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Introduction This study aimed to evaluate the sex-specific characteristics and surgical outcomes in patients with acute type A aortic dissection (ATAAD). Materials and methods We reviewed the surgical records of patients who underwent ATAAD repair at our institution between 2004 and 2020 (n=213). Results Of the 213 patients, 100 (46.9%) were male, and 113 (53.1%) were female. Males were younger than females (62.5 vs. 72.9 years, p<0.0001). Females had more nonspecific symptoms (p=0.04), more frequently developed ATAAD before noon (45.0% vs. 53.1%, p=0.01), and had a significantly longer time from onset to surgery (425.1 vs. 595.8 min, p=0.03). The ascending aorta was replaced more frequently in females than in males (54.5% vs. 72.8%, p<0.01). No significant difference was observed in the in-hospital mortality rate between males and females (9.0% vs. 10.6%, p=0.69). The multivariable logistic analysis demonstrated that being male was not an independent predictor of operative mortality (OR, 0.96; 95% CI, 0.18-5.21; p=0.96). At 10 years, males had significantly better long-term survival rates in the unadjusted cohort than females (79.4% vs. 55.9%, p=0.02). Conclusions Male sex was not an independent predictor of early death in patients with ATAAD after surgery, although significant differences were noted in terms of age, onset time, chief complaint, imaging findings, and surgical procedures. A sex-based management strategy involving specific differences should be considered to improve outcomes.
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PURPOSE: We evaluated the clinical outcomes and costs of surgical aortic valve replacement (SAVR) and transfemoral transcatheter aortic valve implantation (TAVI) for aortic stenosis using the Japanese Diagnosis Procedure Combination (DPC) database. METHODS: Using our extraction protocol, we retrospectively analyzed summary tables in the DPC database from 2016 to 2019, which were provided by the Ministry of Health, Labor and Welfare. A total of 27,278 patients were available (SAVR, n = 12,534; TAVI, n = 14,744). RESULTS: The TAVI group was older than the SAVR group (SAVR vs. TAVI: 74.6 vs. 84.5 years; P < 0.01), with a lower in-hospital mortality (1.0 vs. 0.6%; P < 0.01) and a shorter hospital stay (26.9 vs. 20.3 days; P < 0.01). TAVI conferred more total medical service reimbursement points than SAVR (493,944 vs. 605,241 points; P < 0.01), especially materials points (147,830 vs. 434,609 points; P < 0.01). Total insurance claims for TAVI were approximately 1 million yen higher than those for SAVR. Regarding the details of costs, only the operation cost was higher, while other costs were lower with TAVI than with SAVR. CONCLUSION: Our analysis revealed that both SAVR and TAVI showed acceptable clinical outcomes. TAVI was associated with higher total insurance claims than SAVR. If the material cost of TAVI operations can be reduced, greater cost-effectiveness can be expected.
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Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Japão , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou maisAssuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Realidade Virtual , Humanos , Correção Endovascular de Aneurisma , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/métodos , Implante de Prótese Vascular/métodos , Resultado do TratamentoRESUMO
An 82-years-old woman was admitted with sudden chest pain. Coronary angiography did not reveal any significant stenosis, but left ventriculography showed akinesis and ballooning of the apex with a hyperkinetic basal segment, suggestive of takotsubo cardiomyopathy. She suffered intractable heart failure, and laboratory data, electrocardiogram signs of ST-segment elevation and left ventricular( LV) apical dysfunction failed to show improvement. LV plasty was performed on 106th day after the onset because of aneurysmal change of the left ventricular apex myocardium, unremitting sanguineous pericardial effusion, and anemia. She had a good postoperative course and end-diastolic ventricular volume index was remarkably reduced from 144 to 55 ml/m2. She discharged home on the 38th postoperative day.
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Aneurisma Cardíaco , Cardiomiopatia de Takotsubo , Feminino , Humanos , Idoso de 80 Anos ou mais , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/cirurgia , Eletrocardiografia , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Arritmias Cardíacas , TóraxRESUMO
Coronary artery fistula (CAF) is one of the most common coronary artery anomalies. The most common fistulas originate from the right coronary artery and drain into the right heart structures. Due to the variety of coronary fistulas, the surgical treatment strategy is individualized for each case. We report two cases of giant aneurysmal CAF originating from the left circumflex artery. One case required coronary artery bypass grafting, while the other did not.
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Doença da Artéria Coronariana , Seio Coronário , Anomalias dos Vasos Coronários , Fístula , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , HumanosRESUMO
PURPOSE: To assess the safety and anatomical suitability of using a Gore Iliac Branch Endoprosthesis (IBE) in aortoiliac and iliac aneurysm repair. METHODS: Between 2017 and 2020, 20 patients underwent endovascular aneurysm repair (EVAR) with a Gore IBE device (bilateral IBE, n = 1) after expanding the instructions for use (IFU) criteria. We evaluated the early clinical outcomes and suitability of the IFU criteria, retrospectively. RESULTS: Six patients (30%) met all the IFU criteria. Anatomical suitability according to the IFU criteria for the collective total of 21 IBE limbs was confirmed for 10 (47.6%) proximal common iliac arteries, 21 (100%) external iliac arteries, 18 (85.7%) internal iliac arteries, and in the length from the lowest renal artery to the iliac bifurcation in 15 (71.8%) patients. Assisted primary technical success was achieved in all patients with various bail-out techniques. One patient (5%) required a bare-stent insertion 7 days after EVAR for severe stenosis in the ipsilateral limb caused by a small terminal aorta. There was no case of occlusion of an iliac branch component device. CONCLUSIONS: Gore IBEs were implanted safely and effectively with various bail-out techniques to repair aortoiliac and iliac aneurysms in our Japanese patients with a low rate of inclusion IFU criteria.
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Aneurisma Aórtico/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Próteses e Implantes , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Segurança , Fatores de Tempo , Resultado do TratamentoRESUMO
We report a case of coronary artery to pulmonary artery fistula with a large coronary artery aneurysm (80 mm). A 62-year-old man was referred to our hospital because of syncope without heart failure. Electrocardiogram abnormality and asynergy in the anteroseptal wall were detected on echocardiography. Coronary angiography and multi-detector row computed tomography( MDCT) showed a large coronary artery aneurysm and coronary artery to pulmonary artery fistula originating from the right coronary artery( RCA), left main trunk( LMT) and left anterior descending artery( LAD). The fistula was treated using ligation and endocardial closure, and the aneurysm was resected without coronary artery bypass grafting. Postoperatively, MDCT showed that the fistula and aneurysm had disappeared. MDCT was useful for understanding the spatial relation of the coronary artery to pulmonary artery fistula.
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Fístula Artério-Arterial/diagnóstico por imagem , Aneurisma Coronário/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Artéria Pulmonar/diagnóstico por imagem , Fístula Artério-Arterial/terapia , Aneurisma Coronário/cirurgia , Angiografia Coronária , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: If the aortic root dilates after native aortic valve-sparing root reconstruction with remodeling, aortic regurgitation may recur. However, it has not been demonstrated clearly that the aortic root dilates after remodeling. METHODS: This study enrolled 15 patients who underwent an aortic valve-sparing operation with remodeling (2002-2014) but without any ventriculo-aortic junction (VAJ) fixation. Technically, special care was taken to pass the sutures through the fibrous annulus. The diameter of the aortic root (VAJ, neosinus of Valsalva, and sinotubular junction), degree of aortic regurgitation, and effective height of the aortic valve were measured in the patients. All patients had postoperative follow-up, and the median follow-up period was 7.3 (IQR: 3.1-8.3) years. RESULTS: The mean preoperative diameters of the VAJ, sinus of Valsalva, and sinotubular junction were 23.5 ± 2.3 (20-27) mm, 51.1 ± 7.2 (43-60) mm, and 42.4 ± 9.4 (29-58) mm, respectively. The postoperative diameters of the VAJ changed from 21.6 ± 2.6 (early) to 21.8 ± 2.9 mm (late) (p = 0.75). The diameters of the sinus of Valsalva and sinotubular junction changed from 26.5 ± 3.0 (early) to 28.5 ± 4.2 mm (late) (p = 0.0013), and 22.4 ± 3.0 (early) to 24.3 ± 3.3 mm (late) (p = 0.0003), respectively. The effective height of the aortic valve changed from 9.7 ± 1.3 (early) to 8.9 ± 2.0 mm (late) (p = 0.08). The degree of aortic regurgitation (grade: 0-4) changed from 0.3 ± 0.5 (early) to 1.2 ± 0.8 (late) (p = 01558). CONCLUSIONS: Significant VAJ dilation and changes in aortic valve configuration after our remodeling procedure were not observed. Therefore, fixation of the annulus with remodeling may not be needed for cases without preoperative dilation of the annulus.
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Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Adolescente , Adulto , Idoso , Aorta Torácica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The optimal management of a retrograde type A aortic dissection (RAAD) is controversial, and few reports have discussed the long-term outcomes of surgical strategies. To determine the most appropriate strategy, we studied the early and late outcomes of RAAD cases. METHODS: From 1998 to 2014, 44 patients with RAAD (mean age of 63 ± 11 years) underwent surgical repair. Ascending aortic replacement (AAR) was performed in 21 patients and ascending and total arch replacement (TAR) was performed in 23 patients. Eight of the patients who received TAR underwent complete resection of the primary tear in the distal arch or descending aorta (TAR-R[+]), whereas the remaining 15 patients received elephant trunk implantation as an alternative procedure for tear resection (TAR-R[-]). The early and late outcomes (mean follow-up, 86.5 months) were evaluated. RESULTS: Hospital mortality occurred in 4 of the 44 (9.1%) patients, with no mortalities among the patients undergoing TAR-R[-]. There was a tendency toward a higher incidence of late aorta-related events in the AAR group, with a significantly higher patency rate of the false lumen in the proximal site of the residual aorta compared with the TAR group (p = 0.009). Furthermore, the 5-year rate of freedom from aortic growth greater than 50 mm was significantly lower after AAR than after TAR (p = 0.04). A multivariate analysis indicated that the initial ascending aortic diameter (odds ratio [OR], 1.5; p = 0.02) and AAR (OR, 29.1; p = 0.01) were independent predictors of late aortic expansion. CONCLUSIONS: The surgical outcomes were acceptable in both the AAR and TAR groups. The long-term outcomes potentially support the aggressive adoption of TAR in relatively younger patients with significant ascending aortic enlargement at presentation.
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Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Intervalo Livre de Doença , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: In thoracoabdominal aneurysm (TAAA) repair, our technical modification of visceral reconstruction using longer cut pre-sewn side branches has provided good surgical outcomes. Here, we assessed the long-term durability and patency of revascularized branches using computed tomography (CT) to confirm the validity of our approach. METHODS: Early and late CT evaluations were performed in 11 TAAA patients (males: 5; mean age: 60.6 years) using the Coselli graft to evaluate the position of main graft and the diverging pattern and patency of side branches. Seven of 11 were sutured in an extra-anatomical fashion using longer cut side branches. RESULTS: In Anatomical (n = 4) and Extra-anatomical (n = 7) groups, the early patency of side branches was not significantly different. Although the late patency of right renal artery (RA) was 100% in both groups, the one of left RA was 60% in Extra-anatomical, while 100% in Anatomical. Furthermore, the main graft in Extra-anatomical was significantly posterior and leftward to the spine with left RA side branch diverging at an acute angle. CONCLUSIONS: When a pre-sewn branched graft designed for TAAA is used, the graft should be sutured in a fashion similar to normal patient anatomy to minimize the possibility of kinking of RA side branch for the patency.
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Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular/métodos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos , Técnicas de Sutura , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
We report the case of a 58-year-old man who underwent emergency one-stage hybrid repair for multiple thoracic aortic aneurysms involving giant arch and ruptured descending aortic aneurysms. Retrograde thoracic endovascular aortic repair for the ruptured descending aortic aneurysm was first performed to stabilize the hemodynamics. Then, a total arch replacement with an open stent graft, which was inserted into the previous stent graft of the descending aorta in a sutureless telescoped fashion, was performed without any technical problems. This procedure may be one useful therapeutic option for multiple thoracic aortic aneurysms, especially for emergency cases requiring one-stage repair.
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Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Prótese Vascular , Procedimentos Endovasculares , Stents , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Emergências , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The efficacy and safety of surgical intervention for atrial myxoma are established, but the operative approach to tumor resection and atrial reconstruction are controversial. A biatrial approach is generally used for excision of atrial myxoma and has many advantages. In contrast, there are a few reports about the method of double-patch reconstruction, and the right and left atrium are individually reconstructed with the two patches. We found it to be effective in the case reported here. We suggest that this method can be applied to atrial myxoma in which extensive resection is necessary.
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Procedimentos Cirúrgicos Cardíacos , Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Procedimentos de Cirurgia Plástica , Idoso , Ecocardiografia , Feminino , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Humanos , Mixoma/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Tracheo-innominate artery fistula is fatal unless treated surgically. We describe our surgical approach and results in seven patients. The average patient age was 15.7 years; all patients had prior severe neurological deficits. Three of seven patients were in hemorrhagic shock; control of preoperative bleeding was achieved with tracheostomy tube cuff overinflation. The innominate artery and the trachea were exposed through a collar incision and partial upper sternotomy. The innominate artery was divided at the aortic arch and at the bifurcation, with one exception. Cerebral blood flow was monitored by the blood pressure difference in the bilateral upper extremities and by near-infrared spectroscopy. The tracheal fistula was left adherent to the innominate artery in all but one patient. All patients were discharged without new neurologic deficits or severe morbidity. Overall survival was 84% at 37 months, without any vascular, tracheal, or neurological events.
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Tronco Braquiocefálico/cirurgia , Fístula do Sistema Respiratório/cirurgia , Procedimentos Cirúrgicos Torácicos , Doenças da Traqueia/cirurgia , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares , Adolescente , Adulto , Pressão Sanguínea , Tronco Braquiocefálico/fisiopatologia , Circulação Cerebrovascular , Tubos Torácicos , Criança , Pré-Escolar , Feminino , Técnicas Hemostáticas , Humanos , Masculino , Monitorização Intraoperatória/métodos , Fístula do Sistema Respiratório/diagnóstico , Fístula do Sistema Respiratório/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho , Esternotomia , Procedimentos Cirúrgicos Torácicos/instrumentação , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/fisiopatologia , Traqueostomia/instrumentação , Resultado do Tratamento , Fístula Vascular/diagnóstico , Fístula Vascular/fisiopatologia , Adulto JovemRESUMO
OBJECTIVE: We have performed a simple and uniform technique for reconstruction of artificial chordae in patients with anterior mitral prolapse since 1994. In this study, we investigated the long-term clinical and echocardiographic results of chordae replacement with Gore-Tex sutures for anterior mitral leaflet prolapse. METHODS: A pair of Gore-Tex sutures is passed through a small autologous pericardium and tied on one side of the pericardium. Double-armed mattress stitches on the side without a knot are passed through the head of the papillary muscle and another small pericardium and then tied down. Using this simple technique, 2 pairs of artificial chordae are made. The length of the artificial chordae is determined during the leak test. Chordal replacement with this technique was performed in 30 patients (mean age, 59.3 years) with anterior mitral leaflet prolapse. Echocardiography was performed annually in these patients. Follow-up ranged from 0.2~16.2( 8.0±5.1) years. RESULTS: There were no hospital deaths. Twenty-one patients had no mitral regurgitation( MR) and the others had trivial or mild MR. There were 2 reoperations and 4 cases with recurrent moderate MR in this series. Kaplan-Meier survival and freedom from reoperation at 15 years were 84% and 93%,respectively. Overall, freedom from recurrent moderate or severe MR at 15 years was 81%. CONCLUSIONS: Our simple chordae replacement technique with Gore-Tex sutures for anterior mitral prolapse, results in good long-term durability. To avoid recurrence of regurgitation, intraoperative complete repair is essential.
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Cordas Tendinosas/cirurgia , Prolapso da Valva Mitral/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Politetrafluoretileno/uso terapêutico , Resultado do TratamentoRESUMO
Tricuspid valve infective endocarditis (TVIE) is rare in Japan, though many reports of it in intravenous drug users are found in other countries. We experienced 3 surgical cases of isolated TVIE in 2 nonintravenous drug users and 1 intravenous user, and we presented successful results. The surgical options for TVIE are vegetectomy and valvulectomy, valve repair, and valve replacement, which are controversial in regard to hemodynamic consequences in right-sided low-pressure system and long-term prognosis. We report the 3 surgical cases of isolated TVIE.
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Endocardite Bacteriana/cirurgia , Valva Tricúspide/cirurgia , Adulto , Endocardite Bacteriana/etiologia , Feminino , Humanos , Masculino , Adulto JovemRESUMO
This case report describes a partial aortic root remodeling, which applied a valve-sparing technique, with an adventitial inversion technique for an acute type A aortic dissection with intimal tear extending into the noncoronary sinus of Valsalva. Postoperative computed tomography at six months showed no dissection or pseudoaneurysm in the aortic root.
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Doenças da Aorta/cirurgia , Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Valva Aórtica/patologia , Seio Aórtico/cirurgia , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/patologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/patologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/patologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Dor no Peito , Humanos , Masculino , Período Pós-Operatório , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
BACKGROUND: The right gastroepiploic artery (GEA) is commonly used in coronary artery bypass grafting, but a method for preoperative assessment of the suitability of the GEA has not been established. Here, we assessed the efficacy of 64-slice multidetector computed tomography (MDCT) for this purpose. METHODS: Multidetector computed tomography was performed for 32 patients (24 males, 8 females; mean age, 65.9 +/- 7.4 years) undergoing coronary artery bypass graft surgery. Preoperative MDCT criteria for GEA suitability were no significant stenosis or calcification and a diameter of 2.0 mm or more in the middle portion of the GEA. The skeletonized GEA was inspected in 30 patients to determine the accuracy of evaluation of arteriosclerosis by MDCT (2 patients were excluded owing to severe GEA stenosis). The internal diameter at the anastomotic site was compared with the diameters of the proximal, distal, and middle regions of the GEA on MDCT. RESULTS: The GEA was used to bypass a target coronary artery in 30 patients. The diameter of the middle of the GEA on MDCT correlated strongly with the actual internal diameter at the anastomotic site (r = 0.72, p < 0.0001). The diameter at the anastomotic site calculated from MDCT using the distance from the GEA origin to the anastomotic site and the actual diameter did not differ significantly (2.76 +/- 0.6 versus 2.87 +/- 0.5 mm, p = 0.06). CONCLUSIONS: Preoperative MDCT imaging of the GEA is reliable for diagnosis, and a middle diameter of 2.0 mm or greater can be used to indicate GEA suitability for coronary artery bypass grafting.