小川　達也 （オガワ　タツヤ）

研究者情報

学位

• 博士(医学)（2012年03月 近畿大学大学院　医学研究科）

ホームページURL

https://jglobal.jst.go.jp/detail?JGLOBAL_ID=202101010466922870

科研費研究者番号

• 60411609

J-Global ID

• 202101010466922870

研究活動情報

論文

• Modifiers of the Risk of Diabetes for Long-Term Outcomes After Coronary Revascularization: CREDO-Kyoto PCI/CABG Registry.

  Kyohei Yamaji; Hiroki Shiomi; Takeshi Morimoto; Yukiko Matsumura-Nakano; Natsuhiko Ehara; Hiroki Sakamoto; Yasuaki Takeji; Yusuke Yoshikawa; Ko Yamamoto; Eri T Kato; Kazuaki Imada; Takeshi Tada; Ryoji Taniguchi; Ryusuke Nishikawa; Tomohisa Tada; Takashi Uegaito; Tatsuya Ogawa; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Nobushige Tamura; Keiichi Tambara; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Junichiro Nishizawa; Masahiro Natsuaki; Hiroshi Sakai; Takashi Yamamoto; Naoki Kanemitsu; Nobuhisa Ohno; Katsuhisa Ishii; Akira Marui; Hiroshi Tsuneyoshi; Yasuhiko Terai; Shogo Nakayama; Kazuhiro Yamazaki; Mamoru Takahashi; Takashi Tamura; Jiro Esaki; Shinji Miki; Tomoya Onodera; Hiroshi Mabuchi; Yutaka Furukawa; Masaru Tanaka; Tatsuhiko Komiya; Yoshiharu Soga; Michiya Hanyu; Takenori Domei; Kenji Ando; Kazushige Kadota; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura

  JACC. Asia 2 3 294 - 308 2022年06月 

  BACKGROUND: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization. OBJECTIVES: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions. METHODS: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke. RESULTS: With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P interaction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction. CONCLUSIONS: The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
• Percutaneous coronary intervention using new-generation drug-eluting stents versus coronary arterial bypass grafting in stable patients with multi-vessel coronary artery disease: From the CREDO-Kyoto PCI/CABG registry Cohort-3.

  Hiroki Watanabe; Ko Yamamoto; Hiroki Shiomi; Takeshi Morimoto; Eri Kato; Yukiko Matsumura; Kenji Nakatsuma; Yasuaki Takeji; Hidenori Yaku; Erika Yamamoto; Yugo Yamashita; Yusuke Yoshikawa; Masayuki Fuki; Kyohei Yamaji; Natsuhiko Ehara; Hiroki Sakamoto; Kazuaki Imada; Takeshi Tada; Ryoji Taniguchi; Ryusuke Nishikawa; Tomohisa Tada; Takashi Uegaito; Tatsuya Ogawa; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Nobushige Tamura; Keiichi Tambara; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Junichiro Nishizawa; Masahiro Natsuaki; Hiroshi Sakai; Takashi Yamamoto; Naoki Kanemitsu; Nobuhisa Ohno; Katsuhisa Ishii; Akira Marui; Hiroshi Tsuneyoshi; Yasuhiko Terai; Shogo Nakayama; Kazuhiro Yamazaki; Mamoru Takahashi; Takashi Tamura; Jiro Esaki; Shinji Miki; Tomoya Onodera; Hiroshi Mabuchi; Yutaka Furukawa; Masaru Tanaka; Tatsuhiko Komiya; Yoshiharu Soga; Michiya Hanyu; Kenji Ando; Kazushige Kadota; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura

  PloS one 17 9 e0267906  2022年 

  AIMS: There is a scarcity of studies comparing percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) with coronary artery bypass grafting (CABG) in patients with multi-vessel coronary artery disease. METHODS AND RESULTS: The CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who underwent first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. The current study population consisted of 2464 patients who underwent multi-vessel coronary revascularization including revascularization of left anterior descending coronary artery (LAD) either with PCI using new-generation DES (N = 1565), or with CABG (N = 899). Patients in the PCI group were older and more often had severe frailty, but had less complex coronary anatomy, and less complete revascularization than those in the CABG group. Cumulative 5-year incidence of a composite of all-cause death, myocardial infarction or stroke was not significantly different between the 2 groups (25.0% versus 21.5%, P = 0.15). However, after adjusting confounders, the excess risk of PCI relative to CABG turned to be significant for the composite endpoint (HR 1.27, 95%CI 1.04-1.55, P = 0.02). PCI as compared with CABG was associated with comparable adjusted risk for all-cause death (HR 1.22, 95%CI 0.96-1.55, P = 0.11), and stroke (HR 1.17, 95%CI 0.79-1.73, P = 0.44), but with excess adjusted risk for myocardial infarction (HR 1.58, 95%CI 1.05-2.39, P = 0.03), and any coronary revascularization (HR 2.66, 95%CI 2.06-3.43, P<0.0001). CONCLUSIONS: In this observational study, PCI with new-generation DES as compared with CABG was associated with excess long-term risk for major cardiovascular events in patients who underwent multi-vessel coronary revascularization including LAD.
• Coronary Revascularization in the Past Two Decades in Japan (From the CREDO-Kyoto PCI/CABG Registries Cohort-1, -2, and -3).

  Hiroki Shiomi; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Yusuke Yoshikawa; Kyohei Yamaji; Tomohisa Tada; Junichi Tazaki; Natsuhiko Ehara; Ryoji Taniguchi; Toshihiro Tamura; Atsushi Iwakura; Takeshi Tada; Hirotoshi Watanabe; Satoru Suwa; Mamoru Toyofuku; Tsukasa Inada; Kazuhisa Kaneda; Tatsuya Ogawa; Teruki Takeda; Hiroshi Sakai; Takashi Yamamoto; Keiichi Tambara; Jiro Esaki; Hiroshi Eizawa; Miho Yamada; Eiji Shinoda; Junichiro Nishizawa; Hiroshi Mabuchi; Nobushige Tamura; Manabu Shirotani; Shogo Nakayama; Takashi Uegaito; Mitsuo Matsuda; Mamoru Takahashi; Moriaki Inoko; Naoki Kanemitsu; Takashi Tamura; Kazuhisa Ishii; Ryuzo Nawada; Tomoya Onodera; Nobuhisa Ohno; Tadaaki Koyama; Hiroshi Tsuneyoshi; Hiroki Sakamoto; Takeshi Aoyama; Shinji Miki; Masaru Tanaka; Yukihito Sato; Fumio Yamazaki; Michiya Hanyu; Yoshiharu Soga; Tatsuhiko Komiya; Kenji Ando; Kenji Minatoya; Takeshi Kimura

  The American journal of cardiology 153 20 - 29 2021年08月 

  The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081). From Cohort-1 to Cohort-3, the patients got progressively older across subsequent cohorts (67.0 ± 10.0, 68.4 ± 9.9, and 69.8 ± 10.2 years, ptrend < 0.001). There was increased use of PCI over CABG (73.5%, 81.9%, and 85.2%, ptrend < 0.001) and increased prevalence of evidence-based medications use over time. The cumulative 3-year incidence of all-cause death was similar across the 3 cohorts (9.0%, 9.0%, and 9.3%, p = 0.74), while cardiovascular death decreased over time (5.7%, 5.1%, and 4.8%, p = 0.03). The adjusted risk for all-cause death and for cardiovascular death progressively decreased from Cohort-1 to Cohort-2 (HR:0.89, 95%CI:0.80 to 0.99, p = 0.03, and HR:0.80, 95%CI:0.70 to 0.92, p = 0.002, respectively), and from Cohort-2 to Cohort-3 (HR:0.86, 95%CI:0.78 to 0.95, p = 0.004, and HR:0.77, 95%CI:0.67-0.89, p < 0.001, respectively). The risks for stroke and repeated coronary revascularization also improved over time. In conclusions, we found a progressive and substantial reduction of adjusted risk for all-cause death, cardiovascular death, stroke, and repeated coronary revascularization over the past two decades in Japan.
• Concomitant Mitral Regurgitation in Severe Aortic Stenosis - A Report From the CURRENT AS Registry.

  Ryosuke Murai; Yuichi Kawase; Tomohiko Taniguchi; Takeshi Morimoto; Kazushige Kadota; Masanobu Ohya; Takenobu Shimada; Takeshi Maruo; Yasushi Fuku; Tatsuhiko Komiya; Kenji Ando; Michiya Hanyu; Norio Kanamori; Takeshi Aoyama; Koichiro Murata; Tomoya Onodera; Fumio Yamazaki; Takeshi Kitai; Yutaka Furukawa; Tadaaki Koyama; Makoto Miyake; Chisato Izumi; Yoshihisa Nakagawa; Kazuo Yamanaka; Hirokazu Mitsuoka; Manabu Shirotani; Masashi Kato; Shinji Miki; Hiroyuki Nakajima; Yutaka Hirano; Shunichi Miyazaki; Toshihiko Saga; Sachiko Sugioka; Shintaro Matsuda; Mitsuo Matsuda; Tatsuya Ogawa; Kazuya Nagao; Tsukasa Inada; Shogo Nakayama; Hiroshi Mabuchi; Yasuyo Takeuchi; Hiroki Sakamoto; Genichi Sakaguchi; Keiichiro Yamane; Hiroshi Eizawa; Mamoru Toyofuku; Takashi Tamura; Atsushi Iwakura; Mitsuru Ishii; Masaharu Akao; Kotaro Shiraga; Eri Minamino-Muta; Takao Kato; Moriaki Inoko; Koji Ueyama; Tomoyuki Ikeda; Yoshihiro Himura; Akihiro Komasa; Katsuhisa Ishii; Kozo Hotta; Yukihito Sato; Keiichi Fujiwara; Yoshihiro Kato; Ichiro Kouchi; Yasutaka Inuzuka; Shigeru Ikeguchi; Senri Miwa; Chiyo Maeda; Eiji Shinoda; Junichiro Nishizawa; Toshikazu Jinnai; Nobuya Higashitani; Mitsuru Kitano; Yuko Morikami; Shouji Kitaguchi; Kenji Minatoya; Takeshi Kimura

  Circulation journal : official journal of the Japanese Circulation Society 86 3 427 - 437 2021年07月 

  BACKGROUND: The clinical significance of concomitant mitral regurgitation (MR) has not been well addressed in patients with severe aortic stenosis (AS).Methods and Results:We analyzed 3,815 patients from a retrospective multicenter registry of severe AS in Japan (CURRENT AS registry). We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategy (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death or heart failure hospitalization. At baseline, moderate/severe MR was present in 227/1,197 (19%) patients with initial AVR strategy and in 536/2,618 (20%) patients with a conservative strategy. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR, regardless of the initial treatment strategy (25.2% vs. 14.4%, P<0.001 in the initial AVR strategy, and 63.3% vs. 40.7%, P<0.001 in the conservative strategy). After adjusting confounders, moderate/severe MR was not independently associated with higher risk for the primary outcome measure in the initial AVR strategy (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.67-1.83, P=0.69), and in the conservative strategy (HR 1.13, 95% CI 0.93-1.37, P=0.22). CONCLUSIONS: Concomitant moderate/severe MR was not independently associated with higher risk for the primary outcome measure regardless of the initial treatment strategy.
• Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3).

  Yukiko Matsumura-Nakano; Hiroki Shiomi; Takeshi Morimoto; Kyohei Yamaji; Natsuhiko Ehara; Hiroki Sakamoto; Yasuaki Takeji; Yusuke Yoshikawa; Ko Yamamoto; Kazuaki Imada; Takeshi Tada; Ryoji Taniguchi; Ryusuke Nishikawa; Tomohisa Tada; Takashi Uegaito; Tatsuya Ogawa; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Nobushige Tamura; Keiichi Tambara; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Junichiro Nishizawa; Masahiro Natsuaki; Hiroshi Sakai; Takashi Yamamoto; Naoki Kanemitsu; Nobuhisa Ohno; Katsuhisa Ishii; Akira Marui; Hiroshi Tsuneyoshi; Yasuhiko Terai; Shogo Nakayama; Kazuhiro Yamazaki; Mamoru Takahashi; Takashi Tamura; Jiro Esaki; Shinji Miki; Tomoya Onodera; Hiroshi Mabuchi; Yutaka Furukawa; Masaru Tanaka; Tatsuhiko Komiya; Yoshiharu Soga; Michiya Hanyu; Kenji Ando; Kazushige Kadota; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura

  The American journal of cardiology 145 25 - 36 2021年04月 

  There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.
• Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis.

  Masashi Amano; Chisato Izumi; Tomohiko Taniguchi; Takeshi Morimoto; Makoto Miyake; Shunsuke Nishimura; Takeshi Kitai; Takao Kato; Kazushige Kadota; Kenji Ando; Yutaka Furukawa; Tsukasa Inada; Moriaki Inoko; Katsuhisa Ishii; Genichi Sakaguchi; Fumio Yamazaki; Tadaaki Koyama; Tatsuhiko Komiya; Kazuo Yamanaka; Noboru Nishiwaki; Naoki Kanemitsu; Toshihiko Saga; Tatsuya Ogawa; Shogo Nakayama; Hiroshi Tsuneyoshi; Atsushi Iwakura; Kotaro Shiraga; Michiya Hanyu; Nobuhisa Ohno; Atsushi Fukumoto; Tomoyuki Yamada; Junichiro Nishizawa; Jiro Esaki; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura

  European heart journal. Cardiovascular Imaging 20 3 353 - 360 2019年03月 

  AIMS: Tricuspid regurgitation (TR) has been reported to be associated with worse survival in various heart diseases, but there are few data in aortic stenosis (AS). METHODS AND RESULTS: In the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) Registry enrolling 3815 consecutive patients with severe AS, there were 628 patients with moderate or severe TR (TR group) and 3187 patients with no or mild TR (no TR group). The study patients were subdivided into the initial aortic valve replacement (AVR) stratum (n = 1197) and the conservative stratum (n = 2618) according to treatment strategy. The primary outcome measure was a composite of aortic valve-related death or hospitalization due to heart failure. The 5-year freedom rate from the primary outcome measure was significantly lower in the TR group than in the no TR group (49.1% vs. 67.3%, P < 0.001). Even after adjusting for confounders, the excess risk of TR relative to no TR for the primary outcome measure remained significant [hazard ratio (HR): 1.25, 95% confidence interval (CI): 1.06-1.48; P = 0.008]. The trend for the excess adjusted risk in the TR group was consistent in the initial AVR and the conservative strata (HR 1.55, 95% CI: 0.97-2.48; P = 0.07; HR 1.22, 95% CI: 1.02-1.46; P = 0.03, respectively). In the initial AVR stratum, the 5-year freedom rate from the primary outcome measure was not different between the two groups with (n = 56) or without (n = 91) concomitant tricuspid annuloplasty (61.5% vs. 72.1%, P = 0.48). CONCLUSION: The presence of clinically significant TR concomitant with severe AS is associated with a poor long-term outcome, regardless of the initial treatment strategy.
• Early Surgery vs. Surgery After Watchful Waiting for Asymptomatic Severe Aortic Stenosis.

  Makoto Miyake; Chisato Izumi; Tomohiko Taniguchi; Takeshi Morimoto; Masashi Amano; Shunsuke Nishimura; Takeshi Kitai; Takao Kato; Kazushige Kadota; Kenji Ando; Yutaka Furukawa; Tsukasa Inada; Moriaki Inoko; Katsuhisa Ishii; Genichi Sakaguchi; Fumio Yamazaki; Tadaaki Koyama; Tatsuhiko Komiya; Kazuo Yamanaka; Noboru Nishiwaki; Naoki Kanemitsu; Toshihiko Saga; Tatsuya Ogawa; Shogo Nakayama; Hiroshi Tsuneyoshi; Atsushi Iwakura; Kotaro Shiraga; Michiya Hanyu; Nobuhisa Ohno; Atsushi Fukumoto; Tomoyuki Yamada; Junichiro Nishizawa; Jiro Esaki; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura

  Circulation journal : official journal of the Japanese Circulation Society 82 10 2663 - 2671 2018年09月 

  BACKGROUND: There is no large-scale study comparing postoperative mortality after aortic valve replacement (AVR) for asymptomatic severe aortic stenosis (AS) between initial treatment with AVR vs. eventual AVR after conservative management. Methods and Results: We analyzed data from a multicenter registry enrolling 3,815 consecutive patients with severe AS. Of 1,808 asymptomatic patients, 286 patients initially underwent AVR (initial AVR group), and 377 patients were initially managed conservatively and eventually underwent AVR (AVR after watchful waiting group). Mortality after AVR was compared between the 2 groups. Subgroup analysis according to peak aortic jet velocity (Vmax) at diagnosis was also conducted. There was no significant difference between the 2 groups in 5-year overall survival (OS; 86.0% vs. 84.1%, P=0.34) or cardiovascular death-free survival (DFS; 91.3% vs. 91.1%, P=0.61), but on subgroup analysis of patients with Vmax ≥4.5 m/s at diagnosis, the initial AVR group was superior to the AVR after watchful waiting group in both 5-year OS (88.4% vs. 70.6%, P=0.003) and cardiovascular DFS (91.9% vs. 81.7%, P=0.023). CONCLUSIONS: Asymptomatic severe AS patients who underwent AVR after watchful waiting had a postoperative survival rate similar to those who initially underwent AVR. In a subgroup of patients with Vmax ≥4.5 m/s at diagnosis, however, the AVR after watchful waiting group had worse postoperative survival rate than the initial AVR group.
• Aortic valve replacement with a 17-mm mechanical prosthesis in octogenarian or older patients.

  Tatsuya Ogawa; Masahiko Onoe; Souji Moriwaki; Keisuke Shioji; Ayumi Iwamuro; Takashi Uegaito; Mitsuo Matsuda

  The Journal of thoracic and cardiovascular surgery 152 1 112 - 7 2016年07月 

  OBJECTIVE: Few studies have reported on aortic valve replacement (AVR) in patients aged >80 years who have small aortic annuli. Various surgical techniques have been proposed for treating such patients. We investigated AVR using small-diameter mechanical valves, in patients aged >80 years, to determine its effectiveness. METHODS: Eighteen consecutive patients (15 women; 3 men) aged >80 (mean: 83.3 ± 2.7) years underwent surgical AVR with a 17-mm prosthesis. The clinical status and results of pre- and post-operative echocardiography were evaluated. Midterm examination was conducted at 12.0 ± 1.0 months after AVR. RESULTS: The average preoperative body surface area of the patients was 1.39 ± 0.15 m(2); the average New York Heart Association functional class was 3.28 ± 0.75. Echocardiography showed a peak pressure gradient of 99.1 ± 38.4 mm Hg. Operative mortality was absent. A significant decrease in the peak pressure gradient was found on early (22.6 ± 7.2 mm Hg) and midterm (22.2 ± 8.0 mm Hg) postoperative echocardiography, compared with that in the preoperative period. During this follow-up, 16 patients improved to class I, a significant change in each perioperative period compared with the preoperative period. No mortality was observed at 1 year postoperatively. CONCLUSIONS: In patients aged >80 years who have small aortic annuli, AVR using a 17-mm prosthesis showed satisfactory clinical and hemodynamic results and provided a satisfactory remote prognosis.
• Surgical repair of an acute Stanford type A aortic dissection in a patient with a retrosternal gastric tube.

  Tatsuya Ogawa; Toshihiko Saga; Toshio Kaneda; Sohei Hamanaka

  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 46 1 132 - 3 2014年07月 

  Cardiovascular surgery in patients with a retrosternal gastric tube (RGT) remains rare despite improvements in the prognosis of oesophageal cancer. A 75-year old woman with a history of total thoracic oesophagectomy with RGT reconstruction required emergency aortic arch replacement for an acute Stanford type A aortic dissection. We opted for a median sternotomy approach involving complete dissection of the RGT from surrounding tissues and retraction for surgical access to the dissection. Enhanced computed tomography was useful for the diagnosis and planning of the emergency surgery.
• Autologous pericardial reinforcement after detachment of the coronary buttons of the proximal anastomosis in the Bentall procedure.

  Takehiro Inoue; Tatsuya Ogawa; Shintaro Yugami; Toshihiko Saga

  The Canadian journal of cardiology 29 11 1532.e15-7  2013年11月 

  The present report describes a simple modification to the reinforcement technique by Copeland et al. using autologous pericardium for the Bentall procedure. Our modified technique may decrease the probability of leaks at the aortic root. Further, this technique preserves the advantages of the Valsalva graft, including tension-free coronary anastomosis and anatomical adaptability.
• Pseudoaneurysm at the cannulation site of the ascending aorta arising 8 days postoperatively: report of a case.

  Tatsuya Ogawa; Koichi Toda; Tomoyuki Fujita; Masahiro Higashi; Junjiro Kobayashi

  Surgery today 43 5 566 - 8 2013年05月 

  A postoperative pseudoaneurysm is a rare complication that is difficult to diagnose. Computed tomography (CT) revealed a pseudoaneurysm in the ascending aorta of a 68-year-old female 8 days after mitral valve replacement and tricuspid annuloplasty. The defect was simply repaired during emergency surgery without cardiopulmonary bypass (CPB). The early detection of a postoperative pseudoaneurysm is important to avoid a second operation complicated by adhesions. Enhanced CT was useful for early detection in this patient. Pseudoaneurysm of the ascending aorta at the cannulation site can occur soon after surgery, and early recognition might allow simpler surgery without CPB.
• Small right vertical infra-axillary incision for minimally invasive port-access cardiac surgery: a moving window method.

  Toshio Kaneda; Takako Nishino; Toshihiko Saga; Susumu Nakamoto; Tatsuya Ogawa; Takuma Satsu

  Interactive cardiovascular and thoracic surgery 16 4 544 - 6 2013年04月 

  Port-access cardiac surgery has been developed to minimize skin incision and improve cosmetic outcomes. Using this method, a skin incision is generally made just above where the thoracotomy will be placed, horizontally along the intercostal space at the anterolateral submammary position. However, this type of incision can affect the frontal view and shape of the breast. Here, we report our experience with minimally invasive cardiac surgery using a port-access approach via a small vertical right infra-axillary incision and a moving window method. Twenty patients underwent surgical procedures with this approach from December 2010 to January 2012. Thirteen patients underwent mitral valvuloplasty, four mitral valve replacement, one mitral and tricuspid valve replacement and atrial septal defect closure and two atrial septal defect closure. All surgical procedures were completed using this minimally invasive method. All patients had an uneventful recovery and indicated that they were satisfied with the cosmetic results during the follow-up. Our experience suggests that this technique can effectively minimize skin incision and improve cosmetic outcomes.
• [Acute aortic dissection with anomalous coronary artery].

  Takako Nishino; Toshihiko Saga; Hitoshi Kitayama; Toshio Kaneda; Susumu Nakamoto; Kiyoaki Takaba; Masato Imura; Tatsuya Ogawa; Takuma Satsu; Kousuke Fujii; Shintaro Yukami

  Kyobu geka. The Japanese journal of thoracic surgery 65 6 471 - 4 2012年06月 

  A 38-year-old man was diagnosed with acute type A aortic dissection and severe aortic regurgitation, and taken immediately to the operating room for repair of the ascending aorta using the Bentall procedure. The presence of the anomalous right coronary artery was revealed at the time of the procedure, and was repaired with single coronary button technique. Some case reports have described anomalous coronary artery in association with acute myocardiac infarction or angina pectoris. This report describes a case of anomalous coronary artery diagnosed during an emergency operation for aortic dissection.
• Left atrial thrombus in patient with coronary-left atrium fistula.

  Tatsuya Ogawa; Tomoyuki Fujita; Koichi Toda; Yusuke Shimahara; Junjiro Kobayashi

  General thoracic and cardiovascular surgery 60 6 394 - 6 2012年06月 

  We treated a 77-year-old woman diagnosed with severe aortic stenosis, who had undergone catheter ablation for paroxysmal supraventricular tachycardia at the age of 62. Although the patient remained in sinus rhythm, she had been receiving Coumadin with a target INR level of 2.0 since that time. Preoperative coronary angiography revealed a coronary-left atrium (LA) fistula, while computed tomography and echocardiography findings did not detect thrombus formation. Intra-operative transesophageal echocardiography revealed a 2-cm solid mass, which unexpectedly appeared during deairing manipulation. Prompt cross-clamping and removal of an LA thrombus with closure of the LA appendage contributed to an uneventful postoperative course. The LA should be explored if a coronary-LA fistula is noted, even in non-mitral cases, especially those with a history of catheter ablation.
• Natural killer cells recognize friend retrovirus-infected erythroid progenitor cells through NKG2D-RAE-1 interactions In Vivo.

  Tatsuya Ogawa; Sachiyo Tsuji-Kawahara; Takae Yuasa; Saori Kinoshita; Tomomi Chikaishi; Shiki Takamura; Haruo Matsumura; Tsukasa Seya; Toshihiko Saga; Masaaki Miyazawa

  Journal of virology 85 11 5423 - 35 2011年06月 

  Natural killer (NK) cells function as early effector cells in the innate immune defense against viral infections and also participate in the regulation of normal and malignant hematopoiesis. NK cell activities have been associated with early clearance of viremia in experimental simian immunodeficiency virus and clinical human immunodeficiency virus type 1 (HIV-1) infections. We have previously shown that NK cells function as major cytotoxic effector cells in vaccine-induced immune protection against Friend virus (FV)-induced leukemia, and NK cell depletion totally abrogates the above protective immunity. However, how NK cells recognize retrovirus-infected cells remains largely unclear. The present study demonstrates a correlation between the expression of the products of retinoic acid early transcript-1 (RAE-1) genes in target cells and their susceptibility to killing by NK cells isolated from FV-infected animals. This killing was abrogated by antibodies blocking the NKG2D receptor in vitro. Further, the expression of RAE-1 proteins on erythroblast surfaces increased early after FV inoculation, and administration of an RAE-1-blocking antibody resulted in increased spleen infectious centers and exaggerated pathology, indicating that FV-infected erythroid cells are recognized by NK cells mainly through the NKG2D-RAE-1 interactions in vivo. Enhanced retroviral replication due to host gene-targeting resulted in markedly increased RAE-1 expression in the absence of massive erythroid cell proliferation, indicating a direct role of retroviral replication in RAE-1 upregulation.
• Surgical repair for atrial septal defect associated with myotonic dystrophy.

  Tatsuya Ogawa; Toshihiko Saga; Susumu Nakamoto

  Circulation journal : official journal of the Japanese Circulation Society 71 8 1321 - 2 2007年08月 

  Myotonic dystrophy is a well-known hazard of anesthesia for various kinds of surgery. A 47-year-old male who had an increased CTG repeat of approximately 700 copies in the 3'-untranslated region of the myotonic dystrophy protein kinase gene underwent closure of an atrial septal defect under normothermic beating heart. A strong correlation between reduced left ventricular ejection fraction and stroke volume, and the number of CTG repeats, has been reported. Because this correlation is not completely understood, even if the preoperative cardiac function is normal, it is important to check the number of CTG repeats and the patients who have a large number of them should be carefully treated.
• Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery.

  Toshio Kaneda; Toshihiko Saga; Masahiko Onoe; Hitoshi Kitayama; Susumu Nakamoto; Terufumi Matsumoto; Takehiro Inoue; Masato Imura; Tatsuya Ogawa; Takako Nishino; Kousuke Fujii

  Scandinavian cardiovascular journal : SCJ 39 1-2 87 - 90 2005年04月 

  OBJECTIVE: Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24-28 degrees C) or deep hypothermia (18-24 degrees C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28-32 degrees C). DESIGN: Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP. RESULTS: Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay. CONCLUSIONS: Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.
• Acromegaly with multiple cardiovascular complications--cardiomyopathy, chordae rupture of mitral valve, myocardial infarction and sick sinus syndrome.

  Tadahiko Yamamoto; Hajime Nakamura; Tatsuya Ogawa; Toshihiko Saga; Kinji Ishikawa

  Internal medicine (Tokyo, Japan) 42 8 700 - 3 2003年08月 

  A 62-year-old woman had acromegaly and developed congestive heart failure with cardiomyopathy, mitral regurgitation due to chordae rupture, coronary artery disease and sick sinus syndrome. Since congestive heart failure was resistant to medical therapy, mitral valve replacement, aortocoronary bypass surgery and implantation of permanent pacemaker were performed one month after her admission. Although acromegalic patients with cardiomyopathy are usually resistant to therapy, we successfully treated the patient by the surgeries. It appears that all these diseases resulted from an elevated plasma concentration of growth hormone. Untreated acromegaly for more than ten years may contribute to multiple complications such as those in the present patient.
• Pretreatment of donors with endothelin receptor antagonist TAK-044 improves cardiac functional recovery following preservation with University of Wisconsin solution.

  Toshio Kaneda; Zhi-Wei Zhang; Tatsuya Ogawa; Masaki Otaki; Toshihiko Saga

  Scandinavian cardiovascular journal : SCJ 36 2 105 - 7 2002年03月 

  OBJECTIVE: Previous studies suggest that endothelin-1 (ET-1) plays a role in myocardial ischemia/reperfusion injury. Although administration of an endothelin receptor antagonist to the recipient has been shown to improve myocardial function after ischemia/reperfusion in a rat heart transplantation model, the effect of administering an endothelin receptor antagonist to the donor has not yet been examined. This study was designed to investigate the effects of pretreating donors with an ET(A)/ET(B) endothelin receptor antagonist (TAK-044) on myocardial function after cold preservation of a rat heart. DESIGN: Male rats were pretreated with normal saline (control group, n = 8), TAK-044 (TAK group, n = 8, 1 mg/kg). Following cardiac arrest using cardioplegia, we washed out the coronary vascular beds with cold University of Wisconsin solution followed by 6-h preservation. After preservation, the hearts were mounted on a Langendorff apparatus to estimate aortic flow (AF), coronary flow (CF), cardiac output (CO), systolic pressure (SP), heart rate (HR), and rate-pressure product (RPP: HR x SP). The concentration of lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) within the coronary perfusate during reperfusion was measured. RESULTS: AF, SP, and CO were significantly greater in the TAK group than in the control group (p = 0.0045, 0.004, and 0.0295, respectively). CONCLUSION: Pretreatment of donors with a nonselective endothelin receptor antagonist (TAK-044) improved cardiac functional recovery following preservation and may be beneficial for prolonged myocardial preservation.

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