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Biomedical subjects

Soichiro Kitamura

Publications and source records attributed to Soichiro Kitamura.

At least 91 records · Page 5Linked to original sources
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

Phosphodiesterase type 4 inhibitor prevents acute lung injury induced by cardiopulmonary bypass in a rat model.

OBJECTIVES: Cardiopulmonary bypass (CPB) induces systemic inflammatory response with neutrophil activation and subsequent lung dysfunction. Rolipram, a selective phosphodiesterase type 4 inhibitor, blocks the decrease in levels of cyclic adenosine monophosphate associated with neutrophil activation. Here, we tested the protective effect of rolipram on CPB-induced lung injury in the rat. METHODS: Rats were divided into three groups: control (C), rolipram (R) and sham (S). In the C and R groups, animals underwent CPB at a flow rate of 60 ml/kg per min for 60 min followed by another 60-min observation, whereas the S group rats were sustained for 120 min only with median sternotomy and the placement of cannulae for CPB. Rolipram (40 microg/kg per min) was administered to the R group rats by continuous intravenous infusion from 10 min before the establishment of CPB to the end of the experiment. RESULTS: The R and S groups showed significantly higher mean arterial oxygen pressure and lower mean lung wet-to-dry weight ratio compared with those observed in the C group (R: 489+/-44 or S: 527+/-55 vs. C: 287+/-185, and R: 5.0+/-0.4 or S: 4.7+/-0.3 vs. C: 5.9+/-0.5, respectively; (P < 0.01). Although CD11b expression levels on circulating neutrophils in the C group doubled after CPB, those in the R and S groups remained almost the same (P = 0.0008). Intrapulmonary tumor necrosis factor-alpha concentrations (pg/microg protein) in the C group tended to be higher than those observed in the R and S groups (R: 5.2+/-2.1, S: 5.0+/-2.1 and C: 8.9+/-5.4; R vs. C: P = 0.09 and S vs. C: P = 0.08). Pathological study of lungs revealed that more alveolar hemorrhage and neutrophil accumulation were observed in the C group compared to the R and S groups. CONCLUSIONS: These results suggest that rolipram prevents acute lung injury via the inhibition of neutrophil activation during and after CPB in this setting of a rat model.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2004

Functional biventricular repair using left ventricle-pulmonary artery conduit in patients with discordant atrioventricular connections and pulmonary outflow tract obstruction-does conduit obstruction maintain tricuspid valve function?

OBJECTIVE: The aim of the study is to determine whether function of the tricuspid valve placed for the systemic circulation is related to left ventricular pressure supporting the pulmonary circulation after functional repair for atrioventricular discordance. METHODS: Right ventricular volume and tricuspid regurgitation (TR) were investigated, in relation to left ventricular pressure, in 15 patients with this malformation who underwent functional biventricular repair with left ventricle-pulmonary artery conduit. RESULTS: After the functional biventricular repair, ratio of systolic left ventricular pressure to right ventricular one (LVP/RVP) was 0.58+/-0.24 and right ventricular end-diastolic pressure (RVEDV) significantly increased from 104+/-24 to 137+/-39% of normal predicted value (P = 0.015). Five patients with LVP/RVP>0.6 were free from TR, however, six of seven with LVP/RVP<0.6 developed TR. Three patients required eventual tricupid valve replacement. Conduit replacement was required in seven patients and five were assessed similarly. After the conduit replacement, LVP/RVP decreased from 1.08+/-0.34 to 0.58+/-0.14 and RVEDV increased significantly from 87+/-24 to 129+/-19% (P = 0.011). One patient with postoperative LVP/RVP of 0.36 developed moderate TR. CONCLUSION: Mild obstruction at the pulmonary channel is not necessarily an evil after functional biventricular repair for this malformation, in terms of TR and right ventricular dilatation.

Adolescent↗
PubMed2004

Bone marrow is a source of regenerated cardiomyocytes in doxorubicin-induced cardiomyopathy and granulocyte colony-stimulating factor enhances migration of bone marrow cells and attenuates cardiotoxicity of doxorubicin under electron microscopy.

BACKGROUND: It has been reported previously that granulocyte colony-stimulating factor (GCSF) injection improves infarcted heart function, but the mechanism remains unclear. In this study we sought to determine whether GCSF-mobilized bone marrow cells could regenerate neo-myocardium and repair doxorubicin-induced cardiomyopathy. METHODS: C57BL/6 mice were irradiated and bone marrow cells (BMC; 1 x 10(6)) from green fluorescent protein (GFP) mice (GFP-BMC) were transplanted intravenously, followed by splenectomy. Doxorubicin (2.5 mg/kg, 6 times for 2 weeks) was administered intraperitoneally 2 weeks later. GCSF (50 microg/kg/day for 8 days) was administered sub-cutaneously after doxorubicin injection (Group I, n = 11) and 3 weeks later (Group II, n = 8), and saline was injected in Group III animals (n = 8). Eight weeks after doxorubicin injection, the excised hearts were studied immunologically and electron microscopically. RESULTS: Survival rates were 81.8% in Group I, 50.0% in Group II and 62.5% in Group III. The number of GFP-BMC in Group I (15.4 +/- 7.4 per high-power field) was highest (p < 0.05). In all groups, cardiac troponin I-positive cells derived from GFP-BMC were observed in the hearts. GFP-BMC in hearts stained positively against cardiac troponin I (4.3 +/- 2.5%), myosin heavy chain (5.0 +/- 4.3%), atrial natriuretic peptide (ANP; 3.9 +/- 2.4%) and connexin 43 (11.9 +/- 7.3%) in Group I. Myofibrils, mitochondria and fundamental architecture were almost all preserved in Group I, whereas hearts were severely damaged in Groups II and III. CONCLUSIONS: Bone marrow was shown to be one of the sources of regenerated cardiomyocytes in the doxorubicin-induced cardiomyopathic heart. Early administration of GCSF enhanced the migration of bone marrow cells into the heart, and attenuated the cardiotoxicity of doxorubicin.

Animals↗
PubMed2004

Acute effects of direct cell implantation into the heart: a pressure-volume study to analyze cardiac function.

BACKGROUND: To safely implant cells into the myocardium, we must establish a volume that prevents compromising cardiac performance. We studied pressure-volume (PV) to investigate the adverse effects of direct cell implantation in the acute phase. METHODS: We used 21 minipigs. In the normal heart model, we studied PV by measuring various parameters (including end-systolic pressure, end-systolic elastance, dp/dtmax, end-diastolic volume, and time constant of isovolumetric left ventricular pressure fall [Tau]). We injected solutions into the left ventricular free wall (15 cm(2)). Sampling points were at baseline and after injection of saline (Group I, n = 4) or of blood (Group II, n = 4) at volumes of 1 ml and 10 ml up to 30 minutes after injection. In Group II, we injected additional blood (10 ml) 4 times. In the ischemic heart model, 1 month after ligating the left anterior descending artery, we injected 1 ml saline (Group III, n = 4), bone marrow mononuclear cells (10(8) cells/1 ml; Group IV, n = 4), or bone marrow stromal cells (10(8) cells/1 ml; Group V, n = 3). We studied PV before and after injection. RESULTS: In Group I, we found no significant changes in parameters. In Group II, end-diastolic volume after 10-ml injection (24.4 +/- 3.6 ml) was smaller than end-diastolic volume at baseline (29.5 +/- 5.8 ml, p < 0.01). Tau after 10-ml injection (39.4 +/- 5.3 msec) was greater than at baseline (35.6 +/- 4.0 msec, p < 0.01). One pig died of ventricular fibrillation after a 20-ml injection of blood. We observed no detrimental effects in Groups III, IV, and V. CONCLUSIONS: More than 10 ml cell suspension compromised diastolic function. We safely performed direct injection of bone marrow cells (1 x 10(8)/1 ml).

Animals↗
PubMed2004

Granulocyte-colony stimulating factor directly enhances proliferation of human troponin I-positive cells derived from idiopathic dilated cardiomyopathy through specific receptors.

BACKGROUND: Our previous study showed that granulocyte-colony stimulating factor (G-CSF) enhanced bone-marrow-cell migration into the injured heart and that bone-marrow cells differentiated into cardiomyocytes. However, the number of bone-marrow-derived cardiomyocytes seems too small to have a direct, positive impact on pump function. Therefore, we hypothesized that G-CSF directly could affect the host myocardium through G-CSF receptors (G-CSFRs). METHODS: In experiment 1, we cultured normal mouse heart cells with G-CSF at concentrations of 0, 1, 10, 50, and 100 ng/ml. In experiment 2, we cultured heart cells derived from a recipient with idiopathic cardiomyopathy (IDCM) after heart transplantation. We compared the total number of heart cells and Ki67- and troponin I (TnI)-positive cells with/without G-CSF at 50 ng/ml. We also performed immunochemical staining of the heart specimen from a recipient with IDCM using a rabbit polyclonal anti-G-CSFR antibody. RESULTS: In experiment 1, mouse heart cells with G-CSF (50 ng/ml) proliferated maximally. In experiment 2, the total numbers of heart cells, Ki67-positive cells. TnI-positive cells, Ki67- and TnI-double-positive cells in the G-CSF group were greater than those in the non-G-CSF group at Days 14 and 28 (p <0.05). In the IDCM heart, G-CSFRs on cardiomyocytes were expressed heterogeneously and widely. CONCLUSIONS: Granulocyte-colony stimulating factor directly enhanced the proliferation of TnI-positive cells derived from a recipient with IDCM through the G-CSFR.

Adult↗
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↗
PubMed2004

Modified cavoatriotomy for combined PAPVC repair and maze procedure.

In patients with partial anomalous pulmonary venous connection (PAPVC) to the superior cavoatrial junction, the standard right-sided left atriotomy does not allow sufficient access to the mitral valve and the left atrium. And the injury and traction of the sinus node and sinus node artery should be avoided for prevention of the cardiac rhythm disturbance after operation. We herein report a useful approach to repair the sinus venosus atrial septal defect with PAPVC of the right pulmonary veins to the superior cavoatrial junction in patients also requiring mitral valve replacement and the maze procedure.

Atrial Fibrillation↗
PubMed2004

Bone marrow mononuclear cell transplantation had beneficial effects on doxorubicin-induced cardiomyopathy.

BACKGROUND: Cell transplantation is a promising therapy for treating end-stage heart failure. Bone marrow mononuclear cells (BMMNC) have been used to enhance angiogenesis in ischemic heart disease. However, the effect of BMMNC transplantation in non-ischemic dilated cardiomyopathy is unknown. In this study, we evaluated the efficacy of BMMNC transplantation in doxorubicin-induced cardiomyopathy in a rat model. METHODS: Doxorubicin (15 mg/kg, IP) was introduced into 52 Lewis rats. They were divided into 3 groups at 4 weeks after injection: transplant group (TX, BMMNC [1 x 10(6)] implantation, n = 18), control group (CN, saline injection, n = 18), and sham group (SH, thoracotomy, n = 16). At 4 weeks after surgery, we used echocardiography to measure systolic left ventricular diameter (LVDs), diastolic left ventricular diameter (LVDd), fractional shortening (FS), and left ventricular wall thickness/LVDs. We used a Langendorff apparatus to measure systolic, diastolic, and developed pressures. We used radioimmunoassay to measure circulating atrial natriuretic peptide concentration, and we performed histologic study, including electron-microscopic study. RESULTS: Left ventricular wall thickness/LVDs in the TX group was the largest of all groups (p < 0.05). Systolic and developed pressures in the TX group were the greatest (p < 0.005). Systolic left ventricular diameter, FS, and end-diastolic pressure in the TX group were smaller than in the SH group (p < 0.05). These cardiac parameters did not differ significantly between TX and CN groups, but secondary changes (decreased heart weight, developed ascites, and increased atrial natriuretic peptide concentration) caused by doxorubicin-induced heart failure were most attenuated in the TX group. In the TX group, vascular density was greatest (p < 0.05) in the left ventricular free wall and in the septum. In addition, electron microscopy showed that myocardium in the TX group was most maintained. CONCLUSION: Bone marrow mononuclear cell transplantation had beneficial effects in doxorubicin-induced cardiomyopathy.

Animals↗
PubMed2004

G-CSF promotes bone marrow cells to migrate into infarcted mice heart, and differentiate into cardiomyocytes.

A recent study showed that granulocyte-colony stimulating factor (G-CSF) treatment improved the infarcted cardiac function. Although mobilized stem cells may affect it, the mechanism is unclear. In this study, we investigated the origins of stem cells and phenotypic changes of the migrated cells, and evaluated the efficacy of G-CSF. Eighteen C57BL/6 mice were irradiated (900 cGy) and GFP mouse-derived bone marrow cells (GFP-BMC: 10(6) cells) were injected via a tail vein followed by splenectomy 4 weeks later. Ligation of the left descending coronary artery was performed 2 weeks later. Recombinant human G-CSF (200 microg/kg/day) was injected for 3 days before and 5 days after ligation (group 1, n = 10). Saline was injected in group 2 (n = 8). Four weeks after infarction, hearts and other organs were fixed for histology. The survival rate after postoperative day 3 in group 1 was 100%, while that in group 2 was 50% (p = 0.03). Bone marrow-derived GFP cells (BMD-GFP) in group 1 (103.3+/-71.9/mm2) were located at the infarcted border area significantly more than those in group 2 (43.6+/-23.7/mm2) (p < 0.0001). BMD-GFP cells were positive for troponin I (16.6%), myosin heavy chain-slow (16.7%), and nestin (8.8%) in group 1. Ki-67-positive BMD-GFP in group 1 (10.0+/-7.0/mm2) were significantly more than those in group 2 (4.8+/-6.1/mm2) (p = 0.01). G-CSF increased the survival rate after infarction. G-CSF promoted BMC to migrate into the infarcted border area. Bone marrow was one of the origins of regenerated cardiomyocytes.

Animals↗
PubMed2004

Immunological and histological evaluation of decellularized allograft in a pig model: comparison with cryopreserved allograft.

BACKGROUND AND AIM OF THE STUDY: The remodeling process of the decellularized allograft after implantation remains unclear. Herein, the hemodynamics, recellularization and immunological response of the decellularized allograft were evaluated at four weeks after implantation in a mini-pig model, and compared with a cryopreserved allograft. METHODS: Six porcine pulmonary allografts were harvested from mini-pigs, and cryopreserved for four weeks. In two pigs, the grafts were decellularized with Triton X solution, after which static reseeding of the valve surface was performed for 48 h with autologous endothelial cells harvested from a leg artery. Decellularization, but not reseeding, was carried out in two mini-pigs, and cryopreservation alone in two mini-pigs. Whilst under right heart bypass, the right ventricular outflow tract was replaced in six minipigs. The grafts were explanted after four weeks; analysis included direct pressure measurement, echocardiography, macroscopy, light microscopy with hematoxylin and eosin staining, and immunohistochemical studies to identify macrophages, T lymphocytes, and endothelial cells. RESULTS: Hemodynamically and macroscopically, there were no major differences between the three groups. In the cryopreservation-only group, immunohistochemistry showed an influx of macrophages, and T lymphocytes at the cusps. Endothelial cell coverage was found in the decellularized and decellularized + cell-seeded groups, but no macrophages and T lymphocytes were found at the cusps. CONCLUSION: Decellularization of the cryopreserved allograft may reduce the inflammatory response and improve its long-term durability.

Animals↗
PubMed2003

A calcium channel blocker activates both ecto-5(')-nucleotidase and NO synthase in HUVEC.

Since amlodipine, a long-acting Ca channel blocker, increases both NO and adenosine production in canine hearts, we investigated that amlodipine activates both ecto-5(')-nucleotidase responsible for adenosine production and NO synthase (NOS) for NO production in human umbilical venous endothelial cells (HUVECs), and its cellular signaling. We measured activities of ecto-5(')-nucleotidase and NOS in HUVECs in the condition with additions of xanthine (100 microM)+xanthine oxidase (1.6 x 10(-3)U/ml) in the presence or absence of amlodipine (1 x 10(-9)-1 x 10(-6)M). Amlodipine increased both ecto-5(')-nucleotidase and NOS activities. Xanthine+xanthine oxidase deactivated both NOS and ecto-5(')-nucleotidase, and amlodipine increased both activities of NOS and ecto-5(')-nucleotidase by 117+/-33% and 48+/-6%, respectively. Amlodipine phosphorylated p38MAP kinase and that an inhibitor of p38MAP kinase inhibited the amlodipine-induced activation of both NOS and ecto-5(')-nucleotidase. Furthermore, amlodipine increased both adenosine and NO production in the canine ischemic hearts. We concluded that amlodipine activates both NOS and ecto-5(')-nucleotidase via p38MAP kinase in vitro and enhances both NO and adenosine production in vivo.

Amlodipine↗
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

Implantation of collar-reinforced sumit valve for patient with large calcified mass obstructing the mitral valve orifice.

A 56-year-old female had a severely calcified mitral valve annulus and a huge subvalvular mass. To avoid critical damages of the coronary artery and left ventricle, the annular calcification and the part of the mass adherent to the left ventricle were not resected. Then we performed mitral valve replacement using SuMit valve and collared reinforcement technique with xenopericardium without any major complications. The SuMit valve is designed to be placed in a supraannular position, and is useful to prevent valves from getting stuck.

Calcinosis↗
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↗