A simple and useful option for treatment of acute type A dissection with the tear beyond the aortic arch.
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Acute Disease↗
Biomedical subjects
Yuji Yokote
Publications and source records attributed to Yuji Yokote.
Periannular abscess and aorta-left ventricular fistula after infection in the false lumen of an aortic dissection.
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Abscess↗
Mitral valve surgery under perfused ventricular fibrillation with moderate hypothermia.
The safety and myocardial protective effect of perfused ventricular fibrillation (VF) under moderate hypothermia were investigated. Through a midline sternotomy and opening the left atrium from the right side, isolated mitral valve surgery was performed under aortic cross-clamping (ACC) and cardioplegic arrest using Bretschneider HTK solution in 96 patients, and under perfused VF in 20 patients (VF Group). Patient characteristics, clinical outcomes, and perioperative variables were compared. A satisfactory surgical view was obtained in all VF Group patients. Patient characteristics in the 2 groups were similar, and both groups had comparable results for mortality and morbidity, operation time, cardiopulmonary bypass time, peak levels of creatine kinase (CK) and its myocardial fraction, hours of mechanical ventilation, intensive care unit stay, and postoperative left ventricular ejection fraction. Even in VF Group patients with preoperative critical hemodynamic compromise, inotropes could be discontinued within 3 days. Thus, no detrimental effect of perfused VF was observed. On the other hand, in patients who underwent ACC and cardioplegic arrest of 120min or longer, peak levels of CK and its myocardial fraction were significantly higher than those of the rest of C group patients and VF Group patients. Perfused VF under moderate hypothermia can be a good alternative myocardial protection strategy during mitral valve surgery, particularly in patients in whom ACC is unsuitable or the duration of ACC is expected to be long.
Adult↗
The efficacy and safety of additional bypass graft during isolated coronary artery bypass grafting.
In 19 patients with an undesirable hemodynamic condition (n=15) or with regional asynergy and coexistent ST-T change (n=4) during isolated coronary artery bypass grafting (CABG) surgery, one (n=17) or two (n=3) additional saphenous vein grafts were placed onto left anterior descending (LAD) (n=16), right (n=4), and left circumflex (LCx) (n=2) coronary arteries. Diagnosis of the cause of the suboptimal condition was insufficient graft flow in 16 patients, and spasm of the ungrafted coronary artery in 3. Additional myocardial ischemic time was 17 9 minutes, and the graft flow was 59 25 ml/min. Additional bypass was effective in 94.5%. Eighteen patients could be weaned from cardiopulmonary bypass, and 17 (89.5%) survived and were discharged from hospital. Median duration of mechanical ventilatory support and intensive care unit stay was 15 hours and 4 days, respectively. During 63 44 months follow-up, the additional graft was occluded and the treadmill test was positive for ischemia in 2 patients, and one child patient is now considered for redo CABG. Placement of additional bypass grafts thus appeared to be an effective and relatively safe strategy, although the decision has to be made cautiously.
Adolescent↗