Paper

• Less Aortic Neck Dilatation of the ALTO Stent Graft compared to the Self-Expanding Stent Grafts after Endovascular Aortic Repair for Abdominal Aortic Aneurysms.

  Shigeo Ichihashi; Mitsuyoshi Takahara; Naoki Fujimura; Terutoshi Yamaoka; Hiroshi Banno; Masami Shingaki; Kazuo Shimamura; Fumiaki Kimura; Yoshihiko Kurimoto; Ken Nakazawa; Kiyomitsu Yasuhara; Naoki Toya; Yutaka Kobayashi; Yoshiaki Saito; Tsuyoshi Shibata; Kenjiro Kaneko; Shinsuke Kotani; Yamato Tamura; Seiji Onitsuka; Francesco Bolstad; Shinichi Iwakoshi; Shoji Sakaguchi; Toshihiro Tanaka; Kimihiko Kichikawa

  Cardiovascular and interventional radiology 48 (4) 438 - 446 2025/04 

  PURPOSE: Proximal neck dilatation (PND) is a common issue after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs), being a potential cause of stent graft migration or type Ia endoleak. The ALTO stent graft, featuring a unique polymer sealing mechanism, has been reported to exhibit less PND. This study aims to compare PND and clinical outcomes between the ALTO stent graft and alternative self-expanding stent grafts. METHODS: The CustomSEAL study is a multi-center retrospective observational study involving 18 institutions in Japan. It compares EVAR outcomes using the ALTO stent graft and alternative self-expanding stent grafts for fusiform AAAs. The primary outcome measure was the difference in PND at 12 months post-EVAR. Secondary outcome measures included aneurysm sac diameter changes, reintervention rates, and mortality outcomes during the follow-up. RESULTS: After propensity score matching, 111 patient pairs were extracted. Baseline characteristics, including proximal neck length/diameter and stent graft oversizing, were comparable between groups. The ALTO stent graft was associated with significantly less PND at 12 months (2.3% vs. 26.7%, P < 0.001). There were no significant differences in perioperative outcomes, aneurysm sac diameter changes, reintervention rates, or overall survival between the groups. CONCLUSIONS: The ALTO stent graft demonstrated significantly less PND at 12 months post-EVAR compared to alternative self-expanding stent grafts, highlighting its potential advantage in exerting less chronic expanding force on the proximal aortic neck. Long-term follow-up is needed to validate the clinical benefits of the ALTO stent graft over the alternative self-expanding stent grafts. LEVEL OF EVIDENCE: Non-randomized controlled cohort/follow-up study.
• Validation of the German registry of acute aortic dissection type A score for predicting 30-day mortality after acute type A aortic dissection surgery in a single Japanese aortic centre.

  Shinsuke Kotani; Genichi Sakaguchi

  Interdisciplinary cardiovascular and thoracic surgery 40 (3) 2025/03 

  OBJECTIVES: This study evaluated the applicability of the German Registry of Acute Aortic Dissection Type A (GERAADA) score in predicting 30-day mortality in Japanese patients undergoing surgery for acute type A aortic dissection (ATAAD) and compared its predictive performance with that of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II). METHODS: This single-centre retrospective study involved 154 patients who underwent emergency surgery for ATAAD between January 2019 and April 2024. The GERAADA and EuroSCORE II were calculated for each patient. Predictive accuracy for 30-day mortality was assessed using the area under the receiver operating characteristic curve (AUC). A multivariate logistic regression identified independent predictors of mortality, and long-term outcomes were evaluated using Kaplan-Meier analysis. RESULTS: The 30-day mortality rate was 11.0%. The GERAADA score showed an AUC of 0.80, indicating good discriminatory ability, while the EuroSCORE II demonstrated moderate performance with an AUC of 0.67 (P = 0.07). The GERAADA score significantly overestimated mortality in this cohort, whereas the EuroSCORE II underestimated it. Independent predictors of mortality included the use of catecholamines at referral. Kaplan-Meier analysis revealed a 1-year survival rate of 79.4% with an AUC of 0.72, demonstrating the GERAADA score's utility as a predictor of long-term survival. CONCLUSIONS: The GERAADA score provides accurate predictions of 30-day mortality in Japanese patients undergoing ATAAD surgery, comparable to the EuroSCORE II. This score demonstrates robust predictive ability for short- and long-term outcomes and may serve as a practical tool for risk stratification in ATAAD surgery.
• 【動脈・静脈の疾患2024(上)-最新の診断・治療動向-】動脈・静脈疾患(四肢,体幹)大動脈解離 大動脈解離の治療

  小谷 真介; 坂口 元一

  日本臨床 (株)日本臨床社 82 (増刊4 動脈・静脈の疾患2024(上)) 235 - 242 0047-1852 2024/06
• Surgical Removal of A Broken Intravascular Ultrasonography Catheter for PCI Followed by Off-Pump Coronary Artery Bypass

  Ryusuke Hamada; Kazuma Okamoto; Rie Shimizu; Naoya Miyashita; Shintaro Yukami; Shinsuke Kotani; Tatsuya Ogawa; Genichi Sakaguchi; Kosuke Fujii; Masahiko Onoe

  Journal of Coronary Artery Disease The Japanese Coronary Association 30 (1) 44 - 46 2024
• 低リスクスコアAS患者に対するTAVRの患者背景とアウトカム

  重冨 杏子; 伊藤 丈二; 小谷 真介; 田端 実

  日本心臓血管外科学会雑誌 (NPO)日本心臓血管外科学会 51 (6) 334 - 338 0285-1474 2022/11
• Left atrial appendage rupture: A rare complication of right-sided haemothorax: A case report.

  Akihiko Sugaya; Hiraku Funakoshi; Michiko Mizobe; Ryota Hara; Shinsuke Kotani; Tadao Kubota

  Trauma case reports 40 100667 - 100667 2022/08 

  Cardiac injury accounts for less than 10 % of all traumas and it is a fatal condition associated with cardiac tamponade or massive haemothorax, which requires immediate intervention, such as resuscitative thoracotomy. However, in case of haemothorax without the findings suggestive of cardiac damage such as pericardial effusion, it is difficult to determine the complications of cardiac injury, because injury of the lung or intercostal arteries is usually considered first. We describe a rare case of left atrial appendage rupture with a right-sided massive haemothorax with slight cardiac effusion. A 47-year-old man with no significant medical history was transferred to our emergency department after crashing his motorcycle into a car. A right resuscitative thoracotomy for massive haemothorax was performed, followed by hilarious clamping and pericardial drainage. We found continuous bleeding from a right dorsal pericardial injury which indicated cardiac injury. Soon after the patient was referred to the operating room, left atrial appendage rupture was found, and ligated. The postoperative course was uneventful, and he was discharged on 15th postoperative day without complication. Left atrial appendage rupture is caused by a direct external force to the left atrium, so the pericardial injury is usually ipsilateral to the left side of the pericardium, resulting in perforation of the left thoracic cavity. Therefore, left atrial appendage rupture with a right-sided massive haemothorax is rare. In addition, when a cardiac injury is associated with a pericardial injury, most of the pericardial effusion drains into the thoracic cavity, resulting in a small amount of pericardial effusion, which make it difficult to recognize the cardiac injury. In conclusion, in blunt trauma, even in the case of a right-sided haemothorax, the possibility of cardiac injury in addition to pulmonary contusion should be considered and explored, because cardiac injury could be fatal.
• Transapical cannulation for surgical repair of chronic type B aortic dissection

  Shinsuke Kotani; Minoru Tabata

  Journal of Cardiac Surgery Wiley 37 (4) 1107 - 1109 0886-0440 2022/04
• 成人大動脈縮窄症に対し胸部ステントグラフト内挿術を施行した一例

  原 亮太; 小谷 真介

  日本血管外科学会雑誌 (NPO)日本血管外科学会 31 (5) 273 - 277 0918-6778 2022
• 急性心筋梗塞後に急速に形成したcalcified amorphous tumorの1例

  Kim Andrew T.; 小谷 真介; 呉 祐介; 坂本 祥吾; 田村 謙次; 西平 守和; 井口 朋和; 片岡 亨; 村上 忠弘; 石川 巧; 南村 弘佳

  心臓 (公財)日本心臓財団 50 (3) 305 - 310 0586-4488 2018/03
• Aortic valve aneurysm associated with infective endocarditis: case report and review of literature.

  Hirokazu Minamimura; Takumi Ishikawa; Tadahiro Murakami; Shinsuke Kotani

  General thoracic and cardiovascular surgery 65 (7) 408 - 414 2017/07 

  Although there are several mitral valve aneurysm reports, studies on aortic valve aneurysm are extremely rare. This paper describes an uncommon case of a large saccular aortic valve aneurysm associated with infective endocarditis. A 37-year-old man was hospitalized in our hospital with fever and dyspnea. Echocardiography found severe aortic regurgitation and aortic valve aneurysm of the non-coronary cusp going in and out of the left ventricular chamber. Blood cultures grew Streptococcus viridance. Therefore, the patient underwent aortic valve replacement. During the operation, we observed a 30 × 20 mm ruptured aneurysm that arose from the non-coronary cusp. The aortic valve containing the aneurysm was resected and replaced with a mechanical heart valve. Histopathological examination of the aortic valve aneurysm showed active inflammatory changes. Infective endocarditis was considered to be the cause of this aortic valve aneurysm.
• リウマチ性連合弁膜症にFreestyleステントレス弁のleaflet tearによる大動脈弁閉鎖不全症を合併した1手術例

  南村 弘佳; 小谷 真介; 村上 忠弘; 石川 巧

  日本心臓血管外科学会雑誌 (NPO)日本心臓血管外科学会 46 (2) 70 - 75 0285-1474 2017/03
• 遠位弓部大動脈瘤に合併したStanford B型急性大動脈解離に対しステントグラフト内挿術を施行した1例

  小谷 真介; 南村 弘佳; 石川 巧; 村上 忠弘

  日本血管外科学会雑誌 (NPO)日本血管外科学会 25 27 - 31 0918-6778 2016/12
• S字状中隔を有する連合弁膜症の僧帽弁置換術後に左室流出路閉塞を伴うたこつぼ心筋障害を発症した1例

  南村 弘佳; 小谷 真介; 村上 忠弘; 石川 巧

  日本心臓血管外科学会雑誌 (NPO)日本心臓血管外科学会 45 (4) 180 - 186 0285-1474 2016/07
• 鍼治療に起因した感染性遺残坐骨動脈瘤の一手術例

  南村 弘佳; 小谷 真介; 村上 忠弘; 石川 巧

  日本血管外科学会雑誌 (NPO)日本血管外科学会 24 (7) 953 - 957 0918-6778 2015/12
• 遺残坐骨動脈を合併したLeriche症候群に対する1手術例

  小谷 真介; 南村 弘佳; 石川 巧; 村上 忠弘; 生田 剛士; 清水 幸宏

  日本血管外科学会雑誌 (NPO)日本血管外科学会 24 (5) 857 - 860 0918-6778 2015/08
• A Case of Disseminated Intravascular Coagulation after Thoracic Endovascular Aortic Repair.

  Shinsuke Kotani

  Annals of vascular diseases 8 (4) 334 - 6 2015 

  I report a hemorrhagic complication due to disseminated intravascular coagulation after thoracic endovascular aortic repair for a dissecting aortic aneurysm. A 74-year-old man underwent thoracic endovascular aortic repair and carotid-carotid artery bypass to close the primary entry site of the dissecting aortic aneurysm. Postoperatively, he developed a gradually expanding cervical hematoma. Laboratory data showed disseminated intravascular coagulation. He could not extubated until postoperative day 6 because of the risk of airway obstruction. He was treated with transfusion to replenish the coagulation factor. Disseminated intravascular coagulation may occur secondary to thrombus formation in the false lumen after thoracic endovascular aortic repair.
• Optimal results of aortic valve replacement with small mechanical valves (< 19 mm).

  Yasuyuki Kato; Koji Hattori; Manabu Motoki; Yosuke Takahashi; Shinsuke Kotani; Shinsuke Nishimura; Toshihiko Shibata

  The Journal of heart valve disease 22 (4) 468 - 75 0966-8519 2013/07 

  BACKGROUND AND AIM OF THE STUDY: Controversy exists regarding the optimal operative method or type of prosthesis for patients with a small aortic root. The aim of this retrospective study was to investigate the early and mid-term outcomes of standard aortic valve replacement (AVR) using 16 mm or 18 mm ATS Advanced Performance (AP) or 17 mm St. Jude Medical (SJM) Regent valves for a small aortic root. METHODS: Between April 2003 and August 2009, 78 patients (age range: 50-86 years; 86% aged > or = 65 years) underwent AVR with 16 mm or 18 mm ATS AP valves (16AP group: n = 21, 18AP group: n = 32), or a 17 mm SJM Regent valve (17Regent group: n = 25). Fifty-six patients (72%) had a body surface area (BSA) of < 1.5 m2; the BSA in the 16AP group was significantly smaller than in the other two groups. The early and mid-term outcomes, and the hemodynamic performance of the prostheses, were evaluated and compared among the groups. RESULTS: No operative deaths were observed in the 16AP and 17Regent groups, but one hospital death occurred in the 18AP group. During follow up, there were four cardiac-related deaths (two patients each in the 16AP and 18AP groups). Although the postoperative pressure gradient of the 16AP group was significantly higher than that of the 18AP group, the left ventricular mass in all groups was decreased significantly during follow up, but the extent of left ventricular mass regression was similar among the groups (-30%, -25% and -28% in the 16AP, 17Regent and 18AP groups, respectively; p = 0.844). CONCLUSION: The early and mid-term results of AVR with 16 mm or 18 mm ATS AP valves, or with a 17 mm SJM Regent valve, were satisfactory. Therefore, standard AVR using these small mechanical prostheses, which avoids the need to enlarge the annulus or to conduct stentless bioprosthesis implantation, might represent an acceptable method, especially in elderly patients with a small aortic root.
• Endovascular repair of ruptured aberrant left subclavian artery with right aortic arch.

  Manabu Motoki; Koji Hattori; Yasuyuki Kato; Yosuke Takahashi; Shinsuke Kotani; Shinsuke Nishimura; Toshihiko Shibata

  The Annals of thoracic surgery 95 (2) 699 - 701 2013/02 

  Association of a right-sided aortic arch with an aberrant left subclavian artery is rare. We present a case of successful endovascular repair of a ruptured Kommerell diverticulum associated with a right-sided aortic arch and aberrant left subclavian artery. We treated a 47-year-old woman with a diagnosis of ruptured aberrant left subclavian artery with thoracic endovascular stent-grafts. The descending aorta above Kommerell diverticulum was a reverse-tapered configuration. We managed the rather hostile neck with an extra-large Palmaz stent. A left carotid-to-subclavian bypass with an 8-mm Dacron graft was also performed to restore left arm perfusion and prevent vertebrobasilar insufficiency.
• Double closure repair of mitral paravalvular leak by way of right thoracotomy.

  Shinsuke Kotani; Koji Hattori; Yasuyuki Kato; Toshihiko Shibata

  The Journal of thoracic and cardiovascular surgery 143 (6) 1452 - 3 2012/06
• Hemolytic anemia secondary to mitral leaflet prolapse.

  Yasuyuki Bito; Toshihiko Shibata; Koji Hattori; Yasuyuki Kato; Shinsuke Kotani; Daisuke Kaku

  Journal of cardiac surgery 26 (3) 297 - 8 2011/05
• Simple supra-annular prosthesis insertion for dialysis patients with extensive mitral annular calcification.

  Yasuyuki Kato; Koji Hattori; Yasuyuki Bito; Shinsuke Kotani; Kazushige Inoue; Toshihiko Shibata

  The Journal of heart valve disease 20 (2) 180 - 3 0966-8519 2011/03 

  BACKGROUND AND AIM OF THE STUDY: Mitral annular calcification (MAC) occurs mainly at the posterior half of the annulus, and is often seen in dialysis-dependent patients who have a high risk for cardiac surgery. A simple supra-annular prosthesis insertion ('half-and-half') technique was applied to five dialysis patients with extensive MAC to prevent catastrophic complications. METHODS: Five dialysis patients with extensive MAC underwent mitral valve replacement (MVR) using the 'half-and-half' technique. In all patients, everted mattress sutures were anchored to the left atrial wall just around the posterior half of the calcified annulus with minimum debridement, while horizontal mattress sutures were placed from the left ventricular side to the left atrial side on the non-calcified anterior half of the annulus. In one patient with an entirely calcified annulus who underwent double valve replacement, the anterior MAC was removed through the aorta to enable mitral valve sutures to be placed on the annulus. St. Jude Medical (SJM) valves were secured in the supra-annular position in all patients. RESULTS: No valve dysfunction was observed in any patient. Among the four hospital survivors, there were no valve-related events, except for a trivial paravalvular leak in one patient, during follow up periods ranging from 11 to 33 months. CONCLUSION: This simple supra-annular prosthesis insertion technique was safely and easily performed with minimum debridement of the calcified annulus in five dialysis patients. The technique may represent an alternative approach for high-risk patients with extensive MAC. The SJM valve, with its hinge protruding into the atrial side, is suitable for use in this technique.
• 高度大動脈石灰化を伴う大動脈弁狭窄症に対しapico-aortic bypassを施行した1例

  瀬尾 浩之; 服部 浩治; 加藤 泰之; 元木 学; 小谷 真介; 柴田 利彦

  心臓 (公財)日本心臓財団 42 (10) 1335 - 1339 0586-4488 2010/10
• Images in cardiovascular medicine. Apico-biaxillary bypass for an aortic stenosis patient with severe calcification of the entire aorta.

  Koji Hattori; Toshihiko Shibata; Yasuyuki Kato; Yasuyuki Bito; Shinsuke Kotani; Daisuke Kaku

  Circulation 121 (24) e447-9  2010/06
• Closed cardiopulmonary bypass circuits suppress thrombin generation during coronary artery bypass grafting.

  Atsushi Nakahira; Yasuyuki Sasaki; Hidekazu Hirai; Toshihiro Fukui; Mitsunori Matsuo; Yosuke Takahashi; Shinsuke Kotani; Shigefumi Suehiro

  Interactive cardiovascular and thoracic surgery 10 (4) 555 - 60 2010/04 

  Thrombin generation is considered unavoidable during cardiac surgery using cardiopulmonary bypass (CPB). We compared the effects of open and closed circuits on coagulation and fibrinolysis under identical conditions of priming volume, heparin-coating, and anticoagulation and transfusion protocols. Thirty coronary surgery patients were randomized to surgery using open circuits with open reservoirs and cardiotomy suction (open group, n=15) or closed circuits without either (closed group, n=15). In the closed group, a cell-saving device was used instead of cardiotomy suction. Blood samples were collected at eight time points from before the operation to the first postoperative morning. Thrombin-antithrombin III (TAT), fibrinogen degradation products, and D-dimer were not elevated during CPB in the closed group, but were significantly increased in the open group (P<0.0001 for all markers). The peak TAT value at the termination of CPB in the open group was significantly correlated with CPB time (r(2)=0.879, P=0.037) and the simultaneous peak D-dimer value (r(2)=0.640, P=0.040). In conclusion, the use of closed circuits maximally suppressed thrombin generation and coagulofibrinolytic activation during coronary artery bypass grafting. The respective contribution of open reservoirs and cardiotomy suction to the perioperative thrombin generation remains to be elucidated.
• Thrombus in the distal aortic arch after apicoaortic conduit for severe aortic stenosis.

  Shinsuke Kotani; Koji Hattori; Yasuyuki Kato; Toshihiko Shibata

  Interactive cardiovascular and thoracic surgery 10 (3) 486 - 8 2010/03 

  We report an uncommon case of thrombogenesis in the distal aortic arch after apicoaortic conduit (AAC) for severe aortic stenosis (AS). A 71-year-old woman underwent AAC with a bioprosthetic valve for severe AS because of heavy calcification of the ascending aorta. Although anticoagulant therapy with warfarin was performed, a postoperative computed tomographic (CT) scan revealed a thrombus in the distal aortic arch. Cine magnetic resonance imaging (MRI) revealed stagnation of the blood flow at that site. Administration of warfarin was continued. A follow-up CT-scan showed a marked reduction of the thrombus at six months after the surgery. A follow-up MRI revealed that the antegrade flow through the native aortic valve was decreased at one year after the surgery. We suggest that thrombogenesis may occur after AAC because of stagnation of the blood flow and that the distribution of the blood flow may change during the follow-up period. Therefore, we recommend that postoperative anticoagulant therapy should be initiated immediately, even when a bioprosthetic valve is used.
• 臨床病理カンファレンス 心臓弁膜症

  佐々木 康之; 白井 伸幸; 伊倉 義弘; 竹本 恭彦; 麻植 浩樹; 小谷 真介; 大塚 亮; 芳谷 英俊; 江原 省一; 服部 浩治; 福田 祥大; 末廣 茂文; 上田 真喜子

  綜合臨床 (株)永井書店 59 (2) 320 - 329 0371-1900 2010/02