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山中 勝弘大学院医学研究科 医科学専攻講師
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■ 受賞- 2018年04月 American Association for Thoracic Surgery, Nicholas T. Kouchoukos Paper, Cardiothoracic surgeons国際学会・会議・シンポジウム等の賞
- 2017年09月 日本胸部外科学会, 優秀論文賞, 胸部外科医国内外の国際的学術賞
- 2017年06月 Western Thoracic Surgical Association, Norman E. Shumway Awar, Cardiothoracic Surgeons国際学会・会議・シンポジウム等の賞
- PURPOSE: The purpose of the study was to evaluate the efficacy and safety of pre-emptive transcatheter arterial embolization (P-TAE) of aortic side branches to prevent type II endoleak in patients with abdominal aortic aneurysm after endovascular abdominal aneurysm repair (EVAR). MATERIALS AND METHODS: This multicenter, prospective, single-arm trial enrolled 100 patients with abdominal aortic aneurysm from nine hospitals between 2018 and 2021. There were 85 men and 15 women, with a mean age of 79.6 ± 6.0 (standard deviation) years (range: 65-97 years). P-TAE was attempted for patent aortic side branches, including the inferior mesenteric artery, lumbar arteries, and other branches. The primary endpoint was late type II endoleak incidence at 6 months post-repair. Secondary endpoints included changes in aneurysmal sac diameter at 6- and 12 months, complications, re-intervention, and aneurysm-related mortality. Aneurysm sac changes at 6- and 12 months was compared between the late and no-late type II endoleak groups. RESULTS: Coil embolization was successful in 80.9% (321/397) of patent aortic side branches, including 86.3% of the inferior mesenteric arteries, 80.3% of lumbar arteries, and 55.6% of other branches without severe adverse events. Late type II endoleak incidence at 6 months was 8.9% (8/90; 95% confidence interval: 3.9-16.8%). Aneurysm sac shrinkage > 5 mm was observed in 41.1% (37/90) and 55.3% (47/85) of the patients at 6- and 12-months post-EVAR, respectively. Patients with late type II endoleak had less aneurysm sac shrinkage than those without type II endoleak at 12 months (-0.2 mm vs. -6.0 mm; P = 0.040). No patients required re-intervention for type II endoleak, and no aneurysm-related mortalities occurred. CONCLUSION: P-TAE is safe and effective in preventing type II endoleak, leading to early sac shrinkage at 12 months following EVAR.2024年03月, Diagnostic and interventional imaging, 英語, 国際誌研究論文(学術雑誌)
- PURPOSE: The occurrence of endoleaks, particularly type 2 endoleaks (EL2), is the primary cause of poor long-term prognosis after endovascular aneurysm repair (EVAR). This study aimed to evaluate the efficacy and safety of preemptive transcatheter arterial embolization (P-TAE) for aortic side branches (ASBs) to prevent EL2 before EVAR using the Excluder stent-graft system (EXCLUDER). MATERIALS AND METHODS: In this prospective, multicenter study, 80 patients (mean age, 79.1±6.7 years; 85.0% male patients; mean aneurysmal sac diameter, 48.4±7.4 mm) meeting the eligibility criteria were prospectively enrolled from nine hospitals. Before EVAR, p-TAE was performed to embolize the patent ASBs originating from the abdominal aortic aneurysm. Contrast-enhanced computed tomography was performed at 1 month and 6 months after EVAR. The primary endpoint was EL2 incidence at 6 months, and the secondary endpoints were aneurysmal sac diameter changes at 6 and 12 months, P-TAE outcomes, complications related to P-TAE, re-intervention, and aneurysm-related mortality. RESULTS: All patients successfully underwent P-TAE without serious complications. Coil embolization was successful in 81.6% of ASBs. EL2 incidence at 6 months was identified in 18/70 (25.7%) patients. Aneurysmal sac diameter shrinkage (≥5 mm) was observed in 30.0% of patients at 6 months and in 40.9% at 12 months. Only one patient required re-intervention for EL2 within 1 year of EVAR; aneurysm-related deaths were not observed. CONCLUSION: P-TAE for ASBs before EVAR using EXCLUDER is a safe and effective strategy. It aids in achieving early aneurysmal sac shrinkage and reduces EL2 re-intervention at 1 year after EVAR.2024年03月, Journal of vascular and interventional radiology : JVIR, 英語, 国際誌研究論文(学術雑誌)
- (一社)日本インターベンショナルラジオロジー学会, 2023年02月, 日本インターベンショナルラジオロジー学会雑誌, 37(1) (1), 2 - 12, 日本語
- (NPO)日本血管外科学会, 2023年, 日本血管外科学会雑誌, 32(Suppl.) (Suppl.), O14 - 1, 日本語Type 2 endoleakの抑制を目的とした腹部大動脈瘤に対するEndurantを用いたEVAR前の分枝塞栓術に関する多施設共同前向き臨床研究
- BACKGROUND: Abdominal aortic aneurysm (AAA) is a life-threatening cardiovascular disease characterized by dilated abdominal aorta. Immune cells have been shown to contribute to the development of AAA, and that the gut microbiota is associated with numerous diseases, including cardiovascular diseases, by regulating immune systems or metabolic pathways of the host. However, the interaction between the gut microbiota and AAA remains unknown. METHODS: Apolipoprotein E-deficient male mice were fed a high-cholesterol diet and divided into three groups: the control group was maintained under normal water (control group), the oral AVNM group was maintained under drinking water supplemented with ampicillin, vancomycin, neomycin, and metronidazole, and the i.p. AVNM group was injected AVNM intraperitoneally. After 1 week of pretreatment with antibiotics, these mice were administrated Ang II via subcutaneous osmotic pumps for 4 weeks and euthanized to evaluate AAA formation. RESULTS: Depletion of gut microbiota by oral AVNM ameliorated the incidence of AAAs (control group: 58.9% versus oral AVNM group: 28.6% versus i.p. AVNM group: 75.0%, P = 0.0005) and prevented death due to ruptured aneurysms (control group: 11% versus oral AVNM group: 0% versus i.p. AVNM group: 15%). Oral AVNM suppressed monocyte storage in the spleen, but not in other organs. Despite possessing a higher level of cholesterol, recruitment of monocytes into the suprarenal aorta was suppressed in the oral AVNM group. In AVNM drinking mice, NOD1 ligand, a kind of PRR ligands, increased the development of AAAs and accumulation of macrophages in the aortae. CONCLUSIONS: The gut microbiota plays a critical role in AAA formation. Therefore, regulation of the microbiota or the immune system can be a therapeutic approach for AAA.2022年12月, Hypertension (Dallas, Tex. : 1979), 79(12) (12), 2821 - 2829, 英語, 国際誌研究論文(学術雑誌)
- Spinal cord ischemia (SCI) after endovascular abdominal aortic aneurysm repair is a rare but devastating complication. Occlusion of the artery of Adamkiewicz or feeders to the collateral network for spinal cord circulation (such as the subclavian, intercostal, lumbar, and internal iliac arteries) is associated with the onset of SCI. We present a case of monoplegia owing to SCI after elective endovascular abdominal aortic aneurysm repair with coil embolization of the left internal iliac artery in an elderly patient with a history of arteriosclerosis obliterans and aortic dissection, preoperatively occluding multiple intercostal arteries and the right internal iliac artery.2022年09月, Journal of vascular surgery cases and innovative techniques, 8(3) (3), 447 - 449, 英語, 国際誌
- (NPO)日本血管外科学会, 2022年, 日本血管外科学会雑誌, 31(2) (2), 97 - 101, 日本語
- (NPO)日本血管外科学会, 2022年, 日本血管外科学会雑誌, 31(Suppl.) (Suppl.), SY10 - 2, 日本語腹部大動脈瘤に対するEVARの長期成績と今後の改善点 EVARの長期成績を改善するための予防的大動脈分枝動脈塞栓術の有効性・安全性の検討(多施設共同前向き介入研究)
- The Editorial Committee of Annals of Vascular Diseases, 2021年12月, Annals of Vascular Diseases, 14(4) (4), 400 - 403研究論文(学術雑誌)
- Elsevier Ltd, 2021年07月, Journal of Cardiology Cases, 24(1) (1), 20 - 22, 英語研究論文(学術雑誌)
- Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.2021年02月, Heart and vessels, 36(8) (8), 1234 - 1245, 英語, 国内誌研究論文(学術雑誌)
- BACKGROUND: The aim of this study was to evaluate the fate of the preserved aortic root after supracoronary aortic replacement for acute type A aortic dissection. METHODS: Between October 1999 and March 2018, 339 patients underwent supracoronary aortic replacement for acute type A aortic dissection at our institution. Late outcomes were evaluated, including overall survival, aortic-related death, and aortic root-related reoperation. The median follow-up was 3.7 years (1.4-8.4 years). RESULTS: Operative mortality was 46 patients (13.6%). The cumulative incidences at 5 years for aortic root-related reoperation, aortic-related death, and non-aortic related death were 2.5%, 14.5% and 12.4%, respectively. Multivariable Cox hazard regression analysis demonstrated greater sinus of Valsalva diameter and number of commissural detachments to be significant risk factors for a composite outcome consisting of aortic-related death or aortic root-related reoperation. Mixed-effects regression demonstrated that sinus of Valsalva diameter significantly increased with time (P < .001), and aortic regurgitation significantly worsened (P < .001). CONCLUSIONS: Sinus of Valsalva diameter and commissural detachment were independent predictors of unfavorable outcomes after supracoronary aortic replacement. Close follow-up is particularly necessary for these patients, and aortic root replacement at the time of initial operation may lead to more favorable late outcomes.2021年02月, The Journal of thoracic and cardiovascular surgery, 161(2) (2), 483 - 493, 英語, 国際誌研究論文(学術雑誌)
- W.B. Saunders, 2021年, Seminars in Thoracic and Cardiovascular Surgery, 英語研究論文(学術雑誌)
- BACKGROUND: The aim of this study was to evaluate the impact of diffuse aortic atherosclerosis-related thrombosis, or "shaggy aorta" on the outcomes of open thoracoabdominal aortic aneurysm repair (TAAA). METHODS: From October 1999 to March 2018, 251 patients underwent open TAAA repair using segmental-staged aortic clamping. Twenty-eight patients (11.2%) received emergent or urgent operations. Patients were classified into 3 groups: dissection aneurysm (139 patients, 55.4%), degenerative aneurysm without shaggy aorta (76 patients, 30.3%), and degenerative aneurysm with shaggy aorta (36 patients, 14.3%). Shaggy aorta was assessed using enhanced computed tomography and defined as patients with atheroma thickness ≥5 mm with irregular atheroma surface. Mean follow-up was 4.3 ± 4.1 years. RESULTS: Operative mortality was 8% (20 patients) and spinal cord injury occurred in 25 patients (10.0%), 16 of whom (6.4%) had permanent neurologic dysfunction. Operative mortality was significantly worse in patients with shaggy aorta (dissection: 2.2%, non-shaggy: 6.6%, and shaggy: 33.3%, P < .001) and shaggy aorta was a significant risk factor for spinal cord injury (dissection: 7.2%, non-shaggy: 6.6%, and shaggy: 27.8%, P < .003). Multivariable analysis demonstrated that shaggy aorta was a significant risk factor for composite outcome consisted of operative mortality, spinal cord injury, and acute renal failure (odds ratio, 4.78; 95% confidence interval, 1.91-12.3, P < .001). CONCLUSIONS: Preoperative enhanced computed tomography assessment of shaggy aorta could predict high-risk patients for open TAAA repair.2020年10月, The Journal of thoracic and cardiovascular surgery, 160(4) (4), 889 - 897, 英語, 国際誌研究論文(学術雑誌)
- Aneurysmal change of reconstructed intercostal arteries is believed to be a rare complication after thoracoabdominal aortic repair. To our knowledge, there is no guideline or randomized controlled trials regarding intercostal patch aneurysm management. Therefore, the optimal treatment is still controversial. We describe a successful case of emergent thoracic endovascular aortic repair for ruptured intercostal patch aneurysm in an 83-year-old man following thoracoabdominal aortic aneurysm repair. Our experience illustrated that gradual expansion of large blocks of aortic wall reconstruction should be closely monitored after primary thoracoabdominal aortic replacement.2020年09月, Annals of vascular diseases, 13(3) (3), 316 - 318, 英語, 国内誌研究論文(学術雑誌)
- BACKGROUND: This study evaluates our 18-year experience of total arch replacement in the octogenarian and nonagenarian population. METHODS: Between October 1999 and March 2018, a total of 740 patients underwent total arch replacement at our institution. A total of 139 patients were aged 80 years or more (83.1 ± 2.8 years), and 601 patients were aged less than 80 years (66.9 ± 11.3 years). Early and late outcomes were compared between the groups. RESULTS: In the group aged 80 years or more, operative mortality occurred in 12 patients (8.6%) and significantly improved over time (P = .010). Operative mortality was significantly higher in the group aged 80 years or more (P = .033) when compared with the group aged less than 80 years (4.0%). Regarding postoperative complications, deep sternal wound infection, pneumonia, and tracheostomy occurred in significantly more patients in the group aged 80 years or more. In the group aged 80 years or more, there were 52 late deaths, with 4 aortic-related deaths. Overall survival was 55.4% ± 5.0% at 5 years and 32.2% ± 6.1% at 8 years. Multivariable Cox-hazard regression analysis demonstrated that chronic kidney disease, nonelective surgery, and concurrent procedures were significant risk factors for overall survival in the group aged 80 years or more. Cumulative incidence for reoperation was significantly lower in the group aged 80 years or more (8.7% at 5 years) compared with the group aged less than 80 years (14.2% at 5 years). CONCLUSIONS: Total arch replacement was performed with an acceptable overall survival in octogenarians and nonagenarians, although operative mortality was higher than in younger patients. However, older patients had a lesser burden of reoperation compared with younger patients.2020年08月, The Journal of thoracic and cardiovascular surgery, 160(2) (2), 346 - 356, 英語, 国際誌研究論文(学術雑誌)
- OBJECTIVES: Valve repair for aortic insufficiency (AI) requires a tailored surgical approach determined by the leaflet and aortic disease. In this study, we used a repair-oriented system for the classification of AI, and we elucidated long-term outcomes of aortic root reimplantation with this classification system. METHODS: From 1999 to 2018, a total of 197 patients underwent elective reimplantation (mean age: 52.7 ± 17.7 years; 80% male). The aortic valve was tricuspid in 143 patients, bicuspid in 51 patients and quadricuspid in 3 patients. A total of 93 patients had type I AI (aortic dilatation), 57 patients had type II AI (cusp prolapse) and 47 patients had type III AI (restrictive). In total, 104 of the 264 patients (39%) had more than 1 identified mechanism. RESULTS: In-hospital mortality was 0.5% (1/197). Mid-term follow-up (mean follow-up duration: 5.5 years) revealed a late mortality rate of 4.2% (9/197). Aortic valve reoperation was performed on 16 patients (8.0%). Rates of freedom from aortic valve replacement and freedom from aortic valve-related events at 10 years of follow-up were 87.0 ± 4.0% and 60.6 ± 6.0%, respectively; patients with type Ib AI (98.3 ± 1.7%; 80.7 ± 7.5%) had better outcomes than patients with type III AI (59.6 ± 15.6%; 42.2 ± 13.1%, P = 0.01). In patients with types II and III AI who had bicuspid aortic valves, rates of freedom from aortic valve-related events at 5 years of follow-up were 95.2 ± 4.7% and 71.7 ± 9.1%, respectively (P = 0.03). CONCLUSIONS: This repair-oriented system for classifying AI could help to predict the durable aortic valve repair techniques. Patient selection according to the classification is particularly important for long-term durability. CLINICAL TRIAL REGISTRATION NUMBER: B190050.2020年07月, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 58(1) (1), 138 - 144, 英語, 国際誌研究論文(学術雑誌)
- 2020年05月, Annals of Vascular Surgery, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- (NPO)日本心臓血管外科学会, 2020年03月, 日本心臓血管外科学会学術総会抄録集, 50回, PR19 - 5, 日本語重症大動脈弁狭窄症に対する外科的大動脈弁置換術の術前frail評価の有用性
- (NPO)日本心臓血管外科学会, 2020年03月, 日本心臓血管外科学会学術総会抄録集, 50回, O7 - 4, 日本語遠隔予後から見た70歳未満への冠動脈バイパス術における動脈グラフトの意義
- (NPO)日本心臓血管外科学会, 2020年03月, 日本心臓血管外科学会学術総会抄録集, 50回, O11 - 2, 日本語当院の肺動脈血栓内膜摘除術の成績
- (NPO)日本血管外科学会, 2020年, 日本血管外科学会雑誌, 29(Suppl.) (Suppl.), P8 - 4, 日本語当院におけるIliac Branch Endoprosthesisを用いたステントグラフト内挿術の成績
- Aortic angiosarcoma is an exceedingly rare clinical entity. A significant delay in diagnosis can occur due to its rareness and lack of specific clinical manifestation. A 71-year-old woman was admitted to the emergency department owing to an acute episode of abdominal pain. A computed tomography (CT) scan showed thoraco-abdominal aortic occlusion and splenic infarction. The patient was initially treated with descending aortic replacement for degenerative atherothrombotic aneurysm. An FDG-positron emission tomography-CT scan and biopsy ultimately confirmed the diagnosis of aortic angiosarcoma. This case highlights the difficulties of making an early diagnosis of aortic angiosarcoma.2019年12月, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 56(6) (6), 1204 - 1205, 英語, 国際誌研究論文(学術雑誌)
- (一社)日本脈管学会, 2019年10月, 脈管学, 59(Suppl.) (Suppl.), S133 - S133, 日本語破裂性大動脈瘤に対する治療戦略 下行大動脈瘤破裂に対する胸部ステントグラフト内挿術の早期および遠隔成績
- (一社)日本脈管学会, 2019年10月, 脈管学, 59(Suppl.) (Suppl.), S179 - S179, 日本語腹部大動脈瘤ステントグラフト内挿術後open conversionに至った症例の検討
- (一社)日本脈管学会, 2019年10月, 脈管学, 59(Suppl.) (Suppl.), S175 - S175, 日本語Iliac Branch Endoprosthesisを用いたステントグラフト内挿術の初期成績
- Mosby Inc., 2019年06月, Journal of Thoracic and Cardiovascular Surgery, 157(6) (6), 2138 - 2147.e2, 英語研究論文(学術雑誌)
- (一社)日本インターベンショナルラジオロジー学会, 2019年05月, 日本インターベンショナルラジオロジー学会雑誌, 34(Suppl.) (Suppl.), 255 - 255, 日本語Iliac Branch Endoprosthesisを用いたステントグラフト内挿術の初期成績
- (一社)日本インターベンショナルラジオロジー学会, 2019年05月, 日本インターベンショナルラジオロジー学会雑誌, 34(Suppl.) (Suppl.), 259 - 259, 日本語当院における大動脈解離に対するTEVARの治療成績
- 2019年03月, Ann Thorac Surg, 107(3) (3), 733 - 739, 英語Pretreatment With Diazoxide Attenuates Spinal Cord Ischemia-Reperfusion Injury Through Signaling Transducer and Activator of Transcription 3 Pathway[査読有り]研究論文(学術雑誌)
- 2019年02月, Eur J Cardiothorac Surg, 英語Comparison of early patency rate and long-term outcomes of various techniques for reconstruction of segmental arteries during thoracoabdominal aortic aneurysm repair[査読有り]研究論文(学術雑誌)
- 2019年02月, J Thorac Cardiovasc Surg, 英語Aortic valve repair with valve-sparing root replacement for asymmetric quadricuspid aortic valve and conversion into symmetric tricuspid valve[査読有り]研究論文(学術雑誌)
- OBJECTIVES: The present study analyzed the prevalence of variations of the aortic arch branching in Japanese population, comparing patients with aortic arch disease with healthy controls. METHODS: Between from October 1999 and December 2015, 815 Japanese patients with aortic arch disease defined as aortic arch aneurysm (diameter ≥ 45 mm) and aortic dissection (group A) underwent aortic arch surgery in our institution. As a control group, 1506 traumatic screened patients were enrolled (group C). RESULTS: Aortic arch anomaly was diagnosed in 140 patients (17.2%) in the group A and in 222 patients (14.7%) in the group C (p = 0.125). Significant differences were found in the incidence of aberrant subclavian artery (A: 14 patients, 1.7%, vs. C: 8 patients, 0.5%, p = 0.006). Significantly more patients with aortic arch aneurysm in the group A had anomalies of the aortic arch compared with the group C (p = 0.009), including bovine aortic arch (p = 0.049) and aberrant subclavian artery (p < 0.001). In term of aneurysm location, bovine arch was detected in more patients with proximal arch aneurysm (15.7%, p = 0.043), whereas aberrant subclavian artery was in more patients with distal location (3.7%, p < 0.001). No difference was found in aortic arch anomaly in patients with acute or chronic dissection. CONCLUSION: Aberrant subclavian artery was a significant maker of aortic arch disease in Japanese populations. Bovine arch was a risk maker of proximal arch aneurysm, and aberrant subclavian artery was a risk factor of distal arch aneurysm.2019年02月, Gen Thorac Cardiovasc Surg, 67(2) (2), 219 - 226, 英語, 国内誌[査読有り]研究論文(学術雑誌)
- (NPO)日本血管外科学会, 2019年, 日本血管外科学会雑誌, 28(Suppl.) (Suppl.), PR4 - 6, 日本語EVARにおける内腸骨動脈血流温存の意義・適応 腹部ステントグラフト内挿術における内腸骨動脈塞栓の影響
- (NPO)日本血管外科学会, 2019年, 日本血管外科学会雑誌, 28(Suppl.) (Suppl.), SY1 - 7, 日本語TEVARの長期予後と合併症について 非解離性胸部大動脈瘤に対するTEVARの遠隔予後の検討
- 2019年01月, J Surg Res, 233, 124 - 131, 英語Synergetic Induction of NGF With Diazoxide and Erythropoietin Attenuates Spinal Cord Ischemic Injury[査読有り]研究論文(学術雑誌)
- 2019年01月, J Thorac Cardiovasc Surg, 157(1) (1), 75 - 85, 英語Long-term outcomes of total arch replacement using a 4-branched graft[査読有り]研究論文(学術雑誌)
- 2018年12月, Ann Thorac Surg, 英語Valve sparing aortic root replacement in elderly patients with annulo-aortic ectasia[査読有り]研究論文(学術雑誌)
- 2018年12月, Ann Thorac Surg, 106(6) (6), 1751 - 1758, 英語Synergistic Reduction of Apoptosis With Diazoxide and Erythropoietin in Spinal Cord Ischemic Injury[査読有り]研究論文(学術雑誌)
- OBJECTIVES: The aim of this study was to evaluate the early and long-term outcomes of our multidisciplinary strategy for treating deep sternal wound infection after aortic grafting, which consisted of debridement by a plastic surgeon, negative pressure wound therapy with continuous irrigation and chest wall reconstruction. METHODS: We performed a retrospective analysis of 18 patients who had a deep sternal wound infection following aortic grafting through a median sternotomy between January 2009 and December 2017. All patients had organisms cultured from mediastinal tissue within 2 months from the initial aortic surgery. The prosthetic grafts were exposed in 15 patients during resternotomy. Our protocol involved repeat debridement and negative pressure wound therapy with continuous irrigation twice a week until the results of the culture were negative and chest wall reconstruction was complete. RESULTS: The mean duration from primary aortic surgery to resternotomy was 23.7 ± 15.9 days. Except for 1 patient, 17 patients underwent chest wall reconstruction. The mean duration from resternotomy to chest wall reconstruction was 31.1 ± 28.0 days. The hospital mortality rate was 16.7% (3 patients), although no patients died of wound-related causes. The mean follow-up period was 2.9 ± 2.5 years. Overall survival was 69.6 ± 11.4% at 1 year and 54.2 ± 13.3% at 5 years. Freedom from reoperation for reinfection was 94.4 ± 5.4% at 5 years. CONCLUSIONS: Our wound care strategy achieved acceptable early and late survival in patients who had deep sternal wound infection following aortic grafting. This strategy may benefit those who experience this devastating complication.2018年12月, Eur J Cardiothorac Surg, 55(5) (5), 975 - 983, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- 2018年12月, Gen Thorac Cardiovasc Surg, 英語A successful report of mitral valve repair for parachute-like mitral valve in adult[査読有り]研究論文(学術雑誌)
- 2018年11月, Eur J Cardiothorac Surg, 英語The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement[査読有り]研究論文(学術雑誌)
- 2018年11月, J Thorac Cardiovasc Surg, 156(5) (5), 1796 - 1797, 英語Potential benefit of pharmacological induction of beta common receptor[査読有り]研究論文(学術雑誌)
- (一社)日本脈管学会, 2018年09月, 脈管学, 58(Suppl.) (Suppl.), S107 - S107, 日本語中長期成績からみた腹部大動脈瘤ステントグラフトの功罪 IMA閉塞例におけるEVAR後のType 2エンドリークの検討 予防的IMA塞栓術は有用か?
- 2018年08月, Gen Thorac Cardiovasc Surg, 英語Successful hybrid treatment of a rare case of blunt traumatic rupture of the left atrial basal appendage and aortic arch[査読有り]研究論文(学術雑誌)
- (NPO)日本心臓血管外科学会, 2018年07月, 日本心臓血管外科学会雑誌, 47(4) (4), vii - xii, 日本語
- Springer Tokyo, 2018年06月, General Thoracic and Cardiovascular Surgery, 1 - 3, 英語[査読有り]研究論文(学術雑誌)
- 2018年06月, J Thorac Cardiovasc Surg, 155(6) (6), 2505 - 2516, 英語Optimized induction of beta common receptor enhances the neuroprotective function of erythropoietin in spinal cord ischemic injury[査読有り]研究論文(学術雑誌)
- 2017年10月, JOURNAL OF SURGICAL RESEARCH, 218, 285 - 291, 英語[査読有り]研究論文(学術雑誌)
- 2017年07月, JOVE-JOURNAL OF VISUALIZED EXPERIMENTS, (125) (125), 英語[査読有り]研究論文(学術雑誌)
- 2016年12月, Semin Cardiothorac Vasc Anesth, 20(4) (4), 307 - 313, 英語Total Aortic Arch Replacement: Advantages of Varied Techniques[査読有り]研究論文(学術雑誌)
- 2016年12月, Semin Cardiothorac Vasc Anesth, 20(4) (4), 303 - 306, 英語Hemiarch: The Real Operation for Ascending Aortic Aneurysm[査読有り]研究論文(学術雑誌)
- 2016年12月, Semin Cardiothorac Vasc Anesth, 20(4) (4), 298 - 302, 英語Arterial Cannulation and Cerebral Perfusion Strategies for Aortic Arch Operations[査読有り]研究論文(学術雑誌)
- A 30-year-old man with Marfan syndrome who underwent Crawford type II extension aneurysm repair about 9 years ago was referred to our hospital with persistent fever. Computed tomography (CT) showed air around the mid-descending aortic prosthetic graft. Because the air did not disappear in spite of intravenous antibiotics, (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed. FDG-PET/CT revealed four high-uptake lesions. After dissecting the aortic graft particularly focusing on the high-uptake lesions, this patient underwent in situ graft re-replacement of descending aortic graft with a rifampicin-bonded gelatin-impregnated Dacron graft and omentopexy. The patient remains well without recurrent infection at 3 months after surgery.2016年09月, General thoracic and cardiovascular surgery, 64(9) (9), 549 - 51, 英語, 国内誌研究論文(学術雑誌)
- Springer Tokyo, 2016年05月, General Thoracic and Cardiovascular Surgery, 64(5) (5), 251 - 259, 英語[査読有り]研究論文(学術雑誌)
- OBJECTIVE: The present study aimed to determine the impact of the extent of graft replacement on early and late outcomes in acute DeBakey type I aortic dissection. METHODS: Between October 1999 and July 2014, 197 consecutive patients were surgically treated for acute DeBakey type I aortic dissection. The extent of graft replacement (hemiarch, partial, or total arch replacement) was mainly determined by the location of the primary entry. Early and late results were compared in patients after total arch replacement (n = 88) and combined hemiarch and partial arch replacement: non-total arch replacement (n = 109). RESULTS: The in-hospital mortality rates of the total arch replacement and non-total arch replacement groups were 10.2% and 14.7%, respectively (P = .47). Multivariate analysis revealed preoperative cardiopulmonary resuscitation and visceral organ malperfusion as significant risk factors for in-hospital mortality, but not total arch replacement. During a mean follow-up period of 60 ± 48 months, the 5-year survivals in the total arch replacement and non-total arch replacement groups were 88.6% ± 4.2% and 83.8% ± 4.4%, respectively (P = .54). Rates of distal aortic events (defined as freedom from surgery for distal aorta dilation or distal arch diameter expanding to 50 mm) at 5 years were significantly better in the total arch replacement group than in the non-total arch replacement group (94.9% ± 3.5% vs 83.6% ± 4.9%, P = .01). CONCLUSIONS: The operative mortality of patients with acute DeBakey type I aortic dissection treated by total arch replacement was acceptable with good long-term survival after both total arch replacement and non-total arch replacement. The frequency of distal aortic events might be reduced in patients after total arch replacement compared with non-total arch replacement.2016年, J Thorac Cardiovasc Surg, 151(2) (2), 341-348 - 8, 英語, 国際誌研究論文(学術雑誌)
- BACKGROUND: The mid-term results of valve-sparing aortic root reimplantation (VSRR) for various indications were investigated. METHODS: From 2000 to 2013, 183 consecutive patients undergoing VSRR were enrolled. Expanded indications, defined as a patient on the marginal operative indication, included age 65 years or older (n = 33), age 15 years or younger (n = 4), acute type A aortic dissection (AAAD) (n = 21), aortitis (n = 8), reoperative root replacement (n = 11), cusp prolapse (n = 67), large aortoventricular junction of greater than 28 mm (AVJ) (n = 42), preoperative severe aortic regurgitation (AR) (n = 89), left ventricular ejection fraction 0.40 or less (n = 12), LV dilation (n = 66), New York Heart Association class III or greater (n = 5), need for total arch replacement (n = 29), and concomitant mitral valve repair (n = 12). RESULTS: The overall survival at 5 years was 96.6%. Freedom from greater than mild AR and reoperation at 5 years was 85.8% and 92.9%, respectively. Cox proportional hazard model revealed that AAAD, cusp prolapse, AVJ 28 mm or greater, and operation before 2009 were at risk for late AR recurrence (p = 0.015, p = 0.0041, p = 0.032, and p = 0.014, respectively). After 2009, freedom from late AR in the cusp prolapse group improved (p = 0.055, versus control). Both freedom from recurrent AR and reoperation were worse as the number of expanded indications increased (log-rank trend p = 0.00017 and p = 0.00067, respectively). CONCLUSIONS: Surgical outcomes of VSRR in these patient cohorts were satisfactory with some room for improvement in patients with cusp prolapse. Although the indications for VSRR are being expanded, a larger number of expanded indications were associated with poor outcomes in terms of longevity of valve function.2015年09月, ANNALS OF THORACIC SURGERY, 100(3) (3), 845-852 - 51, 英語, 国際誌研究論文(学術雑誌)
- A 67-year old man with ascending aortic aneurysm was referred because of a quadricuspid aortic valve. He underwent aortic root replacement with a valve-sparing technique. Under deep hypothermic circulatory arrest, replacement of the ascending aorta was successfully performed. The postoperative course was uneventful without recurrence of aortic regurgitation.2015年04月, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 47(4) (4), 741-746 - 3, 英語, 国際誌研究論文(学術雑誌)
- BACKGROUND: Although an association between chronic obstructive pulmonary disease (COPD) and adverse surgical outcomes has been proposed, the impact of COPD severity on postoperative outcomes remains unclear. Our objective was to analyze the prognostic implication of COPD severity on outcomes after total aortic arch replacement. METHODS: Between October 1999 and December 2012, 269 patients undergoing total arch replacement through median sternotomy, who were elective cases with preoperative spirometry records, were retrospectively reviewed. Patients were divided into four groups: control group, with ratio of forced expiratory volume of air in 1 second (FEV1) to forced vital capacity (FVC) of 70% or greater; mild airflow obstruction, with FEV1/FVC ratio less than 70% and FEV1 80% or greater of predicted; moderate airflow obstruction, FEV1/FVC ratio less than 70% and FEV1 50% to 79% of predicted; severe airflow obstruction, FEV1/FVC ratio less than 70% and FEV1 less than 50% of predicted. Symptoms of functional dyspnea and disability were also assessed. Multivariate logistic and Cox regression methods were used to determine if there was an independent association between COPD and short-term and long-term outcomes, respectively. RESULTS: The in-hospital mortality rate was 2.2% (6 of 269). A consistent trend of increasing frequency of postoperative respiratory complications with advanced airflow obstruction was noted. In multivariate analysis, in-hospital mortality (p = 0.022), incidence of respiratory complications (p = 0.021) and overall mortality (p = 0.025) was significantly associated with the symptoms of COPD, respectively. CONCLUSIONS: The severity of COPD as defined by spirometry and symptoms of functional dyspnea may be an important prognostic marker of patients undergoing total arch replacement.2015年01月, ANNALS OF THORACIC SURGERY, 99(1) (1), 72-78 - 8, 英語, 国際誌研究論文(学術雑誌)
- 2014年12月, Eur J Cardiothorac Surg, 46(6) (6), 974 - 980, 英語[査読有り]研究論文(学術雑誌)
- BACKGROUND: We present a series of patients who underwent in situ total aortic arch replacement for infected distal aortic arch aneurysms. METHODS: Between 2002 and 2013, 9 patients with infected distal aortic arch aneurysms underwent total aortic arch replacement using antegrade selective cerebral perfusion. There were 4 male and 5 female patients with a mean age of 72.7±9.0 years. All patients had penetrating atherosclerotic ulcer in the distal aortic arch, which formed saccular aneurysms. Four patients had preoperative hoarseness. Maximum preoperative white blood cell count was 10,211±4375/μL, and mean serum C-reactive protein concentration was 12.7±7.2 mg/dL. Causative microorganisms were identified by blood culture or aortic wall culture and were as follows: Candida albicans, Pseudomonas aeruginosa, Edwardsiella tarda, Streptococcus dysgalactiae, Listeria monocytogenes, Staphylococcus aureus (2 cases), and unknown (2 cases). Radical debridement with in situ total aortic arch replacement was performed in all patients, followed by the omental flap grafting in 7 patients. All surgery was performed on an urgent or emergency basis. RESULTS: Average cardiopulmonary bypass time and lower body circulatory arrest time were 199.7±50.7 minutes and 66.6±13.8 minutes, respectively. There was no in-hospital mortality, but 1 patient died of asphyxia 5 months after hospital discharge. Freedom from recurrence of infection was 100%. CONCLUSIONS: Surgical treatment with the combination of radical debridement with in situ total aortic arch replacement using antegrade selective cerebral perfusion and omental flap grafting was a reliable procedure for the treatment of infected distal aortic arch aneurysms.2014年11月, The Journal of thoracic and cardiovascular surgery, 148(5) (5), 2096 - 100, 英語, 国際誌研究論文(学術雑誌)
- OBJECTIVES: Presenting a surgical strategy for aorto-oesophageal fistula (AEF). METHODS: From October 1999 to August 2013, 16 patients with AEF were treated at Kobe University Hospital. The mean age was 65.5 ± 10.2 years, and the male/female ratio was 13/3. Eight patients had non-dissecting thoracic aneurysm, 3 had chronic aortic dissection, 5 had oesophageal cancer and 1 had fish bone penetration. Five patients were in shock. Four patients had previous thoracic endovascular aortic repair (TEVAR) in the descending aorta and 1 had hemi-arch replacement. As treatment for AEF, 8 patients underwent TEVAR, 2 had a bridge TEVAR to open surgery, 2 had extra-anatomical bypass (EAB) and 5 had in situ reconstruction of the descending aorta. The oesophagus was resected in 8 patients, and an omental flap was installed in 7 patients. For the 4 most recent cases, simultaneous resection of the aorta and oesophagus, in situ reconstruction of the descending aorta using rifampicin-soaked Dacron graft and omental flap installation were performed. RESULTS: Hospital mortality was noted in 4 patients (25.0%; persistent sepsis n = 3 and pneumonia n = 1). However, since 2007, only 1 of 5 patients died (pneumonia). All patients with oesophageal cancer died during follow-up. Two patients underwent oesophageal reconstruction using a pedicled colon graft and one is on the waiting list for oesophageal reconstruction. CONCLUSIONS: Bridging TEVAR is a useful adjunct in treating AEF patients with shock. One-stage surgery consisting of resection of the aneurysm and oesophagus, in situ reconstruction of the descending aorta and omental flap installation provided a better outcome in the AEF surgical strategy compared with conservative treatment.2014年11月, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 46(5) (5), 894 - 900, 英語, 国際誌研究論文(学術雑誌)
- 2014年06月, JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 147(6) (6), 1861 - 1867, 英語[査読有り]研究論文(学術雑誌)
- 2014年, CARDIOLOGY, 128(2) (2), 173 - 173, 英語Efficacy of Nafamostat Mesilate as Anticoagulation During Cardiopulmonary Bypass on Early Surgery in Patients with Active Infective Endocarditis Complicated by Stroke
- 2013年07月, JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 146(1) (1), 235-237 - 7, 英語, 国際誌研究論文(学術雑誌)
- BACKGROUND: We present a single center's experience of secondary interventions after thoracic endovascular aortic repair (TEVAR). METHODS: One hundred and forty-seven patients underwent TEVAR at our institution between 2000 and 2012. A total of 26 patients (19 male, mean age 68.4 ± 12.7 years), including 7 patients with primary TEVAR at other centers, underwent secondary interventions. The median interval to secondary intervention was 17.2 months (range, 0.22 to 36.1). The indications for secondary interventions included procedure-related dissection (n = 1), collapse of the endovascular device (n = 1), aortoesophageal fistula (n = 1), residual dissection (n = 3), and endoleaks causing dilation of the sac (n = 17) or aortic rupture (n = 3). Sixteen patients underwent open conversion including total arch replacement (n = 2), extensive replacement of the aortic arch or descending aorta (n = 10), and thoracoabdominal aortic replacement (n = 4). Second-time TEVAR was performed in the remaining 10 patients. RESULTS: The in-hospital mortality rate was 11.5% (3 patients; 1 case of multiorgan failure after open conversion, and 1 case of mesenteric ischemia and 1 case of aortic rupture after second-time TEVAR). Postoperative stroke after second-time TEVAR occurred in 1 patient. The cumulative survival rate of the 26 patients was 80.0% ± 8.0% at 5 years after secondary intervention. Short proximal neck (p = 0.0036), steep angulation of landing zones (p = 0.033), and nonuse of commercially available devices (p = 0.011) were significantly correlated with incidence of TEVAR failure. CONCLUSIONS: Secondary surgical procedures after TEVAR can be performed with low mortality and morbidity, despite the precarious preoperative conditions and complex aortic pathologies of patients.2013年05月, ANNALS OF THORACIC SURGERY, 95(5) (5), 1584-1590 - 90, 英語, 国際誌研究論文(学術雑誌)
- (一社)日本外科学会, 2013年03月, 日本外科学会雑誌, 114(臨増2) (臨増2), 737 - 737, 日本語腹部大動脈瘤に対するステントグラフト内挿術の適応拡大における問題点研究論文(その他学術会議資料等)
- BACKGROUND: Optimal neuro-protection strategy in aortic arch surgery is a controversial issue. The present study reported surgical outcomes of total arch replacement using selective antegrade cerebral perfusion (SACP). METHODS: From January 2002 to December 2012, 438 consecutive patients (mean age 69.1±13.4 years) underwent total arch replacement using SACP through a median sternotomy. Acute aortic dissection was present in 86 patients (18.3; 80 type A, 6 type B) and shaggy aorta in 36 (8.2%). Emergent/urgent surgery was required in 144 (32.9%). Our current approach included: (I) meticulous selection of arterial cannulation site and type of arterial cannula; (II) selective antegrade cerebral perfusion; (III) maintenance of minimal tympanic temperature between 20 and 23 °C; (IV) early re-warming after distal anastomosis; and (V) maintaining fluid balance below 1,000 mL during cardiopulmonary bypass. A woven Dacron four branch graft was used in all patients. RESULTS: Overall hospital mortality was 4.6% (20/438). Hospital mortality was 9.7% (14/144) in urgent/emergent surgery and 2.0% (6/294) in elective cases. Permanent neurological deficit occurred in 5.3% (23/438) of patients. Prolonged ventilation was necessary in 58 patients (13.2%). Multivariate analysis demonstrated that risk factors for hospital mortality were octogenarian (OR 4.45, P=0.03), brain malperfusion (OR 23.52, P=0.002) and cardiopulmonary bypass time (OR 1.07, P=0.04). The follow-up was completed in 97.9% with mean follow up of 2.3±2.3 years. Survival at 5 and 10 years after surgery was 79.6±3.3% and 71.2±5.0% respectively. In the acute type A dissection group, 10-year survival was 96.8±2.9%, while in the elective non-dissection group 5- and 10-year survival were 81.4±7.2% and 77.0±5.9% respectively. CONCLUSIONS: Our current approach for total aortic arch replacement utilizing SACP was associated with low hospital mortality and morbidities leading to favorable long-term outcome.2013年03月, Ann Cardiothorac Surg, 2(2) (2), 169 - 74, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- 2013年03月, Ann Cardiothorac Surg, 2(2) (2), 222 - 8, 英語, 国際誌[査読有り]研究論文(学術雑誌)
- BACKGROUND: This study was performed to investigate the early and late outcomes of total aortic arch replacement (TAR) with or without coronary artery bypass grafting (CABG). METHODS: From October 1999 to December 2010, 200 consecutive patients underwent elective TAR for nondissecting aneurysm through a median sternotomy. Of this number, 131 (65.5%) had isolated TAR (TAR group) and 69 (34.5%) underwent concomitant CABG (TAR/CABG group). Patients in the TAR/CABG group were older and had more advanced chronic kidney disease and higher additive/logistic European System for Cardiac Operative Risk Evaluation and Japan scores than patients in the TAR group. RESULTS: Overall 30-day mortality was 0.5% (1 of 200) and hospital mortality was 3.5% (7 of 200). Hospital mortality was 1.5% (2 of 131) in the TAR group and 7.2% (5 of 69) in the TAR/CABG group (p=0.036). Multivariate analysis showed that operation time (odds ratio [OR] 1.01, p=0.013) was a risk factor for hospital mortality, but failed to demonstrate concomitant CABG as a risk factor. Cox proportional hazard analysis showed that age (OR 1.08, p=0.05), female sex (OR 3.58, p=0.0004), chronic kidney disease (OR 7.70, p<0.0001), and operation time (OR 1.01, p=0.0002) were risk factors for midterm mortality, whereas concomitant CABG was not (OR 0.92, p=0.87). There was a significant difference in midterm survival and freedom from major cerebrocardiovascular events in the TAR group versus the TAR/CABG group. CONCLUSIONS: Concomitant CABG was not a risk factor for hospital morality with TAR. However, patients with concomitant CABG have more preoperative comorbidities, which may adversely affect outcomes, and which may therefore deserve special attention.2012年08月, ANNALS OF THORACIC SURGERY, 94(2) (2), 530-536 - 6, 英語, 国際誌研究論文(学術雑誌)
- (NPO)日本血管外科学会, 2012年05月, 日本血管外科学会雑誌, 21(3) (3), 400 - 400, 日本語腹部大動脈瘤ステントグラフト内挿術の治療成績 IFU内vs IFU外研究論文(その他学術会議資料等)
- (NPO)日本血管外科学会, 2012年05月, 日本血管外科学会雑誌, 21(3) (3), 424 - 424, 日本語内臓動脈瘤に対する治療方針の検討研究論文(その他学術会議資料等)
- (NPO)日本血管外科学会, 2012年04月, 日本血管外科学会雑誌, 21(2) (2), 162 - 162, 日本語Gianturco Z stent graftによるTEVARの遠隔期type III endoleakの治療経験
- (NPO)日本心臓血管外科学会, 2012年03月, 日本心臓血管外科学会雑誌, 41(Suppl.) (Suppl.), 444 - 444, 日本語腹部大動脈瘤の治療成績 EVAR vs Open Surgery研究論文(その他学術会議資料等)
- W.B. Saunders, 2019年12月01日, Seminars in Thoracic and Cardiovascular Surgery, 31(4) (4), 674 - 678, 英語書評論文,書評,文献紹介等
- (一社)日本脈管学会, 2019年10月, 脈管学, 59(Suppl.) (Suppl.), S175 - S175, 日本語Iliac Branch Endoprosthesisを用いたステントグラフト内挿術の初期成績
- (一社)日本インターベンショナルラジオロジー学会, 2019年09月, 日本インターベンショナルラジオロジー学会雑誌, 34(1) (1), 28 - 35, 日本語【エンドリーク】Type II endoleakの制御を目的とした術前塞栓術
- (NPO)日本血管外科学会, 2019年, 日本血管外科学会雑誌, 28(Suppl.) (Suppl.), SY1 - 7, 日本語TEVARの長期予後と合併症について 非解離性胸部大動脈瘤に対するTEVARの遠隔予後の検討
- 2019年, 日本インターベンショナルラジオロジー学会雑誌(Web), 34(1) (1)TypeII endoleakの制御を目的とした術前塞栓術
- 2019年, 脈管学(Web), 59(supplement) (supplement)Iliac Branch Endoprosthesisを用いたステントグラフト内挿術の初期成績
- 2018年, 脈管学(Web), 58(supplement) (supplement)IMA閉塞例におけるEVAR後のType2エンドリークの検討:予防的IMA塞栓術は有用か?
- (NPO)日本血管外科学会, 2015年05月, 日本血管外科学会雑誌, 24(3) (3), 503 - 503, 日本語破裂性腹部大動脈瘤の手術成績Open vs EVAR
- (NPO)日本血管外科学会, 2014年04月, 日本血管外科学会雑誌, 23(2) (2), 396 - 396, 日本語EVAR後type II endoleakに対する治療成績
- 一般社団法人日本外科学会, 2014年03月05日, 日本外科学会雑誌, 115(2) (2), 489 - 489, 日本語OP-098-7 異型大動脈縮窄症に対するextra-anatomical bypass(EAB)の検討(OP-098 大血管 胸部・その他,一般演題,第114回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2014年03月05日, 日本外科学会雑誌, 115(2) (2), 486 - 486, 日本語OP-097-3 解離性大動脈瘤のTEVAR術後に生じた大動脈食道ろうに対して根治術を思考した1例(OP-097 心臓 その他,一般演題,第114回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2014年03月05日, 日本外科学会雑誌, 115(2) (2), 487 - 487, 日本語OP-097-7 慢性血栓塞栓性肺高血圧症手術症例の検討(OP-097 心臓 その他,一般演題,第114回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2014年03月05日, 日本外科学会雑誌, 115(2) (2), 769 - 769, 日本語PS-097-7 急性Stanford A型大動脈解離に対する大動脈基部置換術の遠隔期成績(PS-097 大血管 その他,ポスターセッション,第114回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2014年03月05日, 日本外科学会雑誌, 115(2) (2), 765 - 765, 日本語PS-095-6 腎動脈下大動脈の屈曲がEVAR後の長期成績に与える影響(PS-095 大血管 ステントグラフト1,ポスターセッション,第114回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2014年03月05日, 日本外科学会雑誌, 115(2) (2), 915 - 915, 日本語PS-170-5 人工血管が存在する縦隔洞炎に対する持続吸引洗浄の有用性(PS-170 心臓 その他-2,ポスターセッション,第114回日本外科学会定期学術集会)
- (一社)日本外科学会, 2014年03月, 日本外科学会雑誌, 115(臨増2) (臨増2), 765 - 765, 日本語腎動脈下大動脈の屈曲がEVAR後の長期成績に与える影響
- 2014年, CARDIOLOGY, 128(2) (2), 127 - 127, 英語Mid-Term Results of Aortic Root Reimplantation in Patients with Severe Aortic Regurgitation研究発表ペーパー・要旨(国際会議)
- 一般社団法人日本外科学会, 2013年03月05日, 日本外科学会雑誌, 114(2) (2), 1079 - 1079, 日本語RSF-12-4 異型大動脈縮窄症に対し非解剖学バイパス術を行った1例(RSF 研修医の発表セッション,第113回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2013年03月05日, 日本外科学会雑誌, 114(2) (2), 737 - 737, 日本語PS-157-2 腹部大動脈瘤に対するステントグラフト内挿術の適応拡大における問題点(PS ポスターセッション,第113回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2013年03月05日, 日本外科学会雑誌, 114(2) (2), 559 - 559, 日本語PS-030-1 超高齢者大動脈弁狭窄に対する大動脈弁置換術からの検討 : どのような症例に低侵襲治療が望まれるか(PS ポスターセッション,第113回日本外科学会定期学術集会)
- 一般社団法人日本外科学会, 2013年03月05日, 日本外科学会雑誌, 114(2) (2), 254 - 254, 日本語PD-10-5 急性A型大動脈解離の遠隔成績(PD パネルディスカッション,第113回日本外科学会定期学術集会)
- (NPO)日本血管外科学会, 2007年04月, 日本血管外科学会雑誌, 16(3) (3), 603 - 603, 日本語腎動脈灌流障害を合併したB型大動脈解離に対する血管内治療の1例
- (一社)日本外科学会, 2007年03月, 日本外科学会雑誌, 108(臨増2) (臨増2), 322 - 322, 日本語胸部下行大動脈緊急破裂例に対する血管内治療の成績
- EVAR EXPERT EXCHANGE 2018, 2018年07月, 日本語, 大阪, 国内会議EVARにおける予防的IMA塞栓術は本当に有用か? -当院におけるEndurant+IMA塞栓の成績-口頭発表(一般)
- 第61回関西胸部外科学会学術集会, 2018年06月, 日本語, 関西胸部外科学会, 名古屋, 国内会議外傷性大動脈損傷の治療成績口頭発表(一般)
- 第47回日本IVR学会総会 (JSIR & ISIR2018), 2018年05月, 日本語, 日本IVR学会, 東京, 国内会議中長期成績からみた腹部大動脈瘤ステントグラフトの功罪 IMA閉塞例におけるEVAR後のType 2エンドリークの検討 予防的IMA塞栓術は有用か?口頭発表(一般)
- Asian Pacific Digestive Disease Week 2014, 2014年11月, 英語, APDW Federation, Bali, Indonesia, 国際会議Effectiveness of self-expandable metal stent for afferent loop obstruction caused by cancer recurrence after pancreatico-duodenectomy口頭発表(一般)
- 第115回日本外科学会総会, 2014年, 日本語, 日本外科学会, 京都, 国内会議腎動脈下大動脈の屈曲がEVAR後の長期成績に与える影響口頭発表(一般)
- 第42回日本血管外科学会総会, 2014年, 日本語, 日本血管外科学会, 青森, 国内会議EVAR後type II endoleakに対する治療成績口頭発表(一般)
- 第113回日本外科学会定期学術集会, 2013年04月, 日本語, 日本外科学会, 福岡, 国内会議腹部大動脈瘤に対するステントグラフト内挿術の適応拡大における問題点口頭発表(一般)
- 第43回心臓血管外科学会, 2013年02月, 日本語, 日本心臓血管外科学会, 東京, 国内会議腹部大動脈瘤の治療成績 EVAR vs Open Surgery口頭発表(一般)
- 日本学術振興会, 科学研究費助成事業, 基盤研究(B), 神戸大学, 2024年04月01日 - 2027年03月31日腹部大動脈瘤への新たな免疫治療開発
- 日本学術振興会, 科学研究費助成事業, 基盤研究(B), 神戸大学, 2023年04月01日 - 2026年03月31日動脈硬化性疾患シングルセルアトラスの作成とゲノム統合解析による発症メカニズム解明本研究の目的は、動脈硬化性疾患(冠動脈疾患CAD、大動脈瘤AA、大動脈弁狭窄症AS)のシングルセルアトラスの作成と全ゲノム解析を行い、トランスオミックス統合解析を行うことで、それぞれの疾患の相違点を炙り出し、疾患のリスク層別化を行い、発症メカニズムを解明することである。本研究では、これら3疾患について、1)病変部のシングルセル+核RNAシークエンス(scRNAseq+snRNAseq)からシングルセルアトラスを作成、各々の疾患特異的マクロファージの同定を行うと同時に、2)T細胞レパトア解析から各々の疾患において、特徴的な抗原が存在するのかを明らかにする。さらには、3)Genotyping of Transcriptomes (GoT)による シングルセルレベルで骨髄のクローン性造血の関与を調べる解析と4)全ゲノム解析による遺伝素因とトランスクリプトームの関連を解析する、expression quantitative locus (eQTL)解析を行う。3)と4)の実施にて、ゲノム・トランスクリプトーム統合解析が達成できる。すでに、3疾患の少数サンプルでのシングルセルトランスクリプトーム解析は終了し、シングルセルアトラスの概要は見えてきている。CADでT細胞受容体レパトア解析が終了し論文報告を行った。AAでは、結果を受けマウスでの実験も同時実施しており、マクロファージやB細胞での疾患特異的な特徴のデータを得ている。ASでのクローン性造血(CH)の原因となる体細胞遺伝子変異の解析数を増加させており、少数患者でのGoT解析を進めている。まずは3)GoTの統合解析手法の確立を目指す。全ゲノム解析は実施できておらず、4)eQTLの実施までには、さらに時間が必要と考えられる。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2022年04月01日 - 2026年03月31日大動脈瘤のMRエラストグラフィ:瘤の「硬さ」はEVAR後の再増大を予測しうるか?健常人ボランティア複数人に対し、大動脈のMRエラストグラフィの撮像を行った。 肝のMRエラストグラフィと同様のパラメータで撮像を行うと、血管壁の弾性率の測定が不可能であり、肝より深部に血管が存在することや、周囲臓器との関係が原因と考えている。Amplitudeなどのパラメータの設定、あるいはpassive driverの位置を調整し、周囲臓器や骨などを避けて振動を与えるなどの工夫を行っているが、現時点で安定した撮像方法は確立できていない。 一方で、基礎実験のため、3Dプリンターを用いた大動脈血管モデルを作成した。上記にて撮像方法をある程度確立した後に、ステントグラフトを留置し、瘤腔に血栓を作成した血管モデルで実験を行う予定である。瘤腔の血栓については、凝固血液やヘパリン化した非凝固血液を使用する予定であり、これについてはin vitroでの検証は行っているが、実際の血管モデルでの作成には至っていない(撮像時に作成予定である)。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2022年04月01日 - 2025年03月31日ヒト大動脈解離におけるシングルセルRNAシークエンスによる成因解析
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2022年04月01日 - 2025年03月31日大動脈解離の発生と進展に好中球が与える影響の検討
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2021年04月01日 - 2024年03月31日胸腹部大動脈術後脊髄再灌流障害の新たな細胞障害機序の解明と治療法の開発
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2019年04月01日 - 2022年03月31日脊髄虚血再灌流障害を予防、回避するための脳脊髄液中のバイオマーカーの同定非常に不本意ながらマウス手術手技の習得にかなりの時間を要した上、マウスモデルの確立に至らなかった。 文献的には4.5分の遮断、9分の遮断でそれぞれ遅発型モデル、即時型モデルができるとの報告であったが結果的には全く安定せず最後までモデルの確立に至らなかった。確立できなかった理由は深部体温の影響かもしくは遮断時間の問題なのか調べるための研究も行ったが結果的には遅発性モデルの作成に至ることができなった。一方で即時型モデルは作成できたが死亡率が極めて高く実験の継続には至らなかった。本研究では臨床経験から照らし合わせると特に遅発型モデルの確立が重要であったが確立できずその原因は不明であった。