The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform

John A. Elefteriades - One of the best experts on this subject based on the ideXlab platform.

  • perioperative risk profiles and volume outcome relationships in proximal Thoracic Aortic Surgery
    The Annals of Thoracic Surgery, 2018
    Co-Authors: Makoto Mori, John A. Elefteriades, Kayoko Shioda, Xiaofei Wang, Abeel A Mangi, James J Yun, Umer Darr, Arnar Geirsson
    Abstract:

    Background Using the national Society of Thoracic Surgeons Adult Cardiac Surgery Database data for Thoracic Aortic surgical procedures for Aortic aneurysm, this study aimed to (1) characterize patients’ risk profiles and outcomes, (2) evaluate center volume-outcome relationships across US centers, and (3) identify risk factors for operative mortality. Methods Between 2011 and 2016, 53,559 operations for ascending Aortic aneurysm performed across 1,045 centers in the United States were identified. Logistic regression related baseline characteristics and comorbidities to operative mortality. Ten-fold cross-validation was performed to estimate sensitivity and specificity across a range of the discrimination threshold. Centers were stratified into five strata by average annual case volume. Predicted probability of operative mortality was calculated from the model and was used to evaluate patients’ risk profiles across the volume strata. Results Operative mortality occurred in 3.2% of all cases and in 2.2% of elective cases. Only 24 (2.3%) centers performed ≥50 cases annually, whereas 609 (58.3%) centers performed fewer than five cases annually. Multiple logistic regression, of which the c-index was 0.80, revealed that compared with centers with ≥50 cases, centers with fewer than five cases had an increased risk of mortality (odds ratio, 2.50; 95% confidence interval, 2.08 to 3.01; p Conclusions Proximal Thoracic Aortic surgical procedures for Aortic aneurysms in the United States are associated with a low operative mortality rate of 2.2% for elective cases. Risk of operative death decreases significantly at an annual center volume of more than 20 to 25 cases per year.

  • direct axillary cannulation with open seldinger guided technique is it safe
    European Journal of Cardio-Thoracic Surgery, 2018
    Co-Authors: Davide Carino, Sherif Elkinany, Bulat A Ziganshin, Maryann Tranquilli, Makoto Mori, Philip Y K Pang, Mrinal Singh, John A. Elefteriades
    Abstract:

    OBJECTIVES Axillary artery cannulation is commonly used in Thoracic Aortic Surgery, often utilizing a sidearm graft. Although our institutional preference is femoral cannulation, we use axillary cannulation in select cases with a 'dirty' aorta on computed tomography scan or intraoperative transoesophageal echocardiography. Since 2011, we have routinely used an open Seldinger-guided approach for axillary cannulation. Here, we report our experience with open Seldinger-guided technique, evaluating its safety and efficacy. METHODS A retrospective analysis of our institutional database from 2011 to 2016 was performed to find cases of peripheral arterial cannulation for Thoracic Aortic Surgery. We identified 404 consecutive patients who underwent peripheral arterial cannulation. Of these, 352 were femoral and 52 were axillary cannulations. All axillary cannulations were performed for ascending and/or arch Surgery. The technique involves a surgical exposure of the artery which is then cannulated by guidewire inside a purse string without arterial incision. RESULTS Indications for Surgery included aneurysm in 63.5% (33/52), dissection in 30.7% (16/52) and pseudoaneurysm in the remaining 5.8% (3/52). Hospital survival was 98.1% (51/52). There were no instances of axillary arterial injury or intraoperative malperfusion phenomena. No postoperative limb ischaemia or stroke was evident. No wound infections or late pseudoaneurysms were observed. CONCLUSIONS The open Seldinger-guided technique for axillary artery cannulation is safe and effective. We strongly recommend this technique, given its speed and simplicity. The vessel is not snared, thereby preserving distal arterial flow and minimizing the risk of acute limb ischaemia. Furthermore, the limited manipulation of the artery lowers the risk of local complications.

  • does bioglue contribute to anastomotic pseudoaneurysm after Thoracic Aortic Surgery
    Journal of Thoracic Disease, 2017
    Co-Authors: Bulat A Ziganshin, Maryann Tranquilli, Changfa Guo, Mohammad A Zafar, Richard S Sieller, John A. Elefteriades
    Abstract:

    Background: Although bovine serum albumin-glutaraldehyde glue (BioGlue®) has been successfully used as a hemostatic adjunct in Aortic surgical procedures, there are reports that it may lead to anastomotic pseudoaneurysm formation. We seek to examine if the use of BioGlue is associated with a high incidence of anastomotic pseudoaneurysm formation following surgical repair of Thoracic Aortic disease. Methods: We reviewed the medical records and follow-up computed tomography (CT) scans of patients from 2001 to 2015 in whom BioGlue was used during surgical repair of Thoracic Aortic disease to detect postoperative anastomotic pseudoaneurysm formation. Results: A total of 233 patients with BioGlue use were identified. Mean age was 63.5±14.0 years (median 66; range 14–88; 25–75%, IQR 54–74 years) and 149 were male (63.9%). Surgical indication was Thoracic Aortic aneurysm in 169 (72.5%) patients, Aortic dissection in 49 (21.0%), intramural hematoma in 9 (3.9%), penetrating Aortic ulcer in 3 (1.3%) and other in 3 (1.3%). Emergency/urgent Surgery was performed in 68 cases (29.2%). Operative mortality was 7.3% (17/233). Re-exploration for bleeding and neurologic deficits occurred in 24 (10.3%) and 21 (9.0%) patients respectively. All operative survivors were followed (100%, 216/216) and CT follow-up was available in 81.9% (177/216) for a mean duration of 2.4 years (median 0.6; 25–75% IQR 0.2–3.6 years). Anastomotic pseudoaneurysm was detected in 1 patient (0.6%) at 3 years postoperatively. This was an elderly female with extremely frail tissues who underwent a reoperative ascending and arch replacement for dissection. Conclusions: The use of BioGlue in Thoracic Aortic Surgery was not associated with excess incidence of anastomotic pseudoaneurysm formation following surgical repair of Thoracic Aortic disease. Its use need not be discouraged on this basis.

  • open seldinger guided femoral artery cannulation technique for Thoracic Aortic Surgery
    The Annals of Thoracic Surgery, 2016
    Co-Authors: Athanasios Tsiouris, Sherif Elkinany, Bulat A Ziganshin, John A. Elefteriades
    Abstract:

    Background Debate regarding the optimal cannulation site for Aortic Surgery continues. We report our recent experience with a simple and rapid open Seldinger-guided technique for femoral cannulation. Aside from speed and simplicity (no need for arterial incision or suture closure), this technique has the added benefit that the distal limb continues to be perfused, as no arterial snare is required. Methods We recently began routinely utilizing an open Seldinger-guided technique for femoral artery cannulation. The artery is exposed surgically but cannulated by guidewire inside a pursestring without arterial incision. The pursestring is simply tied when decannulation is performed. We report our experience with the routine application of this technique from August 2011 to April 2015. Results We reviewed the outcome of 337 consecutive peripheral arterial cannulations performed for Thoracic Aortic Surgery (303 femoral, 34 axillary) using the open Seldinger technique. Within the femoral cannulation group, the hospital survival rate was 97% (295 of 303). The survival rate for elective operations was 98% (277 of 283), and 90% (18 of 20) for emergent/urgent. Seldinger-guided femoral cannulation was performed for replacement of the ascending/Aortic arch in 88% (266 of 303), the descending Thoracic aorta in 7% (22 of 303), and the thoracoabdominal aorta in 5% (15 of 303). There were no instances of intraoperative malperfusion phenomena, arterial dissection, or vascular injury or rupture. No patients had postoperative acute limb ischemia. Local wound complications were observed in 1% of patients (3 of 303). The stroke rate was 1.6% (5 of 303). The same open Seldinger technique was also used without complication in the axillary cannulation group. Conclusions An open Seldinger-guided femoral (or axillary) cannulation technique is quick and easy to perform, with minimal vascular or other complications and extremely low risk of stroke. This technique is recommended for its speed, simplicity, and effectiveness, and for its preservation of distal arterial flow (which is occluded with the traditional arterial incision/arterial snare technique).

  • femoral artery cannulation for Thoracic Aortic Surgery safe under transesophageal echocardiographic control
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Bassem Ayyash, Maryann Tranquilli, John A. Elefteriades
    Abstract:

    Objective Choice of cannulation site (femoral, axillary) for cardiopulmonary bypass for Thoracic Aortic Surgery is controversial. We review a single-center consecutive experience with femoral cannulation in the era of transesophageal echocardiography (TEE). Methods Femoral artery cannulation is our preference for both aneurysms and dissections. If intraoperative TEE (or preoperative computed tomography) shows mobile atheroma, we avoid femoral cannulation and use the right axillary artery. Charts were reviewed to detect any cannulation- or perfusion-related complications. Results Eight hundred eighty patients underwent cannulation for cardiopulmonary bypass for Thoracic Aortic Surgery: 767 femoral (87%) and 113 other (13%, 87 Aortic, 22 axillary, 4 innominate). Among the femoral cases, 673 (87.7%) were elective and 94 (12.2%) urgent or emergency. Hospital survival was 723 of 767 (94%): 654 of 673 (97%) for elective cases and 69 of 94 (73%) for urgent or emergency cases. Survivals were 549 of 572 (95%) for ascending and arch, 91 of 97 (93%) for descending, and 83 of 98 (84%) for thoracoabdominal. Stroke (fixed neurologic deficit) occurred in 14 of 767 cases (1.8%): 9 ascending or arch and 5 descending or thoracoabdominal. There were 5 paraplegias in the descending or thoracoabdominal group. There was 1 instance of intraoperative descending dissection (well tolerated), no arterial ruptures, and 6 instances (0.7%) of local femoral arterial narrowing requiring surgical correction (patch graft). One patient (0.1%) had postoperative ischemia of the cannulated limb, and 25 patients (3.2%) had local wound problems (infection 21, seroma 4) treated conservatively. Conclusions This large experience in the TEE era strongly supports femoral cannulation for Aortic Surgery, with good survival, low stroke rate, minimal perfusion-related rupture or dissection, and minimal limb ischemia. If intraoperative TEE shows mobile atheroma, axillary cannulation is preferred.

Shinichi Takamoto - One of the best experts on this subject based on the ideXlab platform.

  • status of cardiovascular Surgery in japan between 2017 and 2018 a report based on the japan cardiovascular Surgery database 4 Thoracic Aortic Surgery
    Asian Cardiovascular and Thoracic Annals, 2021
    Co-Authors: Tomonobu Abe, Hiroaki Miyata, Noboru Motomura, Hiraku Kumamaru, Kiyoharu Nakano, Shinichi Takamoto
    Abstract:

    AimWe aimed to analyze the current treatment status of Thoracic/thoracoabdominal Aortic diseases in Japan.MethodsUsing the Japan Cardiovascular Surgery Database, the number of cases, operative mort...

  • current status of cardiovascular Surgery in japan 2015 and 2016 analysis of data from japan cardiovascular Surgery database 4 Thoracic Aortic Surgery
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Hideyuki Shimizu, Hiroaki Miyata, Noboru Motomura, Norimichi Hirahara, Shinichi Takamoto
    Abstract:

    Thoracic and thoracoabdominal Aortic diseases are treated using operative procedures like open Aortic repair (OAR), Thoracic endovascular Aortic repair (TEVAR), or hybrid Aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to Aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. We extracted nationwide data of Aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., Aortic root, ascending aorta, Aortic root to arch, Aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following Aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal Aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. The number of operations for Thoracic and thoracoabdominal Aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting Aortic arch aneurysms.

  • current status of cardiovascular Surgery in japan 2013 and 2014 a report based on the japan cardiovascular Surgery database 5 Thoracic Aortic Surgery
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Hideyuki Shimizu, Hiroaki Miyata, Noboru Motomura, Norimichi Hirahara, Shinichi Takamoto
    Abstract:

    Although open Aortic repair (OAR) is still considered to be a standard treatment for Thoracic Aortic diseases, the indications for Thoracic endovascular treatment (TEVAR)/hybrid Aortic repair (HAR) have expanded in recent years. The purpose of this study was to review the current status of treatment of Thoracic Aortic diseases in Japan. Data for 2013 and 2014 concerning Surgery for diseases of the Thoracic/thoracoabdominal aorta were extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality were evaluated in terms of pathologic diagnosis (acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (JS; <5%, 5–10%, 10–15%, ≥15%), and their correlations. There were 30,271 total cases in this study and the overall operative mortality was 5.9%. Among the three types of treatment, 73.2% of patients underwent OAR (root 98.3%; ascending 97.4%; root to arch 95.5%; arch 81.7%; descending 34.2%; thoracoabdominal 64.4%). While the rate of OAR was negatively correlated with JS for the treatment of the thoracoabdominal region (JS < 5, 80.4%; 5% ≤ JS < 10, 67.6%; 10% ≤ JS < 15, 58.8%; JS ≥ 15, 55.7%), a correlation was not observed in other anatomic regions. The operative mortality associated with OAR was well reflected by JS (JS < 5, 2.1%; 5% ≤ JS < 10, 5.5%; 10% ≤ JS < 15, 10.2%; JS ≥ 15, 20.3%); however, the operative mortality associated with TEVAR/HAR was less than that with JS. The distribution of treatment differs depending on the site of disease and is not markedly influenced by JS. It is clear that JS is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than the JS in TEVAR/HAR, and a new risk score for TEVAR/HAR should be established.

  • deep sternal wound infection after cardiac Surgery
    Journal of Cardiothoracic Surgery, 2013
    Co-Authors: Hiroshi Kubota, Hiroaki Miyata, Noboru Motomura, Shinichi Takamoto, Kiyonori Harii, Norihiko Oura, Shinichi Hirabayashi
    Abstract:

    Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac Surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular Surgery cases, 17,441 Thoracic Aortic Surgery cases, 4,726 valvular Surgery plus CABG cases, and 1,800 Thoracic Aortic Surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as in-hospital or 30-day mortality. Risk factors for DSWI were also examined. The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve Surgery, 2.8% after valve Surgery plus CABG, 1.9% after Thoracic Aortic Surgery, and 3.4% after Thoracic Aortic Surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups. The incidence of DSWI after cardiac Surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac Surgery.

  • Anxiety and depression after Thoracic Aortic Surgery or coronary artery bypass.
    Asian cardiovascular & thoracic annals, 2013
    Co-Authors: Yuko Okamoto, Noboru Motomura, Sachiyo Murashima, Shinichi Takamoto
    Abstract:

    Background: although the outcome of Thoracic Aortic Surgery has improved remarkably, mortality remains high, and mental distress is often present. Psychological outcomes of coronary artery disease have been increasingly researched but few studies have been conducted in Thoracic Aortic Surgery patients. Objective: to compare the psychological outcomes of patients undergoing Thoracic Aortic Surgery with those of patients undergoing coronary artery bypass grafting. Methods: a questionnaire was mailed to 190 patients who underwent Thoracic Aortic Surgery or coronary artery bypass, at 1–5 years postoperatively. Psychological outcomes were assessed using the hospital anxiety and depression scale. Results: 128 patients responded; 49 had Aortic Surgery and 79 had coronary artery bypass. The incidence of borderline or significant anxiety was 14% in Thoracic Aortic Surgery patients and 16% in coronary bypass patients; depression was present in 28% and 20%, respectively. Psychological outcome scores in the 2 groups did not differ significantly. Emergency Surgery was associated with depression after Aortic Surgery, and symptoms such as chest pain and fatigue were associated with both anxiety and depression after coronary artery bypass. Conclusions: some psychological problems remain in the midterm following Thoracic Aortic Surgery. While we expected a more psychologically compromised outcome in the Thoracic Aortic Surgery group, psychological outcomes were quite similar to those in coronary artery bypass patients. The similarity of the profiles of both groups suggests that Thoracic Aortic Surgery patients have a parallel course of midterm psychological improvement following Surgery.

Noboru Motomura - One of the best experts on this subject based on the ideXlab platform.

  • status of cardiovascular Surgery in japan between 2017 and 2018 a report based on the japan cardiovascular Surgery database 4 Thoracic Aortic Surgery
    Asian Cardiovascular and Thoracic Annals, 2021
    Co-Authors: Tomonobu Abe, Hiroaki Miyata, Noboru Motomura, Hiraku Kumamaru, Kiyoharu Nakano, Shinichi Takamoto
    Abstract:

    AimWe aimed to analyze the current treatment status of Thoracic/thoracoabdominal Aortic diseases in Japan.MethodsUsing the Japan Cardiovascular Surgery Database, the number of cases, operative mort...

  • Association between prehospital transfer distance and surgical mortality in emergency Thoracic Aortic Surgery
    The Journal of thoracic and cardiovascular surgery, 2020
    Co-Authors: Yu Izumisawa, Hideki Endo, Nao Ichihara, Arata Takahashi, Kan Nawata, Hiroshi Shiraishi, Hiroaki Miyata, Noboru Motomura
    Abstract:

    Abstract Objective To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency Thoracic Aortic Surgery. Methods A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency Thoracic Aortic Surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. Results A total of 12,004 patients underwent emergency Thoracic Aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. Conclusions No significant association was found between surgical mortality and prehospital transfer distance in emergency Thoracic Aortic Surgery cases. Suspected cases of acute Thoracic Aortic syndrome may be transferred safely to distant high-volume hospitals.

  • current status of cardiovascular Surgery in japan 2015 and 2016 analysis of data from japan cardiovascular Surgery database 4 Thoracic Aortic Surgery
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Hideyuki Shimizu, Hiroaki Miyata, Noboru Motomura, Norimichi Hirahara, Shinichi Takamoto
    Abstract:

    Thoracic and thoracoabdominal Aortic diseases are treated using operative procedures like open Aortic repair (OAR), Thoracic endovascular Aortic repair (TEVAR), or hybrid Aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to Aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. We extracted nationwide data of Aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., Aortic root, ascending aorta, Aortic root to arch, Aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following Aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal Aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. The number of operations for Thoracic and thoracoabdominal Aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting Aortic arch aneurysms.

  • current status of cardiovascular Surgery in japan 2013 and 2014 a report based on the japan cardiovascular Surgery database 5 Thoracic Aortic Surgery
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Hideyuki Shimizu, Hiroaki Miyata, Noboru Motomura, Norimichi Hirahara, Shinichi Takamoto
    Abstract:

    Although open Aortic repair (OAR) is still considered to be a standard treatment for Thoracic Aortic diseases, the indications for Thoracic endovascular treatment (TEVAR)/hybrid Aortic repair (HAR) have expanded in recent years. The purpose of this study was to review the current status of treatment of Thoracic Aortic diseases in Japan. Data for 2013 and 2014 concerning Surgery for diseases of the Thoracic/thoracoabdominal aorta were extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality were evaluated in terms of pathologic diagnosis (acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (JS; <5%, 5–10%, 10–15%, ≥15%), and their correlations. There were 30,271 total cases in this study and the overall operative mortality was 5.9%. Among the three types of treatment, 73.2% of patients underwent OAR (root 98.3%; ascending 97.4%; root to arch 95.5%; arch 81.7%; descending 34.2%; thoracoabdominal 64.4%). While the rate of OAR was negatively correlated with JS for the treatment of the thoracoabdominal region (JS < 5, 80.4%; 5% ≤ JS < 10, 67.6%; 10% ≤ JS < 15, 58.8%; JS ≥ 15, 55.7%), a correlation was not observed in other anatomic regions. The operative mortality associated with OAR was well reflected by JS (JS < 5, 2.1%; 5% ≤ JS < 10, 5.5%; 10% ≤ JS < 15, 10.2%; JS ≥ 15, 20.3%); however, the operative mortality associated with TEVAR/HAR was less than that with JS. The distribution of treatment differs depending on the site of disease and is not markedly influenced by JS. It is clear that JS is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than the JS in TEVAR/HAR, and a new risk score for TEVAR/HAR should be established.

  • deep sternal wound infection after cardiac Surgery
    Journal of Cardiothoracic Surgery, 2013
    Co-Authors: Hiroshi Kubota, Hiroaki Miyata, Noboru Motomura, Shinichi Takamoto, Kiyonori Harii, Norihiko Oura, Shinichi Hirabayashi
    Abstract:

    Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac Surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular Surgery cases, 17,441 Thoracic Aortic Surgery cases, 4,726 valvular Surgery plus CABG cases, and 1,800 Thoracic Aortic Surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as in-hospital or 30-day mortality. Risk factors for DSWI were also examined. The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve Surgery, 2.8% after valve Surgery plus CABG, 1.9% after Thoracic Aortic Surgery, and 3.4% after Thoracic Aortic Surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups. The incidence of DSWI after cardiac Surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac Surgery.

Hiroaki Miyata - One of the best experts on this subject based on the ideXlab platform.

  • status of cardiovascular Surgery in japan between 2017 and 2018 a report based on the japan cardiovascular Surgery database 4 Thoracic Aortic Surgery
    Asian Cardiovascular and Thoracic Annals, 2021
    Co-Authors: Tomonobu Abe, Hiroaki Miyata, Noboru Motomura, Hiraku Kumamaru, Kiyoharu Nakano, Shinichi Takamoto
    Abstract:

    AimWe aimed to analyze the current treatment status of Thoracic/thoracoabdominal Aortic diseases in Japan.MethodsUsing the Japan Cardiovascular Surgery Database, the number of cases, operative mort...

  • Association between prehospital transfer distance and surgical mortality in emergency Thoracic Aortic Surgery
    The Journal of thoracic and cardiovascular surgery, 2020
    Co-Authors: Yu Izumisawa, Hideki Endo, Nao Ichihara, Arata Takahashi, Kan Nawata, Hiroshi Shiraishi, Hiroaki Miyata, Noboru Motomura
    Abstract:

    Abstract Objective To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency Thoracic Aortic Surgery. Methods A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency Thoracic Aortic Surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. Results A total of 12,004 patients underwent emergency Thoracic Aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. Conclusions No significant association was found between surgical mortality and prehospital transfer distance in emergency Thoracic Aortic Surgery cases. Suspected cases of acute Thoracic Aortic syndrome may be transferred safely to distant high-volume hospitals.

  • current status of cardiovascular Surgery in japan 2015 and 2016 analysis of data from japan cardiovascular Surgery database 4 Thoracic Aortic Surgery
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Hideyuki Shimizu, Hiroaki Miyata, Noboru Motomura, Norimichi Hirahara, Shinichi Takamoto
    Abstract:

    Thoracic and thoracoabdominal Aortic diseases are treated using operative procedures like open Aortic repair (OAR), Thoracic endovascular Aortic repair (TEVAR), or hybrid Aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to Aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. We extracted nationwide data of Aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., Aortic root, ascending aorta, Aortic root to arch, Aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following Aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal Aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. The number of operations for Thoracic and thoracoabdominal Aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting Aortic arch aneurysms.

  • current status of cardiovascular Surgery in japan 2013 and 2014 a report based on the japan cardiovascular Surgery database 5 Thoracic Aortic Surgery
    The Japanese Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Hideyuki Shimizu, Hiroaki Miyata, Noboru Motomura, Norimichi Hirahara, Shinichi Takamoto
    Abstract:

    Although open Aortic repair (OAR) is still considered to be a standard treatment for Thoracic Aortic diseases, the indications for Thoracic endovascular treatment (TEVAR)/hybrid Aortic repair (HAR) have expanded in recent years. The purpose of this study was to review the current status of treatment of Thoracic Aortic diseases in Japan. Data for 2013 and 2014 concerning Surgery for diseases of the Thoracic/thoracoabdominal aorta were extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality were evaluated in terms of pathologic diagnosis (acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (JS; <5%, 5–10%, 10–15%, ≥15%), and their correlations. There were 30,271 total cases in this study and the overall operative mortality was 5.9%. Among the three types of treatment, 73.2% of patients underwent OAR (root 98.3%; ascending 97.4%; root to arch 95.5%; arch 81.7%; descending 34.2%; thoracoabdominal 64.4%). While the rate of OAR was negatively correlated with JS for the treatment of the thoracoabdominal region (JS < 5, 80.4%; 5% ≤ JS < 10, 67.6%; 10% ≤ JS < 15, 58.8%; JS ≥ 15, 55.7%), a correlation was not observed in other anatomic regions. The operative mortality associated with OAR was well reflected by JS (JS < 5, 2.1%; 5% ≤ JS < 10, 5.5%; 10% ≤ JS < 15, 10.2%; JS ≥ 15, 20.3%); however, the operative mortality associated with TEVAR/HAR was less than that with JS. The distribution of treatment differs depending on the site of disease and is not markedly influenced by JS. It is clear that JS is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than the JS in TEVAR/HAR, and a new risk score for TEVAR/HAR should be established.

  • deep sternal wound infection after cardiac Surgery
    Journal of Cardiothoracic Surgery, 2013
    Co-Authors: Hiroshi Kubota, Hiroaki Miyata, Noboru Motomura, Shinichi Takamoto, Kiyonori Harii, Norihiko Oura, Shinichi Hirabayashi
    Abstract:

    Deep sternal wound infection (DSWI) is a serious postoperative complication of cardiac Surgery. In this study we investigated the incidence of DSWI and effect of re-exploration for bleeding on DSWI mortality. We reviewed 73,700 cases registered in the Japan Adult Cardiovascular Surgery Database (JACVSD) during the period from 2004 to 2009 and divided them into five groups: 26,597 of isolated coronary artery bypass graft (CABG) cases, 23,136 valvular Surgery cases, 17,441 Thoracic Aortic Surgery cases, 4,726 valvular Surgery plus CABG cases, and 1,800 Thoracic Aortic Surgery plus CABG cases. We calculated the overall incidence of postoperative DSWI, incidence of postoperative DSWI according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI cases according to operative procedure, 30-day mortality and operative mortality of postoperative DSWI according to whether re-exploration for bleeding, and the intervals between the operation and deaths according to whether re-exploration for bleeding were investigated. Operative mortality is defined as in-hospital or 30-day mortality. Risk factors for DSWI were also examined. The overall incidence of postoperative DSWI was 1.8%. The incidence of postoperative DSWI was 1.8% after isolated CABG, 1.3% after valve Surgery, 2.8% after valve Surgery plus CABG, 1.9% after Thoracic Aortic Surgery, and 3.4% after Thoracic Aortic Surgery plus CABG. The 30-day and operative mortality in patients with DSWI was higher after more complicated operative procedures. The incidence of re-exploration for bleeding in DSWI cases was 11.1%. The overall 30-day/operative mortality after DSWI with re-exploration for bleeding was 23.0%/48.0%, and it was significantly higher than in the absence of re-exploration for bleeding (8.1%/22.0%). The difference between the intervals between the operation and death according to whether re-exploration for bleeding had been performed was not significant. Age and cardiogenic shock were significant risk factors related to re-exploration for bleeding, and diabetes control was a significant risk factor related to DSWI for all surgical groups. Previous CABG was a significant risk factor related to both re-exploration for bleeding and DSWI for all surgical groups. The incidence of DSWI after cardiac Surgery according to the data entered in the JACVSD registry during the period from 2004 to 2009 was 1.8%, and more complicated procedures were followed by higher incidence and mortality. When re-exploration for bleeding was performed, mortality was significantly higher than when it was not performed. Prevention of DSWI and establishment of an effective appropriate treatment for DSWI may improve the outcome of cardiac Surgery.

Brett T Reece - One of the best experts on this subject based on the ideXlab platform.

  • spinal cord protection for Thoracic Aortic Surgery bench to bedside
    Seminars in Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Christian V Ghincea, Yuki Ikeno, Muhammad Aftab, Brett T Reece
    Abstract:

    This article summarizes the anatomically driven pathophysiology of spinal cord injury, the impact of ischemia reperfusion on the cellular level, current research in developing neuronal ischemic tolerance, and promotion of collateralization. It addresses neuroprotective strategies in modern clinical practice, current pharmacologic interventions, and continued challenges in the management of complex Aortic disease. The pathophysiology of spinal cord injury includes disruption and recovery of collateral blood flow and the effects of malperfusion on the spinal cord. The optimal approach to spinal cord protection is to employ an integrated and protocolized set of strategies to simultaneously maximize spinal cord blood flow, improve ischemic tolerance, and promote collateralization. In the laboratory setting, investigation should continue to pursue a more granular understanding of ischemic injury and seek to translate protective therapies to clinical practice.

  • the evolution of chemokine release supports a bimodal mechanism of spinal cord ischemia and reperfusion injury
    Circulation, 2012
    Co-Authors: Phillip D Smith, Ferenc Puskas, Xianzhong Meng, Joon H Lee, Joseph C Cleveland, Michael J Weyant, David A Fullerton, Brett T Reece
    Abstract:

    Background—Paraplegia remains a devastating complication of Thoracic Aortic Surgery. The mechanism of the antecedent spinal cord ischemia and reperfusion injury (IR) remains poorly described. IR involves 2 injuries, an initial ischemic insult and subsequent inflammatory amplification of the injury. This mechanism is consistent with the clinical phenomenon of delayed onset paraplegia. This study sought to characterize the inflammatory response in the spinal cord after IR and hypothesized that this would support a bimodal mechanism of injury. Methods and Results—Male C57Bl/6 mice were subjected to 5 minutes of Aortic arch and left subclavian occlusion with subsequent reperfusion to generate spinal cord ischemia. Functional outcomes were scored at 12-hour intervals. Spinal cords were harvested after 0, 6, 12, 18, 24, 36, and 48 hours of reperfusion. Cytokine levels were analyzed using a mouse magnetic bead–based multiplex immunoassay. Inflammatory chemokine concentrations (interleukin [IL]-1β, IL-6, keratino...

  • comparison of systemic and retrograde delivery of adenosine a2a agonist for attenuation of spinal cord injury after Thoracic Aortic cross clamping
    The Annals of Thoracic Surgery, 2006
    Co-Authors: Brett T Reece, David O Okonkwo, Peter I Ellman, Thomas S Maxey, Carlos Tacheleon, Patrick S Warren, Jeffrey J Laurent, Joel Linden, Irving L Kron, Curtis G Tribble
    Abstract:

    Background Paraplegia remains a devastating complication of Thoracic Aortic Surgery, which has been attenuated by retrograde adenosine and systemic adenosine A 2A receptor activation. We hypothesized that despite retrograde spinal perfusion of an adenosine A 2A agonist (ATL-146e), systemic therapy produces superior spinal cord protection with reduced inflammation. Methods Forty pigs underwent 30-minute Thoracic Aortic cross-clamping. Pigs received: no therapy (control); retrograde saline (retrograde control); retrograde ATL-146e; systemic ATL-146e; systemic ATL-146e with retrograde saline; or systemic and retrograde ATL-146e. Retrograde therapies were given during ischemia. Systemic ATL-146e (0.06 μg·kg −1 ·min −1 ) was given intravenously for 3 hours at reperfusion. At 24 hours, motor function was assessed using the Tarlov scale. Tissue was analyzed for neuronal viability, microtubule-associated protein-2 expression, and neutrophil sequestration (myeloperoxidase activity). Results Four pigs received retrograde barium showing both radiographic and histologic spinal cord perfusion. Tarlov scores at 24 hours were significantly improved versus both control groups in all ATL groups except the combined ATL-146e group (all p p p Conclusions Both retrograde and systemic ATL-146e therapies attenuate ischemic spinal cord injury, but combining the two routes was less effective. Given comparable results between the two routes and the simplicity of systemic delivery, peripheral venous ATL-146e at reperfusion should be preferred for spinal cord protection in Thoracic Aortic Surgery.