLUSIONS: Coronary endarterectomy and stent removal with on-lay LIMA patch is a safe and effective technique used in patients with ISR involving diffuse target vessel disease.

Adult↗
PubMed2005

Total arterial myocardial revascularization using composite and sequential grafting with the off-pump technique.

BACKGROUND: Multiple arterial myocardial revascularizations are increasingly undertaken using off-pump techniques; however, various arterial grafting techniques are utilized. This study aimed to review the outcome of combining arterial composite and sequential grafting with off-pump techniques. METHODS: We retrospectively reviewed the records of 107 consecutive patients who underwent coronary bypass surgery with off-pump and arterial composite grafting techniques between April 2001 and March 2004. The left internal thoracic artery (LITA) was harvested in all patients, and the right internal thoracic artery (RITA), the radial artery (RA), and the gastroepiploic artery (GEA) were harvested in 69 patients, in 83 patients, and in 53 patients, respectively. Early postoperative angiograms were evaluated in 97 patients. RESULTS: There were 488 distal anastomoses, an average of 4.5 per patient. Forty-four in situ LITAs were used as LITA Y-composite grafts with a free RITA (n = 19), RA (n = 24), or free GEA (n = 1). Forty-three in situ RITAs were used as RITA-RA grafts (n = 42) or a RITA-GEA graft (n = 1). Twenty-one in situ GEAs were used as composite grafts with the RA (n = 17) or a free RITA (n = 4). There were no hospital deaths. The patency of the LITA was 100%, and that of the RA was 97.3%, while patencies of both in situ and free RITA and GEA were 100%. During the follow-up period (mean: 22.1 months), there were 3 late deaths, but none were cardiac related. CONCLUSIONS: Total arterial revascularization with composite and sequential grafting is a safe and effective technique in patients undergoing off-pump coronary artery bypass surgery.

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PubMed2005

Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy.

BACKGROUND: The diffusely diseased left anterior descending coronary artery (LAD) remains a challenge for both interventional cardiologists and cardiac surgeons. In this study we assessed the surgical outcomes obtained from coronary artery reconstruction, with or without endarterectomy, for a diffusely diseased LAD. METHODS: Two hundred and fifty patients were treated with an extended LAD reconstruction, with or without endarterectomy, as part of coronary artery bypass grafting to achieve complete revascularization. The left internal thoracic artery (LITA) was used to reconstruct the LAD in all patients. There were 197 men and 53 women. The mean age was 65.1 +/- 9.0 years. Coronary artery reconstruction was performed without endarterectomy in 183 patients (73.2%) and with endarterectomy in 67 patients (26.8%). The off-pump technique was used in 204 patients (81.6%). RESULTS: The operative mortality was 1.6%. Perioperative myocardial infarction was observed in 6.4% of the patients. The mean LAD incision length was 4.3 +/- 1.7 cm. The patency rate of the LITA to LAD was 98.6% by early angiographic examination (mean, 7.5 +/- 2.6 postoperative days). There were 3 late cardiac-related deaths at a mean follow-up of 21.2 +/- 10.7 months. The actuarial survival was 92.0% at 45 months. Freedom from death or cardiac events was 88.1% at 45 months. CONCLUSIONS: Coronary artery reconstruction, with or without endarterectomy, using the left internal thoracic artery for a diffusely diseased LAD can be performed with acceptable early and midterm results.

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PubMed2005

Surgical treatment for primary cardiac leiomyosarcoma causing right ventricular outflow obstruction.

A 55-year-old man was admitted to another hospital because of dry cough and dyspnea that rapidly worsened before admission. Chest computed tomography revealed a low-density mass that nearly obstructed the main pulmonary arterial trunk. Pulmonary thromboembolism was suspected and treated with catheter-directed thrombolysis therapy. Despite optimal thrombolysis and anticoagulant therapy, his symptoms persisted. He was referred for further examination and possible surgery for presumed pulmonary thromboembolism. The mass appeared more likely to be a tumor than a thrombus on careful analysis of the magnetic resonance imaging. At surgery, the anterior wall of the main pulmonary arterial trunk, the pulmonary valve, annulus, and the right ventricular outflow tract were all invaded by what was found to be a tumor and were resected under conventional cardiopulmonary bypass. The resected area was reconstructed with a 25-mm-diameter bioprosthetic valve and Xenomedica patch. Final pathological diagnosis was primary cardiac leiomyosarcoma involving the pulmonary valve. Postoperative course was uneventful, and he was discharged 11 days after surgery without adjuvant therapy because he refused it. Ten months later, the patient was well, but a chest X-ray revealed some coin lesions in the bilateral lung fields that were thought to be metastatic tumor.

Heart Neoplasms↗
PubMed2005

Recurrent cardiogenic shock caused by dynamic mitral regurgitation in a patient with hypertrophic obstructive cardiomyopathy: a case report.

A 68-year-old man with hypertrophic obstructive cardiomyopathy developed recurrent cardiogenic shock due to dynamic mitral regurgitation. The pressure gradient in the left ventricular outflow tract under medication was 30 mmHg, and he complained of no symptom. He developed shock with dyspnea suddenly after bathing and defecation. Echocardiography and left ventriculography revealed massive mitral regurgitation and mild increment of pressure gradient in the left ventricular outflow tract (50 mmHg). He underwent successful mitral valve replacement following treatment with beta-blocker under intraaortic balloon pumping support. This case illustrates that exacerbation of the systolic anterior motion of the mitral anterior leaflet can cause dynamic severe mitral regurgitation with 'mild' increment of pressure gradient in the left ventricular outflow tract, resulting in cardiogenic shock with severe lung edema.

Adrenergic beta-Antagonists↗
PubMed2004

Off-pump coronary artery bypass grafting in patients with renal dysfunction.

BACKGROUND: Renal dysfunction is a predictor of increased morbidity and mortality after coronary artery bypass grafting, whether it is dialysis-dependent or not. Several studies have shown the efficacy of off-pump technique in reducing morbidity and mortality in patients with renal dysfunction. However, the actual effect of renal dysfunction in off-pump coronary artery bypass grafting has not been well understood. METHODS: We conducted a retrospective review of 402 consecutive patients undergoing off-pump coronary artery bypass grafting from April 2001 to June 2003. Sixty-eight patients had chronic renal dysfunction (group A); 19 patients were dialysis-dependent; 334 patients had normal renal function (group B). Operative variables, morbidity, and mortality were compared between the two groups. Furthermore, multivariable analysis was performed to identify predictors for short-term survival. RESULTS: Preoperative characteristics were similar in the two groups. Blood transfusion rate was higher in group A than group B (57.4% and 25.7%, respectively; p < 0.001). In-hospital mortality was similar (1.5% and 1.2% in group A and B, respectively; p = 0.853). Multivariable analysis revealed that unstable angina, low ejection fraction, peripheral vascular disease and redo surgery are significant risk factors for poor early result of off-pump coronary artery bypass grafting. CONCLUSIONS: Early outcomes of off-pump coronary artery bypass grafting in patients with renal dysfunction were comparable to those in patients with normal renal function. Renal dysfunction is not a predictor of poor early outcomes after off-pump coronary artery bypass grafting.

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PubMed2004

Coronary endarterectomy and stent removal after iatrogenic perforation.

Coronary perforation is a rare complication of percutaneous coronary intervention. We report a case of type 3 coronary artery perforation after stenting of the left anterior descending coronary artery. Pericardiocentesis was required to treat cardiac tamponade and prolonged balloon inflation did not stop the bleeding. Urgent surgical intervention with coronary endarterectomy, removal of the stent, and bypass grafting using the left internal mammary artery to the left anterior descending artery was successful. Complete removal of stent with endarterectomy is a feasible option for perforation as a complication of coronary stenting.

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PubMed2003

Off-pump long onlay bypass grafting using left internal mammary artery for diffusely diseased coronary artery.

Surgical treatment of a diffusely diseased coronary artery has been considered a relative contraindication for off-pump coronary artery bypass grafting. To our knowledge, long onlay-patch grafting with off-pump coronary artery bypass grafting has not been described. Two sets of Octopus 3 tissue stabilizers were placed longitudinally along the target coronary artery. This allowed us to perform surgical angioplasty and bypass grafting without cardiopulmonary bypass support (double Octopus technique). We report our early experience with off-pump long onlay bypass grafting in patients with a diffusely diseased coronary artery using double Octopus tissue stabilizers. Diffusely diseased coronary artery; off-pump coronary artery bypass grafting; coronary artery reconstruction; coronary artery bypass grafting; onlay patch anastomosis

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PubMed2003

Complete revascularization in patients with severe left ventricular dysfunction.

OBJECTIVE: This study evaluates whether patients with coronary artery disease and severely depressed left ventricular ejection fraction (LVEF) benefit from complete revascularization by multivessel coronary artery bypass. METHODS: From April 1994 to May 2002, 42 patients who underwent coronary artery bypass grafting (CABG) at our institution had impaired left ventricular (LV) function [an ejection fraction (EF) of 30% or less]. The average preoperative LVEF was 23.8%. The mean number of grafts was 4.6. Complete revascularization by multivessel bypass grafting was the goal for all patients. RESULTS: Thirty days mortality was 0 and hospital mortality was 2.4%. The mean graft patency rate for 35 (83%) patients at one month was 98.8%. The mean postoperative LVEF improved significantly, from 23.8% to 35.2% (p<0.05), and the New York Heart Association (NYHA) classification was improved in most patients. The Kaplan-Meier estimate of survival at 5 years was 83.1%, and that of the cardiac event-free rate at 5 years was 77.5%. CONCLUSION: For patients with poor LV function, complete surgical revascularization by multivessel bypass grafting can be performed safely, with satisfactory hospital mortality and long-term results.

Adult↗
PubMed2003

Off pump long-onlay-patch angioplasty to the LAD using the left internal mammary artery.

Surgical treatment for diffusely diseased coronary arteries has been considered to be a relative contraindication for off pump coronary artery bypass (OPCAB) grafting. We report a case of off pump long-onlay-bypass grafting using the left internal mammary artery. To our knowledge, the long-onlay-patch grafting with OPCAB technique has not been previously described. Two sets of Octopus-3 tissue stabilizers were placed longitudinally along the target coronary artery (Double-Octopus technique). This technique allowed us to performed surgical angioplasty and bypass grafting without cardiopulmonary bypass support. Patients with severe diffuse coronary lesions who are at high risk for cardiopulmonary bypass will benefit from this technique.

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