研究者詳細 - 小谷　恭弘

論文 - 小谷　恭弘

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Management Strategies for Truncus Arteriosus: A Comparative Analysis of Staged vs. Primary Repair

Yasuyuki Kobayashi, Shunji Sano, Yuto Narumiya, Ayari Kimura, Etsuji Suzuki, Shingo Kasahara, Yasuhiro Kotani

Pediatric Cardiology 2025年1月

掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

We reviewed the outcomes of truncus arteriosus repair (primary vs. staged repair incorporating bilateral pulmonary artery banding), focusing on survival, reintervention, and functional data. We analyzed 39 patients who underwent a first intervention for truncus arteriosus (staged, n = 19; primary, n = 20) between 1992 and 2022. The median follow-up period was 8.0 (2.2–13.2) years. Survival, freedom from reoperation, and freedom from catheter intervention were estimated using the Kaplan–Meier method. High-risk patients were defined as those with a weight ≤ 2.5 kg, ≥ moderate truncal valve regurgitation, interrupted aortic arch, or preoperative shock. In the staged group, patients with a median weight of 2.6 kg had a median intensive care unit stay of 5 days and no hospital mortality after bilateral pulmonary artery banding. At repair, the staged group had a larger conduit for the right ventricular outflow tract (14 vs. 12 mm; P = .008). Catheter intervention on the branch pulmonary artery was required in 67% of patients in the staged group, but right ventricular end-diastolic pressure at follow-up was comparable between the groups (P = .541). Survival rates were higher among high-risk patients in the staged group (87.5% vs. 21.4% at 15 years; P = .004) but were comparable between groups for standard-risk patients (P = 1.000). Bilateral pulmonary artery banding was a safe, effective procedure. Reintervention for branch pulmonary artery was common but did not affect functional outcomes. Staged repair may play a pivotal role regarding survival in high-risk patients, and risk stratification is vital.

DOI： 10.1007/s00246-025-03790-z

その他リンク： https://link.springer.com/article/10.1007/s00246-025-03790-z/fulltext.html

Evaluation of the effects of fenestration in Fontan circulation using a lumped parameter model

Naohiro Horio, Shuji Shimizu, Yasuhiro Kotani, Yoshinori Miyahara, Shingo Kasahara

The Journal of Physiological Sciences 74 ( 1 ) 2024年12月

掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

Fenestration has been reported to enhance Fontan hemodynamics in several cases of Fontan circulation. However, the indication criteria for fenestration remain under discussion. To assess the effectiveness of fenestration in Fontan circulation, we conducted a theoretical analysis using a computational model of the fenestrated Fontan circulation. The cardiac chambers and vascular systems were modeled using the time-varying elastance model and the modified Windkessel model, respectively. When the pulmonary vascular resistance index was 4.01 Wood units m², fenestration significantly reduced central venous pressure from 18.0 to 16.1 mmHg and decreased stressed blood volume from 610 to 555 ml. However, in the models with reduced ventricular end-systolic elastance, increased ventricular stiffness constant, or heightened systemic vascular resistance, the advantages of fenestration were diminished. Thus, fenestration may effectively improve the hemodynamics of Fontan circulation in patients with elevated pulmonary vascular resistance.

DOI： 10.1186/s12576-024-00947-y

その他リンク： https://link.springer.com/article/10.1186/s12576-024-00947-y/fulltext.html

Evaluation of the Efficacy and Accuracy of Super-Flexible Three-Dimensional Heart Models of Congenital Heart Disease Made via Stereolithography Printing and Vacuum Casting: A Multicenter Clinical Trial 査読

Isao Shiraishi, Masaaki Yamagishi, Takaya Hoashi, Yoshiaki Kato, Shigemitsu Iwai, Hajime Ichikawa, Tatsuya Nishii, Hiroyuki Yamagishi, Satoshi Yasukochi, Masaaki Kawada, Takaaki Suzuki, Takeshi Shinkawa, Naoki Yoshimura, Ryo Inuzuka, Yasutaka Hirata, Keiichi Hirose, Akio Ikai, Kisaburo Sakamoto, Yasuhiro Kotani, Shingo Kasahara, Toshiaki Hisada, Kenichi Kurosaki

Journal of Cardiovascular Development and Disease 11 ( 12 ) 387 - 387 2024年12月

掲載種別：研究論文（学術雑誌）出版者・発行元：MDPI AG

Three-dimensional (3D) printing is an advanced technology for accurately understanding anatomy and supporting the successful surgical management of complex congenital heart disease (CHD). We aimed to evaluate whether our super-flexible 3D heart models could facilitate preoperative decision-making and surgical simulation for complex CHD. The super-flexible heart models were fabricated by stereolithography 3D printing of the internal and external contours of the heart from cardiac computed tomography (CT) data, followed by vacuum casting with a polyurethane material similar in elasticity to a child’s heart. Nineteen pediatric patients with complex CHD were enrolled (median age, 10 months). The primary endpoint was defined as the percentage of patients rated as “essential” on the surgeons’ postoperative 5-point Likert scale. The accuracy of the models was validated by a non-destructive method using industrial CT. The super-flexible heart models allowed detailed anatomical diagnosis and simulated surgery with incisions and sutures. Thirteen patients (68.4%) were classified as “essential” by the primary surgeons after surgery, with a 95% confidence interval of 43.4–87.4%, meeting the primary endpoint. The product error within 90% of the total external and internal surfaces was 0.54 ± 0.21 mm. The super-flexible 3D heart models are accurate, reliable, and useful tools to assist surgeons in decision-making and allow for preoperative simulation in CHD.

DOI： 10.3390/jcdd11120387

Effects of systemic ventricular assist in failing Fontan patients: a theoretical analysis using a computational model.

Eiri Kisamori, Yasuhiro Kotani, Toshiaki Shishido, Shingo Kasahara, Shuji Shimizu

The journal of physiological sciences : JPS 74 ( 1 ) 53 - 53 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Mechanical circulatory support is a potential treatment for failing Fontan patients. In this study, we performed a theoretical analysis using a computational model to clarify the effects of systemic ventricular assist device (VAD) in failing Fontan patients. Cardiac chambers and vascular systems were described using the time-varying elastance model and modified Windkessel model, respectively. A VAD was simulated as a nonlinear function. In systolic and diastolic ventricular dysfunction and atrioventricular valve regurgitation models, systemic VAD increased the cardiac index and decreased the central venous pressure (CVP). However, in the high pulmonary vascular resistance model, CVP became extremely high above 15 mmHg to maintain the cardiac index when the pulmonary vascular resistance index (PVRI) was above 5 Wood units m2. In Fontan patients with ventricular dysfunction or atrioventricular valve regurgitation, systemic VAD efficiently improves the hemodynamics. In Fontan patients with PVRI of > 5 Wood units m2, systemic VAD seems ineffective.

DOI： 10.1186/s12576-024-00946-z

Expression of c-jun/c-fos mRNA Indicates Persistent Myocardial Stretch During Asphyxia-Induced Cardiac Arrest

Yutaka Yokota, Sachiko Kadowaki, Satoru Yamazaki, Yuya Nishida, Toshiaki Shishido, Shuji Shimizu, Shingo Kasahara, Yasuhiro Kotani

International Heart Journal 65 ( 5 ) 939 - 944 2024年9月

Effects of dapagliflozin on myoglobin efflux from cardiomyocyte during myocardial ischemia/reperfusion in anesthetized rats. 査読国際誌

Tomohiro Hayashida, Yosuke Kuroko, Shuji Shimizu, Tsuyoshi Akiyama, Takanori Suezawa, Yukio Kioka, Yasuhiro Kotani, Toshiaki Shishido, Shingo Kasahara

Scientific reports 14 ( 1 ) 16337 - 16337 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

It has been suggested that sodium-glucose cotransporter 2 (SGLT2) inhibitors have cardioprotective effects during myocardial ischemia/reperfusion (I/R) independent of glucose-lowering action. However, the effects of SGLT2 inhibitors on structural damage to cardiomyocytes in the ischemic region during I/R remain unknown. We applied a microdialysis technique to the heart of anesthetized rats and investigated the effects of an SGLT2 inhibitor, dapagliflozin, on myocardial interstitial myoglobin levels in the ischemic region during coronary occlusion followed by reperfusion. Dapagliflozin was administered systemically (40 μg/body iv) or locally via a dialysis probe (100 μM and 1 mM) 30 min before coronary occlusion. In the vehicle group, coronary occlusion increased the dialysate myoglobin concentration in the ischemic region. Reperfusion further increased the dialysate myoglobin concentration. Intravenous administration of dapagliflozin reduced dialysate myoglobin concentration during ischemia and at 0-15 min after reperfusion, but local administration (100 μM and 1 mM) did not. Therefore, acute systemic administration of dapagliflozin prior to ischemia has cardioprotective effects on structural damage during I/R.

DOI： 10.1038/s41598-024-67195-3

Long-term outcome and cardiac function after anatomic repair of congenitally corrected transposition. 査読国際誌

Fumi Yokohama, Norihisa Toh, Yasuhiro Kotani, Yoichi Takaya, Yosuke Kuroko, Kenji Baba, Teiji Akagi, Shingo Kasahara, Hiroshi Ito

Interdisciplinary cardiovascular and thoracic surgery 38 ( 3 ) 2024年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: There is limited information on long-term outcomes and trajectories of ventricular and valvular functions in patients with congenitally corrected transposition of the great arteries after anatomic repair according to the operative strategy with a median follow-up period of more than 10 years. METHODS: Twenty-nine patients who underwent anatomic repair in Okayama University Hospital between January 1994 and December 2020 were reviewed. Outcomes were compared between patients who underwent a double switch operation (DS group) and patients with an atrial switch with a Rastelli operation (Rastelli-Senning/Mustard group). RESULTS: Fifteen (52%) were in the DS group and 14 (48%) were in the Rastelli-Senning/Mustard group. The median follow-up period after anatomic repair was 12.7 (interquartile range 4.2-18.8) years. There were 3 (10%) early deaths and 3 (10%) late deaths. Survival rates for the entire cohort at 10 and 20 years were 86% and 71%, respectively, and were not different between the 2 groups. Using competing risk analysis, risks of heart failure, cardiac rhythm device implantation and atrial arrhythmia showed no significant differences between the 2 groups, whereas risk of reoperation was higher in the Rastelli-Senning/Mustard group than that in the DS group. Four patients after a DS operation and 1 patient after a Rastelli technique developed more than moderate aortic regurgitation. CONCLUSIONS: During a median follow-up period of more than 10 years, mortality rate and ventricular and valvular functions after anatomic repair were acceptable, though the incidences of late complications were relatively high, especially in the Rastelli-Senning/Mustard group.

DOI： 10.1093/icvts/ivae033

Staged repair for complete atrioventricular septal defect in patients weighing less than 4.0 kg 査読

Yasuyuki Kobayashi, Shingo Kasahara, Shunji Sano, Hiroyuki Suzuki, Etsuji Suzuki, Takashi Yorifuji, Yasuhiro Kotani

The Journal of Thoracic and Cardiovascular Surgery 167 ( 3 ) 1136 - 1144 2024年3月

成人期における修正大血管転位症患者の臨床像

小谷恭弘, 杜徳尚, 黒子洋介, 小林純子, 川畑拓也, 馬場健児, 赤木禎治, 笠原真悟

日本成人先天性心疾患学会雑誌 13 ( 1 ) 120 - 120 2024年1月

TOF術後遠隔期に大動脈基部拡大および大動脈弁逆流のためCabrol法にてBentall手術を行った1例

黒子洋介, 小林純子, 小谷恭弘, 笠原真悟

日本成人先天性心疾患学会雑誌 13 ( 1 ) 118 - 118 2024年1月

Minimally Invasive Surgical Repair of Simple Congenital Heart Defects Using the Right Vertical Infra-Axillary Thoracotomy Approach. 国際誌

Dien Minh Tran, Vinh Quang Tran, Mai Tuan Nguyen, Duyen Dinh Mai, Anh Vuong Doan, Son Thanh Hoang, Yasuhiro Kotani, Truong Ly-Thinh Nguyen

Innovations (Philadelphia, Pa.) 19 ( 5 ) 520 - 525 2024年

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To evaluate the safety and efficacy of surgical repair for patients diagnosed with simple congenital heart defects (CHD) using the minimally invasive right vertical infra-axillary minithoracotomy (RVIAT) approach. METHODS: We retrospectively reviewed the clinical data of consecutive patients who underwent minimally invasive RVIAT for repair of CHD between August 2019 and August 2022. There were 382 patients who underwent 8 primary procedures and were included in this study. RESULTS: The median age of the patients was 16.2 (interquartile range [IQR], 7.2 to 41.9) months, and the median weight of the patients was 8.8 (IQR, 6.5 to 14) kg. The preoperative diagnoses were as follows: ventricular septal defect, atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, cor triatriatum, complete atrioventricular septal defect, and myxoma. The mean aortic cross-clamp time, bypass time, and operation time were 45.4 ± 19.3 min, 65.6 ± 23.1 min, and 154.5 ± 29.7 min, respectively. There was no in-hospital mortality or conversion to median sternotomy. Two patients (0.5%) required early reoperation; 1 due to postoperative bleeding and 1 for permanent pacemaker implantation. Other complications included trivial residual shunts (23 of 382, 6%), pleural effusion (3 of 382, 0.8%), pneumothorax (0.8%), and wound infection (4 of 382, 1%). There were 2 late noncardiac deaths. Late reoperation was performed on 1 patient with progressive aortic valve regurgitation who required aortic valvuloplasty. CONCLUSIONS: RVIAT is a minimally invasive approach that can be safely performed on patients with simple CHDs. RVIAT may be a good alternative approach for median sternotomy and cardiac intervention.

DOI： 10.1177/15569845241273650

Video-assisted transarterial modified Konno procedure with concurrent myectomy for hypertrophic obstructive cardiomyopathy 査読

Hiroyuki Suzuki, Yasuhiro Kotani, Shunji Sano, Shingo Kasahara

JTCVS ( 22 ) 261 - 264 2023年12月

Detection of hepatocellular carcinoma during Fontan-associated liver disease follow-up: a report of three cases

Hideki Onishi, Norihisa Toh, Teiji Akagi, Kenji Baba, Yasuhiro Kotani, Akinobu Takaki, Shingo Kasahara, Hiroshi Ito

Clinical Journal of Gastroenterology 17 ( 1 ) 148 - 154 2023年11月

Intravenous infusion of cardiac progenitor cells in animal models of single ventricular physiology. 査読国際誌

Takuya Goto, Daiki Ousaka, Kenta Hirai, Yasuhiro Kotani, Shingo Kasahara

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 64 ( 4 ) 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: The goal of this study was to identify the practical applications of intravenous cell therapy for single-ventricle physiology (SVP) by establishing experimental SVP models. METHODS: An SVP with a three-stage palliation was constructed in an acute swine model without cardiopulmonary bypass. A modified Blalock-Taussig (MBT) shunt was created using an aortopulmonary shunt with the superior and inferior venae cavae (SVC and IVC, respectively) connected to the left atrium (n = 10). A bidirectional cavopulmonary shunt (BCPS) was constructed using a graft between the IVC and the left atrium with an SVC cavopulmonary connection (n = 10). The SVC and the IVC were connected to the pulmonary artery to establish a total cavopulmonary connection (TCPC, n = 10). The survival times of half of the animal models were studied. The other half and the biventricular sham control (n = 5) were injected intravenously with cardiosphere-derived cells (CDCs), and the cardiac retention of CDCs was assessed after 2 h. RESULTS: All SVP models died within 20 h. Perioperative mortality was higher in the BCPS group because of lower oxygen saturation (P < 0.001). Cardiac retention of intravenously delivered CDCs, as detected by magnetic resonance imaging and histologic analysis, was significantly higher in the modified Blalock-Taussig and BCPS groups than in the TCPC group (P < 0.01). CONCLUSIONS: Without the total right heart exclusion, stage-specific SVP models can be functionally constructed in pigs with stable outcomes. Intravenous CDC injections may be applicable in patients with SVP before TCPC completion, given that the initial lung trafficking is efficiently bypassed and sufficient systemic blood flow is supplied from the single ventricle.

DOI： 10.1093/ejcts/ezad304

Doubly committed ventricular septal defect: Is it safe to perform surgical closure through the pulmonary trunk approached by right vertical axillary thoracotomy? 査読国際誌

Uoc Huu Nguyen, Truong Ly Thinh Nguyen, Yasuhiro Kotani, Mai Tuan Nguyen, Duyen Dinh Mai, Van Anh Thi Nguyen, Nam Trung Nguyen

JTCVS open 15 368 - 373 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: This study investigated the safety of performing surgical repair for doubly committed ventricular septal defects by right vertical infra-axillary minithoracotomy (RVIAT). METHODS: A retrospective comparative study was performed to evaluate the outcomes of patients who underwent doubly committed ventricular septal defects closure from January 2019 to May 2022. Seventy-four patients were enrolled in the study and treated with either the median sternotomy approach (MSA: n = 37) or the RVIAT approach (RVIAT: n = 37). RESULTS: The median weight and age in the MSA group were significantly lower than those in the RVIAT group (MSA: 6.0 kg [interquartile range] (IQR), 5.2 to 8.7 kg] vs RVIAT: 7.5 kg [IQR, 5.6-14 kg]; P = .034 and MSA: 4.9 months [IQR, 3.6-9.4 month] vs 9.6 months [IQR, 5.0-60.4 months]; P = .0084). No patients died, and no patients in the RVIAT group required conversion to the MSA approach. The mean prebypass surgical time was longer in the RVIAT group (36.1 ± 8.2 minutes vs 31.8 ± 5.6 minutes; P = .03). There were no significant differences between the 2 groups in cardiopulmonary bypass time, aortic crossclamp time, or operation time. Significantly shorter ventilation times were observed in the RVIAT group (11.9 ± 8.2 hours vs 15.4 ± 6.3 hours; P = .006). CONCLUSIONS: Closure of doubly committed ventricular septal defects through the pulmonary trunk by the RVIAT approach is feasible and safe, and does not increase the risk of bypass-related complications.

DOI： 10.1016/j.xjon.2023.06.012

When to intervene the pulmonary artery: Importance of anatomical assessment in the diagnosis of pulmonary artery coarctation. 査読国際誌

Eiri Kisamori, Yasuhiro Kotani, Hiroyuki Suzuki, Junko Kobayashi, Takuya Kawabata, Yosuke Kuroko, Shingo Kasahara

The Journal of thoracic and cardiovascular surgery 166 ( 3 ) 926 - 932 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Pulmonary artery coarctation (PACoA) is a major problem that increases the frequency of intervention. However, there is little evidence regarding the prediction of PACoA development. METHODS: A retrospective chart review was performed on 42 patients who underwent modified Blalock-Taussig shunt and preoperative contrast-enhanced computed tomography. An uneven PA branching was defined as an abnormal ductus arteriosus connection to the left PA distal to the PA branching on contrast-enhanced computed tomography. RESULTS: Nineteen (45.2%) of 42 patients were diagnosed with PACoA. The median diameters of the ductus on the aorta and PA sides were 4.1 mm and 3.6 mm in the PACoA group and 3.6 mm and 2.9 mm in the non-PACoA group, respectively (P = .07 and .28, respectively). Tortuous ductus was recognized in 7 (36.8%) patients in the PACoA group and 14 (60.8%) patients in the non-PACoA group (P = .12). PACoA was associated with pulmonary atresia (16 patients [84.2%] in the PACoA group and 12 patients [52.1%] in the non-PACoA group) (P = .02). All 19 patients had uneven PA branching in the PACoA group, whereas 5 of 23 (21.7%) patients had uneven PA branching in the non-PACoA group (P < .001). CONCLUSIONS: Uneven PA branching rather than the ductus arteriosus size was strongly associated with PACoA development; therefore, morphologic assessment by contrast-enhanced computed tomography should be considered in patients with pulmonary atresia.

DOI： 10.1016/j.jtcvs.2023.02.021

Surgical management of a low-birth-weight neonate with ductal-dependent pulmonary circulation. 査読国際誌

Yoshinori Inoue, Hiroyuki Suzuki, Shingo Kasahara, Yasuhiro Kotani

The Journal of thoracic and cardiovascular surgery 2023年8月

大動脈離断/心室中隔欠損症の術後遠隔期の検討

福嶋遥佑, 大月審一, 馬場健児, 近藤麻衣子, 栗田佳彦, 重光祐輔, 平井健太, 原真祐子, 岩崎達雄, 笠原真悟, 小谷恭弘

日本小児循環器学会総会・学術集会抄録集 59回 [II - 06] 2023年7月

Diamond-like carbon coating to inner surface of polyurethane tube reduces Staphylococcus aureus bacterial adhesion and biofilm formation

Noriaki Kuwada, Yasuhiro Fujii, Tatsuyuki Nakatani, Daiki Ousaka, Tatsunori Tsuji, Yuichi Imai, Yasuyuki Kobayashi, Susumu Oozawa, Shingo Kasahara, Kazuo Tanemoto

Journal of Artificial Organs 27 ( 2 ) 108 - 116 2023年5月

掲載種別：研究論文（学術雑誌）出版者・発行元：Springer Science and Business Media LLC

Abstract

Staphylococcus aureus is one of the main causative bacteria for polyurethane catheter and artificial graft infection. Recently, we developed a unique technique for coating diamond-like carbon (DLC) inside the luminal resin structure of polyurethane tubes. This study aimed to elucidate the infection-preventing effects of diamond-like carbon (DLC) coating on a polyurethane surface against S. aureus. We applied DLC to polyurethane tubes and rolled polyurethane sheets with our newly developed DLC coating technique for resin tubes. The DLC-coated and uncoated polyurethane surfaces were tested in smoothness, hydrophilicity, zeta-potential, and anti-bacterial properties against S. aureus (biofilm formation and bacterial attachment) by contact with bacterial fluids under static and flow conditions. The DLC-coated polyurethane surface was significantly smoother, more hydrophilic, and had a more negative zeta-potential than did the uncoated polyurethane surface. Upon exposure to bacterial fluid under both static and flow conditions, DLC-coated polyurethane exhibited significantly less biofilm formation than uncoated polyurethane, based on absorbance measurements. In addition, the adherence of S. aureus was significantly lower for DLC-coated polyurethane than for uncoated polyurethane under both conditions, based on scanning electron microscopy. These results show that applying DLC coating to the luminal resin of polyurethane tubes may impart antimicrobial effects against S. aureus to implantable medical polyurethane devices, such as vascular grafts and central venous catheters.

DOI： 10.1007/s10047-023-01403-1

その他リンク： https://link.springer.com/article/10.1007/s10047-023-01403-1/fulltext.html

Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects. 査読国際誌

Yasuyuki Kobayashi, Shingo Kasahara, Shunji Sano, Yasuhiro Kotani

The Journal of thoracic and cardiovascular surgery 165 ( 2 ) 411 - 421 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: We compared 2-patch repair (TP) with modified single-patch repair (MSP) for complete atrioventricular septal defects and evaluated their effect on the left atrioventricular valve (LAVV) competence. We also identified risk factors for unfavorable functional outcomes. METHODS: This retrospective study included 118 patients with complete atrioventricular septal defects who underwent intracardiac repair from 1998 to 2020 (MSP: 69; TP: 49). The median follow-up period was 10.4 years. The functional outcome of freedom from moderate or greater LAVV regurgitation (LAVVR) was estimated using the Kaplan-Meier method. RESULTS: The hospital mortality was 1.7% (2/118) and late mortality was 0.8% (1/118). Eight patients required LAVV-related reoperation (MSP: 4; TP: 4) and none required left ventricular outflow tract-related reoperation. In the MSP group without LAVV anomaly, the receiver operating characteristic curve analysis revealed that the ventricular septal defect (VSD) depth was strongly associated with moderate or greater postoperative LAVVR, with the best cutoff at 10.9 mm. When stratified according to the combination of intracardiac repair type and VSD depth, the MSP-deep VSD (VSD depth >11 mm) group showed the worst LAVV competence among the 4 groups (P = .002). According to multivariate analysis, weight <4.0 kg, LAVV anomaly, and moderate or greater preoperative LAVVR were independent risk factors for moderate or greater postoperative LAVVR, whereas MSP was not a risk factor. CONCLUSIONS: Postoperative LAVVR remains an obstacle to improved functional outcomes. MSP provides LAVV competence similar to TP unless deep VSD is present. The surgical approach should be selected on the basis of anatomical variations, specifically VSD depth.

DOI： 10.1016/j.jtcvs.2022.07.041

Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease. 査読国際誌

Ayako Chida-Nagai, Naoki Masaki, Kay Maeda, Konosuke Sasaki, Hiroki Sato, Jun Muneuchi, Yoshie Ochiai, Hiroomi Murayama, Masahiro Tahara, Atsuko Shiono, Atsushi Shinozuka, Fumihiko Kono, Daisuke Machida, Shinichi Toyooka, Seiichiro Sugimoto, Kazufumi Nakamura, Satoshi Akagi, Maiko Kondo, Shingo Kasahara, Yasuhiro Kotani, Junichi Koizumi, Katsuhiko Oda, Masako Harada, Daisuke Nakajima, Akira Murata, Hazumu Nagata, Koichi Yatsunami, Tomio Kobayashi, Yoshikiyo Matsunaga, Takahiro Inoue, Hiroyuki Yamagishi, Naomi Nakagawa, Katsuki Ohtani, Masaki Yamamoto, Yushi Ito, Tatsunori Hokosaki, Yuta Kuwahara, Satoshi Masutani, Koji Nomura, Tsutomu Wada, Hirofumi Sawada, Masayuki Abiko, Tatsunori Takahashi, Yuichi Ishikawa, Seigo Okada, Atsushi Naitoh, Takako Toda, Tatsuya Ando, Akihiro Masuzawa, Shinsuke Hoshino, Masaaki Kawada, Yuichi Nomura, Kentaro Ueno, Naoki Ohashi, Tsuyoshi Tachibana, Yuchen Cao, Hideaki Ueda, Sadamitsu Yanagi, Masaaki Koide, Norie Mitsushita, Kouji Higashi, Yoshihiro Minosaki, Tomohiro Hayashi, Takashi Okamoto, Kenji Kuraishi, Eiji Ehara, Hidekazu Ishida, Hitoshi Horigome, Takashi Murakami, Kohta Takei, Taku Ishii, Gen Harada, Yasutaka Hirata, Jun Maeda, Shunsuke Tatebe, Chiharu Ota, Yasunobu Hayabuchi, Hisanori Sakazaki, Takashi Sasaki, Keiichi Hirono, Sayo Suzuki, Masahiro Yasuda, Atsuhito Takeda, Madoka Sawai, Kagami Miyaji, Atsushi Kitagawa, Yosuke Nakai, Nobuyuki Kakimoto, Kouta Agematsu, Atsushi Manabe, Yoshikatsu Saiki

Frontiers in cardiovascular medicine 10 1212882 - 1212882 2023年

記述言語：英語掲載種別：研究論文（学術雑誌）

AIMS: Limited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH. METHODS: This retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death. RESULTS: The 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45-13.73; P = .009). CONCLUSIONS: The IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered.

DOI： 10.3389/fcvm.2023.1212882

Repeated Syncope During Exercise as a Result of Anomalous Origin of Left Coronary Artery With Intramural Aortic Course in a Teenage Boy. 査読国際誌

Naofumi Amioka, Kazufumi Nakamura, Naoaki Matsuo, Atsuyuki Watanabe, Yasuhiro Kotani, Shingo Kasahara, Hiroshi Ito

Texas Heart Institute journal 49 ( 6 ) 2022年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Texas Heart Institute Journal

Anomalous origin of the left coronary artery from the opposite sinus of Valsalva with an intramural aortic course (L-ACAOS-IM) can cause syncope, sometimes as a prodrome of lethal events, including sudden cardiac death, in young athletes. The detailed mechanism of syncope in patients with L-ACAOS-IM is still unclear. This case report describes a 17-year-old boy who presented to the hospital because of syncope following chest pain with increasing frequency during exercise, such as playing soccer and running. In a treadmill exercise test, a decrease in blood pressure was seen (from 99/56 mm Hg to 68/38 mm Hg); chest pain and faintness accompanied by ST-segment elevation in lead aVR and ST-segment depression at other leads on electrocardiography were noted. These findings and symptoms disappeared spontaneously within a few minutes while clinicians prepared for emergency medications. Coronary computed tomography angiography (CCTA) showed that the origin of the left coronary artery (LCA) was the opposite sinus of Valsalva, and the course of the LCA was through the aortic wall toward the left coronary sinus. He was diagnosed with L-ACAOS-IM. After surgical treatment by unroofing the intramural part of the LCA and reconstructing a neo-ostium, he no longer experienced syncope during exercise. This case suggests that low cardiac output caused by myocardial ischemia, not life-threatening arrythmia, is a main mechanism of syncope in patients with L-ACAOS-IM. Consideration should be given to performing CCTA before an exercise stress test for young patients with syncope and chest pain to avoid the risk of severe myocardial ischemia.

DOI： 10.14503/THIJ-21-7677

Physiologic biventricular repair in a patient with unrepaired adult congenital heart disease with severe cyanosis. 査読国際誌

Hiroyuki Suzuki, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

JTCVS techniques 15 220 - 223 2022年10月

Modified Konno procedure for structural valve deterioration of freestyle bioprosthesis

Naohiro Horio, Masanori Hirota, Takanori Suezawa, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

Chirurgia (Turin) 35 ( 5 ) 299 - 301 2022年10月

掲載種別：研究論文（学術雑誌）

Although the freestyle aortic root bioprosthesis offers excellent clinical outcomes, the surgical mortality after reoperation is extremely high compared to that after aortic valve replacement and Bentall operation. We have described a surgical technique for structural valve deterioration of the freestyle bioprosthesis with a small aortic annulus. Modified Konno procedure with anterior aortic annular enlargement was indicated to repair the tentative pseudoaneurysm. Postoperative image of the aortic root showed a successful reconstruction without stenosis. This approach was found to be safe and efficient in this complicated reintervention case.

DOI： 10.23736/S0394-9508.21.05376-6

Sinus plication technique for neoaorta dilation and regurgitation in patients with repaired congenital heart diseases. 査読国際誌

Eiri Kisamori, Yasuhiro Kotani, Hiroyuki Suzuki, Shingo Kasahara

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 62 ( 4 ) 2022年9月

Vascular occlusion with 0.035-inch hydrogel expandable coils in congenital heart diseases and vascular anomalies. 査読国際誌

Kenji Baba, Maiko Kondo, Takahiro Eitoku, Yusuke Shigemitsu, Kenta Hirai, Shinichi Otsuki, Tomoyuki Kanazawa, Tatsuo Iwasaki, Toshihiro Iguchi, Norihisa Toh, Yasuhiro Kotani, Shingo Kasahara

Journal of cardiology 80 ( 3 ) 249 - 254 2022年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: We present our experience with transcatheter vascular occlusion using 0.035-inch hydrogel expandable coils, which has been reported only in a few cases in the pediatric cardiology fields. METHODS: This study is a retrospective analysis of all patients who underwent transcatheter embolization with 0.035-inch hydrogel coils at the Department of Pediatrics, Okayama University Hospital, between October 2018 and September 2020. RESULTS: Twenty patients with a median age of 5.1 years (0.05-26.0 years) and a median weight of 13.8 kg (3.0-56.8 kg) were included. A total of fifty-four 0.035-inch hydrogel coils, including 35 Azur 35 and nineteen Azur CX 35 coils (Terumo, Tokyo, Japan), were successfully deployed in 22 target vessels. The target vessels consisted of 10 aortopulmonary collaterals, 8 veno-venous collaterals, and 4 pulmonary arteriovenous malformations. We achieved technical success in all the target vessels. In total, the mean target vessel diameter was 4.4 mm, the mean number of 0.035-inch hydrogel coils was 2.5 per vessel. The mean device to vessel ratio was 1.6 for the anchor coil and 1.2 for the additional coil. Post-implantation angiograms revealed that the primary occlusion rate was 18/22 (82%). There were no periprocedural complications. CONCLUSIONS: The 0.035-inch hydrogel expandable coils are effective and safe in patients with congenital heart disease and vascular anomalies. These occlusion devices could be valuable options for interventional pediatric cardiologists.

DOI： 10.1016/j.jjcc.2022.04.005

Journey Toward Improved Long-Term Outcomes After Norwood-Sano Procedure: Focus on the Aortic Arch Reconstruction. 査読国際誌

Shunji Sano, Toshikazu Sano, Yasuyuki Kobayashi, Yasuhiro Kotani, Peter C Kouretas, Shingo Kasahara

World journal for pediatric & congenital heart surgery 13 ( 5 ) 581 - 587 2022年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

The disadvantage of right ventricle-to-pulmonary artery (RV-PA) shunt is the need for more unplanned interventions to address stenosis in the shunt or branch pulmonary arteries, as compared to the modified Blalock-Taussig shunt group. Ring-enforced RV-PA PTFE conduit and dunk technique minimized these complications and right ventricle (RV) damage. Aortic arch obstruction increases afterload and leads to ventricular dysfunction and tricuspid regurgitation; therefore, most surgeons prefer to use homograft, autologous pericardium, or bovine pericardium to reconstruct the neoaorta. Artificial materials decrease the elastic properties, increase wall stiffness, and decrease the distensibility of the aorta; and as a result, RV function gradually deteriorates. This inelastic reconstructed aorta may be one of the reasons why long-term outcomes after the Fontan procedure are worse in hypoplastic left heart syndrome (HLHS) patients, in comparison to non-HLHS. Reconstruction of the neoaorta without any patch materials, or at least techniques that largely minimize the use of non-autologous materials, will offer a further refinement of our ability to optimize ventriculoarterial coupling and thereby long-term RV function.

DOI： 10.1177/21501351221116766

Minimally invasive approaches to atrial septal defect closure. 査読国際誌

Igor E Konstantinov, Yasuhiro Kotani, Edward Buratto, Antonia Schulz, Yaroslav Ivanov

JTCVS techniques 14 184 - 190 2022年8月

A Ruptured Coronary Artery Aneurysm Secondary to Kawasaki Disease. 査読国際誌

Hiroyuki Suzuki, Yosuke Kuroko, Yasuhiro Kotani, Naoya Sakoda, Shingo Kasahara

JACC. Case reports 4 ( 13 ) 790 - 793 2022年7月

記述言語：英語

Coronary artery aneurysm occurs in 0.3%-0.8% of patients with Kawasaki disease, and cases of rupture are extremely rare. Only 2 cases have been reported in which the patients survived. We report a case of ruptured coronary artery aneurysm that was treated with coronary artery bypass grafting and extracorporeal membrane oxygenation. (Level of Difficulty: Advanced.).

DOI： 10.1016/j.jaccas.2022.05.012

A highly calcified conduit compressing the heart. 査読国際誌

Hiroyuki Suzuki, Eiri Kisamori, Yasuhiro Kotani, Shingo Kasahara

Asian cardiovascular & thoracic annals 30 ( 6 ) 741 - 742 2022年7月

Impact of decompression of the right ventricle on the sinusoidal communications in pulmonary atresia and intact ventricular septum. 査読国際誌

Takahiro Eitoku, Shingo Kasahara, Kenji Baba, Yasuhiro Kotani

The Journal of thoracic and cardiovascular surgery 163 ( 6 ) 2210 - 2215 2022年6月

Strategy of delayed repair of total anomalous pulmonary venous connection in right atrial isomerism and functional single ventricle. 査読国際誌

Eiri Kisamori, Yasuhiro Kotani, Fiza Komel Raja, Junko Kobayashi, Yosuke Kuroko, Takuya Kawabata, Shingo Kasahara

JTCVS open 10 308 - 319 2022年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Repair of total anomalous pulmonary venous connection (TAPVC) in neonates with right atrial isomerism and functional single ventricle is challenging. In our novel strategy, primary draining vein stenting (DVS) was applied to patients with preoperative pulmonary vein obstruction to delay TAPVC repair. This study investigated our initial experience with a strategy of delayed TAPVC repair, incorporating DVS. METHODS: Twenty-nine patients with right atrial isomerism and functional single ventricle who had a severe obstruction in the course of draining veins, who required surgical or catheter intervention in their neonatal period were retrospectively reviewed (primary DVS: n = 11; primary TAPVC repair: n = 18). RESULTS: Patients in the primary DVS group had more mixed type TAPVC (primary DVS: n = 5, 45.5%; primary TAPVC repair: n = 2, 11.1%; P = .03) and required more systemic to pulmonary shunt surgeries during their lifetime (primary DVS: n = 9, 81.8%; primary TAPVC repair: n = 6, 33.3%; P = .047). Kaplan-Meier analysis showed that primary DVS repair was associated with improved survival compared with primary TAPVC repair (survival rates at 90 days, 1 year, 3 years and 5 years: primary DVS: 100%, 80%, 68.6%, and 54.9%; primary TAPVC repair: 55.6%, 38.9%, 38.9%, and 38.9%, respectively [P = .04]). Of the 4 patients who underwent stenting of the ductus venosus, 3 had elevated liver enzymes after surgical repair of TAPVC due to ductus venosus steal, which markedly improved after coil embolization of the stent. CONCLUSIONS: For neonates with obstructive TAPVC and functional single ventricle, our delayed TAPVC repair using primary DVS appeared to improve survival compared with the conventional strategy.

DOI： 10.1016/j.xjon.2021.11.012

Staged Repair of Tetralogy of Fallot: A Strategy for Optimizing Clinical and Functional Outcomes. 査読国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Yosuke Kuroko, Takuya Kawabata, Shunji Sano, Shingo Kasahara

The Annals of thoracic surgery 113 ( 5 ) 1575 - 1581 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: This study evaluated the impact of a staged surgical strategy incorporating a modified Blalock-Taussig shunt (BTS) for tetralogy of Fallot on pulmonary valve annulus growth, the rate of valve-sparing repair at the time of intracardiac repair, and long-term functional outcomes. METHODS: This retrospective study involved 330 patients with tetralogy of Fallot who underwent intracardiac repair between 1991 and 2019 and included 57 patients (17%) who underwent BTS. The mean follow-up period was 15.0 ± 7.3 years. We compared the data of patients who underwent BTS and patients who did not undergo BTS before intracardiac repair. RESULTS: The median age before BTS was 71 days (range, 28 to 199) and the median body weight was 4.3 kg (range, 3.3 to 6.8 kg). There were no inhospital or interstage deaths after BTS. The pulmonary valve annulus Z scores of patients with BTS revealed significant growth after BTS (from -4.2 ± 1.8 to -3.0 ± 1.7, P < .001). Valve-sparing repair was eventually performed in 207 patients (63%), including 26 (46%) who underwent staged repair. The overall freedom from pulmonary regurgitation-related reintervention was 99.7%, 99.1%, and 95.8% at 1, 5, and 20 years, respectively. CONCLUSIONS: A staged surgical strategy incorporating BTS as the first palliation for symptomatic patients resulted in no mortality. Blalock-Taussig shunt may have contributed to the avoidance of primary transannular patch repair and facilitated pulmonary valve annulus growth; therefore, approximately half of the symptomatic neonates and infants were recruited for valve-sparing repair. Staged repair may have led to functionally reliable delayed transannular patch repair, thereby resulting in fewer surgical reinterventions.

DOI： 10.1016/j.athoracsur.2021.01.087

Impact of pulmonary artery coarctation on pulmonary artery growth and definitive repair following modified Blalock-Taussig shunt. 査読国際誌

Yasuhiro Kotani, Yasuyuki Kobayashi, Sachiko Kadowaki, Eiri Kisamori, Junko Kobayashi, Takuya Kawabata, Yosuke Kuroko, Shingo Kasahara

The Journal of thoracic and cardiovascular surgery 163 ( 5 ) 1618 - 1626 2022年5月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Pulmonary artery coarctation may pose a risk for pulmonary stenosis and subsequent failure to achieve definitive repair. We sought to assess the impact of pulmonary artery coarctation on pulmonary artery growth. METHODS: A retrospective chart review was performed in 130 patients, including 37 single ventricles with a modified Blalock-Taussig shunt as first palliation. Pulmonary artery coarctation was defined as discrete stenosis of the pulmonary artery, with a diameter of less than 3 mm and with the ductus arteriosus connected. Preoperative echocardiography showed pulmonary artery coarctation in 29 patients (22%). Concomitant pulmonary artery plasty was performed in 14 patients with discrete stenosis having a diameter of less than 2 mm. RESULTS: Pre-modified Blalock-Taussig shunt left pulmonary artery z-scores were lower in patients with pulmonary artery coarctation than in those without (-4.0 [-5.8, -2.1] vs -1.7 [-2.6, -0.8], P < .001), and this remained the same even after modified Blalock-Taussig shunt (-2.5 [-5.1, -0.5] vs -0.5 [-2.4, 0.8], P = .010). Concomitant pulmonary artery plasty did not result in catch-up growth of the left pulmonary artery (post-modified Blalock-Taussig shunt left pulmonary artery z-score in patients with pulmonary artery plasty: -3.0 (-6.5, -2.0) versus those without: -1.8 (-3.3, -0.3), P = .279). Definitive repair/Fontan completion was achieved in 111 patients (85%), and this was not affected by the presence of pulmonary artery coarctation. CONCLUSIONS: Pulmonary artery coarctation affected disproportionate pulmonary artery growth throughout the staged repair, but did not result in failure of definitive repair/Fontan completion. Pulmonary artery plasty during the neonatal period did not contribute to catch-up growth of the left pulmonary artery; therefore, surgical indications and timing should be carefully considered.

DOI： 10.1016/j.jtcvs.2021.09.070

Stepwise Treatment for Heterotaxy Syndrome and Functional Single Ventricle Complicated by Infra-Cardiac Total Anomalous Pulmonary Venous Connection with Ductus Venosus Stent Placement and Subsequent Occlusion. 査読国際誌

Yuki Imai, Kenji Baba, Shinichi Otsuki, Maiko Kondo, Takahiro Eitoku, Yusuke Shigemitsu, Yosuke Fukushima, Kenta Hirai, Tatsuo Iwasaki, Tomoyuki Kanazawa, Yasuhiro Kotani, Shingo Kasahara

Pediatric cardiology 43 ( 4 ) 756 - 763 2022年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Even today, when the surgical outcome of congenital heart disease in the neonatal period has improved, the prognosis for heterotaxy syndrome and functional single ventricle complicated with total anomalous pulmonary venous connection (TAPVC), especially the infra-cardiac type, is catastrophic. We describe a strategy that combines percutaneous ductus venosus (DV) stent placement and occlusion after TAPVC repair to ensure survival from initial surgery to bidirectional cavopulmonary shunt (BCPS) procedure and facilitate subsequent treatment. Three consecutive patients with heterotaxy syndrome and functional single ventricle complicated by infra-cardiac TAPVC treated with our own strategy were retrospectively studied. In two infants, DV stent placement was performed on the day of birth. In one case at 11 days of age. The risk of pulmonary vein obstruction was reduced, and on-pump surgery, including TAPVC repair, was performed on a standby basis. Since the rapid increase in hepatic enzymes occurred on postoperative day 0 to 1 in all cases, percutaneous stent occlusion was performed until postoperative day 3. The procedure improved liver function. One patient died due to severe atrioventricular valve regurgitation, one case underwent BCPS, and one patient was waiting to undergo. DV stent placement can avoid TAPVC repair in the early neonatal period. After TAPVC repair, the portosystemic shunt remained, resulting in hepatic dysfunction, but this could be improved by stent and vertical vein occlusion. A series of stepwise treatments can be useful to help such critically ill infants survive the high-risk neonatal period and achieve good BCPS circulation.

DOI： 10.1007/s00246-021-02782-z

Commentary: "A new hope" in patients with Fontan circulation: High-risk Fontan operation can be done, but for "perfect Fontan" we still aim. 査読国際誌

Yasuhiro Kotani

JTCVS open 9 233 - 234 2022年3月

Papillary-Ventricular Complex Tugging for Ischemic/Functional Mitral Regurgitation. 査読国際誌

Masanori Hirota, Takanori Suezawa, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Fumi Yokohama, Yoichi Takaya, Hiroshi Ito, Shingo Kasahara

The Annals of thoracic surgery 113 ( 1 ) e71-e73 2022年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

Surgical restoration of subvalvular geometry is very important to prevent recurrence of ischemic/functional mitral regurgitation (MR). We evaluated an approach to the radical repair of left ventricular (LV) remodeling for three different cases with responsible coronary lesions. Leaflet tethering was corrected by tugging of the papillary-ventricular complex, which consists of the base of papillary muscles and posterior LV wall. The main lesion of the postinfarction scar was concomitantly excluded. Restoration of LV remodeling diminished MR with minimal leaflet tethering and improved systolic LV function. This technique may be an aggressive and encouraged approach for patients with ischemic/functional MR.

DOI： 10.1016/j.athoracsur.2021.03.095

Right Vertical Infra-Axillary Thoracotomy Approach in Simple Congenital Heart Diseases 査読

Yasuyuki Kobayashi, Shingo Kasahara, Yasuhiro Kotani

Operative Techniques in Thoracic and Cardiovascular Surgery 27 ( 3 ) 294 - 301 2022年

Repair of Common Atrioventricular Valve in Univentricular Circulation Using Adjustable Annular Bridging Technique 査読

Shingo Kasahara, Yasuhiro Kotani

Operative Techniques in Thoracic and Cardiovascular Surgery 27 ( 3 ) 302 - 308 2022年

Risk factors and outcomes of pediatric extracorporeal membrane oxygenation. 査読国際誌

Hiroshi Taka, Yasuhiro Kotani, Yosuke Kuroko, Susumu Iwadou, Tatsuo Iwasaki, Shingo Kasahara

Asian cardiovascular & thoracic annals 29 ( 9 ) 916 - 921 2021年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD. METHODS: We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38-53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge. RESULTS: The median ECMO duration was 160 (91-286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min. CONCLUSIONS: Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.

DOI： 10.1177/0218492321997379

Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch? 査読国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Takuya Kawabata, Yosuke Kuroko, Shunji Sano, Shingo Kasahara

Interactive cardiovascular and thoracic surgery 33 ( 5 ) 765 - 772 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: This study aimed to evaluate whether recoarctation of the aorta (reCoA) after the Norwood procedure for hypoplastic left heart syndrome correlates with pre- and postoperative anatomic factors. METHODS: This retrospective study included 48 patients who underwent Norwood procedure with right ventricle-to-pulmonary artery conduit between 2009 and 2017. Anatomical factors such as preoperative length, diameter of the main pulmonary artery (MPA), and postoperative neoaortic arch angle stratified by arch reconstruction technique were analysed using the receiver operating characteristic analysis. RESULTS: Eleven patients needed surgical intervention for reCoA at stage 2. Out of the 30 patients who underwent direct anastomosis during arch reconstruction, 7 developed reCoA. Seven patients received the full patch augmentation (patch augmentation for both lesser and greater curvatures) and were all spared from reCoA. Among the patients who had direct anastomosis, the preoperative MPA length was correlated with the postoperative arch angle (P = 0.021) and was associated with the occurrence of reCoA (P = 0.002) and the best cutoff value for MPA length was 10 mm. The postoperative arch angle was also correlated with the incidence of reCoA (P < 0.001) and was larger in patients who underwent the full patch augmentation than in patients who had direct anastomosis (126° vs 112°, P = 0.005) despite comparable MPA length. CONCLUSIONS: ReCoA after the Norwood procedure correlates with MPA length when a direct anastomosis was used. Direct anastomosis can be considered in patients with a longer preoperative MPA. In other cases, the full patch augmentation should be considered for obtaining a large and smooth neoaortic arch.

DOI： 10.1093/icvts/ivab170

Successful Handmade Monobloc Aortomitral Valve Replacement for Extensive Aortic Root Abscess. 査読国際誌

Takanori Suezawa, Masanori Hirota, Naoya Sakoda, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Shingo Kasahara

The Annals of thoracic surgery 112 ( 2 ) e131-e134 2021年8月

記述言語：英語

Aortic root abscess is one of the most catastrophic complications of aortic valve endocarditis. Complete débridement is recommended regardless of the kind of infected lesion. A 37-year-old man with extensive aortic root abscess due to prosthetic aortic valve endocarditis was surgically treated. The main lesion was the aortomitral continuity extending to the commissure between the left and right coronary cusps. After débridement, the aortic annulus underneath the left coronary artery was reconstructed using a handmade aortomitral monobloc valve without aortic annuloplasty. This valve was required for the extensive root abscess of the left and noncoronary sinus to achieve complete débridement.

DOI： 10.1016/j.athoracsur.2020.11.046

Perioperative Milrinone Infusion Improves One-Year Survival After the Norwood-Sano Procedure. 査読国際誌

Tomoyuki Kanazawa, Kazuyoshi Shimizu, Tatsuo Iwasaki, Kenji Baba, Shinichi Otsuki, Yasuhiro Kotani, Shingo Kasahara, Hiroshi Morimatsu

Journal of cardiothoracic and vascular anesthesia 35 ( 7 ) 2073 - 2078 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: The aim of this study was to investigate whether milrinone infusion improved one-year survival in patients who underwent the Norwood-Sano procedure. DESIGN: A retrospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: Children who underwent the Norwood-Sano procedure from January 2008 to December 2014. INTERVENTIONS: Patients were categorized into two groups: group E+D, who received routine epinephrine and dopamine infusion, and group M, who received routine milrinone infusion for intra- and postoperative inotropic support. MEASUREMENTS AND MAIN RESULTS: The primary outcome of this study was one-year survival after the Norwood-Sano procedure. A total of 45 patients were included (group E+D, 22; group M, 23). One-year survival in group M was significantly higher than that in group E+D (95.7% [22/23] v 72.7% [16/22], p = 0.03). A Kaplan-Meier curve also showed that one-year survival in group M was significantly higher than that in group E+D (p = 0.04), from the result of the log-rank test. The number of patients who had any arrhythmias in the intensive care unit (ICU) was significantly lower in group M than in group E+D (21.7% [5/23] v 50% [11/22], p = 0.03). The duration of ICU stay did not have statistical difference between groups (group M 19; interquartile range [IQR], 15-28) v group E+D 19.5 (IQR, 16.3-35.5) days, p = 0.57). CONCLUSIONS: Perioperative milrinone infusion improved the mortality after the Norwood-Sano procedure. Potential advantages of milrinone compared with epinephrine are fewer arrhythmias and better systemic perfusion, which could decrease lethal cardiac events in the ICU.

DOI： 10.1053/j.jvca.2021.02.017

Anatomic Risk Factors for Reintervention After Arterial Switch Operation for Taussig-Bing Anomaly. 査読国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Yosuke Kuroko, Atsushi Tateishi, Shunji Sano, Shingo Kasahara

The Annals of thoracic surgery 112 ( 1 ) 163 - 169 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: This study aimed to determine the factors related to reintervention, especially for pulmonary stenosis (PS), in patients with Taussig-Bing anomaly (TBA) after the arterial switch operation. METHODS: This retrospective study included 34 patients with TBA who underwent the arterial switch operation between 1993 and 2018. Preoperative anatomic and physiologic differences and long-term outcomes were determined using a case-matched control with transposition of the great arteries with ventricular septal defect and TBA with an anterior and rightward aorta. RESULTS: At arterial switch operation, median age was 43 days (range, 16 to 102) and median body weight was 3.6 kg (range, 2.8 to 3.8 kg). Aortic arch obstruction and coronary anomalies were present in 64% and 41% of patients, respectively. The hospital mortality rate was 11%, including one cardiac death, and the late mortality rate was 2.9%. Furthermore, 41% patients underwent 26 reinterventions for PS. Patients undergoing PS-related reintervention had a significantly larger native pulmonary artery to aortic annulus size ratio than patients not receiving reintervention (1.69 vs 1.41, P = .02). This ratio was the only predictor of PS-related reintervention; it was significantly higher in the TBA group than in the transposition of great arteries/ventricular septal defect group. The PS-related reintervention was required more in the TBA group than in the transposition of great arteries/ventricular septal defect group. CONCLUSIONS: Regardless of complex coronary anatomy and associated anomalies, early and late survival were acceptable. Postoperative PS was strongly associated with having a larger native pulmonary valve, suggesting that an optimal surgical reconstruction was required for achieving an appropriate aortopulmonary anatomic relationship during the arterial switch operation.

DOI： 10.1016/j.athoracsur.2020.06.016

Endocardial Hemangioma of the Right Ventricle: Complete Excision With Right Ventricular Restoration. 査読国際誌

Masanori Hirota, Takanori Suezawa, Yasuyuki Kobayashi, Takuya Kawabata, Yosuke Kuroko, Yasuhiro Kotani, Hiroshi Ito, Shingo Kasahara

The Annals of thoracic surgery 111 ( 6 ) e411-e413 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Primary cardiac tumor can arise from any location in the right and left cardiac chamber. Complete excision is generally recommended because of uncertainty regarding malignancy; however it is important to minimize the resultant functional deterioration after surgery. We report a case of endocardial hemangioma (4 × 3 × 3 cm) on the free wall of the right ventricle, located between the anterior and posterior papillary muscles. We describe details of the procedure to preserve the right ventricular volume and competence of the tricuspid valve.

DOI： 10.1016/j.athoracsur.2020.09.078

Multiple Late Complications After Takeuchi Repair of Anomalous Left Coronary Artery From the Pulmonary Artery. 査読国際誌

Fumi Yokohama, Norihisa Toh, Yasuhiro Kotani, Nobuhisa Watanabe, Yoichi Takaya, Teiji Akagi, Shingo Kasahara, Hiroshi Ito

JACC. Case reports 3 ( 5 ) 731 - 735 2021年5月

記述言語：英語

Takeuchi repair is a unique surgical approach in anomalous left coronary artery from the pulmonary artery. We present an adult patient with anomalous left coronary artery from the pulmonary artery with multiple late structural complications after Takeuchi repair who was evaluated using multimodality imaging, including newly developed cardiac fusion imaging with computed tomography and echocardiography. (Level of Difficulty: Advanced.).

DOI： 10.1016/j.jaccas.2021.02.035

Corrigendum to 'Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience' [Eur J Cardiothorac Surg 2020;58:230-236]. 査読国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Yosuke Kuroko, Takuya Kawabata, Shunji Sano, Shingo Kasahara

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 59 ( 4 ) 931 - 931 2021年4月

Ex vivo evaluation of the biventricular cardiac function for donation after circulatory death model: An experimental study. 査読国際誌

Yasuyuki Kobayashi, Yasuhiro Kotani, Naoya Sakoda, Sachiko Kadowaki, Shingo Kasahara

Artificial organs 45 ( 4 ) 373 - 381 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Few reports on a biventricular working heart model with ex vivo perfusion exist owing to the complexity of establishing a circuit. Hence, we investigated it for donation after circulatory death. The heart in six juvenile pigs (~20 kg) was arrested by asphyxiation. After 30 minutes of global ischemia, the heart was harvested, reperfused with normoxemic blood cardioplegia for 20 minutes, and subsequently perfused with hyperxemic blood. After 70 minutes of controlled reperfusion, the system was switched to the biventricular working mode. Cardiac function was assessed before anoxia and during the biventricular mode. Left and right ventricular functions worsened during the biventricular mode, as compared to those before anoxia (dP/dtmax , 673 ± 120 vs. 283 ± 95 and 251 ± 35 vs. 141 ± 21 mm Hg/s, respectively; P < .001). Systemic (resistance/100 g net heart weight) and pulmonary vascular resistance indexes during the biventricular mode were similar to those before anoxia (829 ± 262 vs. 759 ± 359, P = .707, and 167 ± 57 vs. 158 ± 83 dynes·sec·cm-5 - l-100-g net heart weight, P = .859, respectively). The biventricular working heart model with ex vivo perfusion was feasible, exhibited stable hemodynamics, and has the potential to be a powerful tool for direct cardiac function assessment.

DOI： 10.1111/aor.13834

Assessment of the right ventricle in donation after circulatory death hearts. 査読国際誌

Sachiko Kadowaki, Yasuhiro Kotani, Yasuyuki Kobayashi, Takuya Goto, Shingo Kasahara

Artificial organs 45 ( 3 ) 263 - 270 2021年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

In donation after circulatory death heart transplantation, the donor heart is exposed to circulatory load. The right ventricle, due to its structure, has high compliance for volume load but is particularly vulnerable to increased pressure load. This study used a porcine model to conduct a functional assessment of the hemodynamics of the heart, with a focus on the right ventricle. Six pigs weighing 24.6 ± 1.4 kg were used. Circulatory death was induced by asphyxiation after median sternotomy. After 30 minutes in the state of global warm ischemia, the ascending aorta was clamped, followed by a 20-minute reperfusion of the heart with a 20°C blood cardioplegia solution. Systemic circulation was established by cardiopulmonary bypass after aortic cross-clamping. After initial reperfusion, the blood cardioplegia solution was replaced with blood. The blood was then rewarmed while the heart was still in a non-working state. Cardiac function was assessed twice in situ, first by the thermodilution method, and then, by the pressure-volume measurement both at preischemia and at three hours after initiation of reperfusion. The recovery rate of cardiac output was 75%. End-systolic elastance (P = .02) and pulmonary arterial elastance significantly increased (P = .03), but the ratio of arterial elastance to end-systolic elastance was preserved (P = .91) in the right ventricle. Despite a decrease in cardiac output after reperfusion from warm ischemia, the right ventricle had a potential to respond the elevated afterload. It is important that donations after circulatory death heart transplantation should be performed with attention to avoiding right ventricular distension.

DOI： 10.1111/aor.13823

Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular Vein and Expanded Polytetrafluoroethylene Conduits. 査読国際誌

Kenta Hirai, Kenji Baba, Takuya Goto, Daiki Ousaka, Maiko Kondo, Takahiro Eitoku, Yasuhiro Kotani, Shingo Kasahara, Shinichi Ohtsuki, Hirokazu Tsukahara

Pediatric cardiology 42 ( 1 ) 100 - 108 2021年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

Bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) conduits have been described as alternatives to the homograft for right ventricular outflow tract (RVOT) reconstruction. This study compared RVOT reconstructions using BJV and ePTFE conduits performed in a single institution. The valve functions and outcomes of patients aged < 18 years who underwent primary RVOT reconstruction with a BJV or ePTFE conduit between 2013 and 2017 were retrospectively investigated. 44 patients (20 and 24 with BJV and ePTFE conduits, respectively) met the inclusion criteria. The mean follow-up time was 4.5 ± 1.5 years. No significant differences in peak RVOT velocity (1.8 ± 0.9 m/s vs 2.1 ± 0.9 m/s, P = 0.27), branch pulmonary stenosis (P = 0.50), or pulmonary regurgitation (P = 0.44) were found between the BJV and ePTFE conduit groups, respectively. Aneurysmal dilatation of the conduit was observed in 25.0% of the patients in the BJV conduit group but not in the ePTFE conduit group (P = 0.011). All the cases with aneurysmal dilatation of the BJV conduit were complicated with branch pulmonary stenosis up to 3.0 m/s (P = 0.004). No conduit infections occurred during the follow-up period, and no significant difference in conduit replacement (20.0% vs 8.3%, P = 0.43) was found between the BJV and ePTFE conduit groups, respectively. The outcomes of the RVOT reconstructions with BJV and ePTFE conduits were clinically satisfactory. Aneurysmal dilatation was found in the BJV conduit cases, with branch pulmonary stenosis as the risk factor.

DOI： 10.1007/s00246-020-02458-0

How to Reconstruct Neo-Aortic Arch Without Patch at Norwood-Sano Procedure 査読

Shunji Sano, Peter C. Kouretas, Yasuyuki Kobayashi, Yasuhiro Kotani, Shingo Kasahara

Operative Techniques in Thoracic and Cardiovascular Surgery 25 ( 4 ) 221 - 241 2020年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：W.B. Saunders

The Norwood procedure consists of a complex reconstruction resulting in: (1) unobstructed systemic outflow from the right ventricle to neo-aorta, (2) creation of large atrial septal defect, and (3) a controlled source of pulmonary blood flow (PBF) from the systemic circulation. The Sano modification provides the source of PBF from the right ventricle. Both procedures have advantages and disadvantages, therefore, there have been many debates regarding which procedure is better as a first stage palliation. Another ongoing debate of first stage palliation is the method of reconstruction of the neo-aorta. Aortic arch obstruction increases afterload and leads to ventricular dysfunction and tricuspid regurgitation. Recent SVR Trial identified recurrent coarctation requiring intervention in 18% of patients. We believe that another important point regarding reconstruction of the neo-aorta is the use of only native tissue and minimizing the use of inelastic patch material. Because elastic properties of the arterial tree are known to have a profound influence on ventricular function, arterial elasticity may therefore be of particular importance to those patients with hypoplastic left heart syndrome. During the past 20 years, we have modified our original technique of aortic arch reconstruction. Proximal arch plication and creation of elongated flaps of the main pulmonary artery are 2 of our recent modifications which facilitate neo-aortic reconstruction with native tissue. We describe a technique where direct anastomosis of neo-aorta is achieved with avoidance of foreign material in a majority of our patients.

DOI： 10.1053/j.optechstcvs.2020.07.004

Residual Restrictive Right Ventricular Physiology after One-and-a-Half Ventricular Repair Conversion in Pulmonary Atresia with Intact Ventricular Septum. 国際誌

Kazuki Suruga, Norihisa Toh, Yasuhiro Kotani, Hideki Onishi, Teiji Akagi, Shingo Kasahara, Hiroshi Ito

CASE (Philadelphia, Pa.) 4 ( 6 ) 523 - 525 2020年12月

The impact of pulmonary artery banding and cardiac resynchronization therapy for the adult patient with congenitally corrected transposition of the great arteries 査読

Kadowaki S, Kotani Y, Toh N, Kuroko Y, Tateishi A, Akagi T, Ito H, Kasahara S

General Thoracic and Cardiovascular Surgery 68 ( 9 ) 1024 - 1026 2020年9月

Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience 国際誌

European Journal of Cardio-Thoarcic Surgery 58 ( 2 ) 230 - 236 2020年8月

Clinical impact of transcatheter atrial septal defect closure on new onset atrial fibrillation in adult patients: Comparison with surgical closure 国際誌

Journal of Cardiology 76 ( 1 ) 94 - 99 2020年7月

Bioprosthetic Pulmonary Valve Replacement 招待査読

Kotani Y

Operative Techniques in Thoracic and Cardiovascular Surgery 25 ( 1 ) 13 - 26 2020年3月

Outcomes of Patients with Pulmonary Atresia with Intact Ventricular Septum Reaching Adulthood

Congenital Heart Disease 15 ( 1 ) 1 - 12 2020年

Congenital left ventricular aneurysm diagnosed with atrial septal defect 査読国際誌

Kobayashi Y, Kotani Y, Kuroko Y, Arai S, Kasahara S

Asian Cardiovascular and Thoracic Annals 27 ( 5 ) 404 - 406 2019年6月

Balloon atrial septostomy in hypoplastic left heart syndrome with restrictive atrial septum 査読国際誌

Fukushima Y, Baba K, Kondo M, Kurita Y, Eitoku T, Shigemitsu Y, Hirai K, Tsukahara H, Iwasaki T, Kasahara S, Kotani Y, Otsuki S

Pediatrics International 61 ( 4 ) 339 - 344 2019年4月

Infective Endocarditis of Patent Foramen Ovale Closure Device Presenting as an Amoeboid-Like Mass 査読国際誌

Yamaoka H, Takaya Y, Watanabe N, Akagi T, Nakagawa K, Toh N, Kotani Y, Kasahara S, Itoh H

JACC Cardiovasc Interv 11 ( 22 ) 2337 - 2338 2018年11月

Repair of Intramural Coronary Artery in Anomalous Aortic Origin of a Coronary Artery 招待査読

Kotani Y, Sano S, Kasahara S

Operative Techniques in Thoracic and Cardiovascular Surgery 23 ( 1 ) 40 - 48 2018年10月

Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion 査読国際誌

Lo Rito M, Al-Radi OO, Saedi A, Kotani Y, Ben Sivarajan V, Russell JL, Caldarone CA, Van Arsdell GS, Honjo O

J Thorac Cardiovasc Surg 155 ( 5 ) 2069 - 2077 2018年5月

Fontan Failure and Death in Contemporary Fontan Circulation: Analysis From the Last Two Decades 査読国際誌

Kotani Y, Chetan D, Zhu J, Saedi A, Zhao L, Mertens L, Redington AN, Coles J, Caldarone CA, Van Arsdell GS, Honjo O

Ann Thorac Surg 105 ( 4 ) 1240 - 1247 2018年4月

Surgery for tricuspid regurgitation in a case of anomalous systemic venous return 査読国際誌

Eto K, Kotani Y, Kobayashi Y, Edaki D, Kasahara S, Masuda Z

Asian Cardiovasc Thorac Ann 26 ( 3 ) 227 - 230 2018年3月

Aortopexy for left pulmonary vein obstruction 査読国際誌

Kotani Y, Sano T, Arai S, Kasahara S

Journal of Thoracic and Cardiovascular Surgery 155 ( 2 ) e69-e70 2018年2月

Nonbacterial thrombotic endocarditis involving all four cardiac valves 査読国際誌

Kawada S, Kuriyama M, Kotani Y, Tsushima S, Tanabe A, Kioka Y

Asian Cardiovascular and Thoracic Surgery Annals 26 ( 1 ) 44 - 46 2018年1月

Intracoronary Cardiac Progenitor Cells in Single Ventricle Physiology: The PERSEUS (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) Randomized Phase 2 Trial. 査読国際誌

Shuta Ishigami,Shinichi Ohtsuki *,Takahiro Eitoku*,Daiki Ousaka,Maiko Kondo*,Yoshihiko Kurita*,Kenta Hirai,Yosuke Fukushima,Kenji Baba*,Takuya Goto,Naohiro Horio,Junko Kobayashi,Yosuke Kuroko*,Yasuhiro Kotani*,Sadahiko Arai*,Tatsuo Iwasaki*,Shuhei Sato*,Shingo Kasahara*,Shunji Sano*,Hidemasa Oh*

Circulation Research 120 ( 7 ) 1162 - 1173 2017年3月

Delayed Diagnosis of Aortic Dissection Following Thrombolytic Therapy in a Patient with Acute Ischemic Stroke;Report of a Case 査読

Yosuke Miyamoto,Zenichi Masuda*,Yasuhiro Kotani*,Suguru Tarui,Yosuke Kuroko,Yasuhiro Fujii*,Susumu Ozawa*,Shunji Sano*

Japanese Journal of Thoracic Surgery, Kyobu geka. The Japanese journal of thoracic surgery 69 ( 12 ) 1037 - 1040 2016年11月

A staged decompression of right ventricle allows growth of right ventricle and subsequent biventricular repair in patients with pulmonary atresia and intact ventricular septum 査読国際誌

Yasuhiro Kotani*,Shingo Kasahara*,Yasuhiro Fujii*,Takahiro Eitoku,Kenji Baba*,Shin Ichi Otsuki*,Yosuke Kuroko,Sadahiko Arai*,Shunji Sano*

European Journal of Cardio-thoracic Surgery, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 50 ( 2 ) 298 - 303 2016年8月

Impact of Norwood versus hybrid palliation on cardiac size and function in hypoplastic left heart syndrome. 査読国際誌

Grotenhuis HB, Ruijsink B, Chetan D, Dragulescu A, Friedberg MK, Kotani Y, Caldarone CA, Honjo O, Mertens LL.

Heart 102 ( 12 ) 966 - 74 2016年6月

A STAGED DECOMPRESSION OF RIGHT VENTRICLE ALLOWS REGRESSION OF RIGHT VENTRICLE TO CORONARY ARTERY FISTULA AND SUBSEQUENT ACHIEVEMENT OF BIVENTRICULAR REPAIR IN PATIENTS WITH PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM 査読

Takahiro Eitoku, Yasuhiro Kotani, Kenji Baba, Maiko Kondou, Shingo Kasahara, Sadahiko Arai, Shinichi Ohtsuki, Shunji Sano

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 67 ( 13 ) 947 - 947 2016年4月

Surgical outcome of hypoplastic left heart syndrome with intact atrial septum. 査読国際誌

Arai S, Fujii Y, Kotani Y, Kuroko Y, Kasahara S, Sano S

Asian Cardiovascular and Thoracic Annals 23 ( 9 ) 1034 - 8 2015年11月

The Chicken or the Eggs? Examining the Causal Relationship Between the Development of Atrioventricular Valve Regurgitation and Ventricular Dysfunction in Patients With Functionally Single Ventricle Physiology 査読

Yasuhiro Kotani, Devin Chetan, Selvi Senthilnathan, Arezou Saedi, Christopher A. Caldarone, Glen S. Van Arsdell, Luc Mertens, Osami Honjo

CIRCULATION 132 2015年11月

Left Ventricular Myxoma Occluding the Suprarenal Abdominal Aorta in an Infant. 査読国際誌

Kawabata T, Kasahara S, Ohtsuki S, Kuroko Y, Kotani Y, Fujii Y, Yoshizumi K, Arai S, Sano S.

Ann Thorac Surg 100 ( 1 ) 309 - 11 2015年7月

The Utility of Aortic Blood Flow Measurements in the Prediction of Pulmonary Artery Banding Outcome. 査読国際誌

Kotani Y, Coles M, D Desai N, Honjo O, Caldarone CA, Coles JG, Van Arsdell GS

Ann Thorac Surg 99 ( 6 ) 2096 - 100 2015年6月

Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients. 査読国際誌

Kotani Y, Zhu J, Grosse-Wortmann L, Honjo O, Coles JG, Van Arsdell GS, Caldarone CA

J Thorac Cardiovasc Surg 149 ( 5 ) 1332 - 8 2015年5月

Persistent fenestration may be a marker for physiologic intolerance after Fontan completion 査読国際誌

Kotani Y, Chetan D, Saedi A, Zhu J, Grosse-Wortmann L, Coles JG, Caldarone CA, Van Arsdell GS, Honjo O

J Thorac Cardiovasc Surg 148 ( 6 ) 2532 - 8 2014年12月

Fate of the hypoplastic proximal aortic arch in infants undergoing repair for coarctation of the aorta through a left thoracotomy 査読国際誌

Kotani Y, Anggriawan S, Chetan D, Zhao L, Liyanage N, Saedi A, Mertens LL, Caldarone CA, Van Arsdell GS, Honjo O

Ann Thorac Surg 98 ( 4 ) 1386 - 93 2014年10月

Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair? 査読国際誌

Zhu J, Kotani Y, Chetan D, Zhao L, Coles JG, Caldarone CA, Van Arsdell GS, Honjo O

Ann Thorac Surg 97 ( 5 ) 1664 - 70 2014年5月

Anatomic Factors Determining Surgical Decision Making in Patients with Transposition of the Great Arteries with Left Ventricular Outflow Tract Obstruction 査読国際誌

Honjo O, Kotani Y, Bharucha T, Mertens L, Caldarone CA, Redington AN, Van Arsdell GS

Eur J Cardiothorac Surg 44 ( 6 ) 1085 - 94 2013年12月

The Natural and Surgically-Modified History of Anomalous Pulmonary Veins from the Left Lung 査読国際誌

Kotani Y, Chetan D, Zhu J, Anand V, Caldarone CA, Van Arsdell GS, Coles JG, Honjo O

Ann Thorac Surg 96 ( 5 ) 1711 - 8 2013年11月

Anatomical Risk Factors Associated With Left-Sided Pulmonary Vein Obstruction in Single Ventricle Patients 査読

Yasuhiro Kotani, Jiaquan Zhu, Lars Grosse-Wortmann, Osami Honjo, John Coles, Glen S. Van Arsdell, Christopher A. Caldarone

CIRCULATION 128 ( 22 ) 2013年11月

Salvage Hybrid Palliation for Critically-Ill Infants With Functionally Single-Ventricle Physiology 査読

Devin Chetan, Diana Magee, Yasuhiro Kotani, Alejandro Floh, Steven Schwartz, Glen Van Arsdell, Christopher Caldarone, Osami Honjo

CIRCULATION 128 ( 22 ) 2013年11月

Outcomes of Mechanical Circulatory Support for Patients With Functionally Single-Ventricle Physiology at Different Stages of Surgical Palliation 査読

Arezou Saedi, Devin Chetan, Yasuhiro Kotani, Nishanthi Liyanage, Lisa Zhao, Christopher Caldarone, Glen Van Arsdell, Osami Honjo

CIRCULATION 128 ( 22 ) 2013年11月

Determinants and clinical significance of flow via the fenestration in the Fontan pathway: a multimodality study 査読国際誌

Grosse-Wortmann L, Dragulescu A, Drolet C, Chaturvedi R, Kotani Y, Mertens L, Taylor K, La Rotta G, van Arsdell G, Redington A, Yoo SJ

Int J Cardiol 168 ( 2 ) 811 - 7 2013年9月

Surgical palliation strategy does not affect interstage ventricular dysfunction or atrioventricular valve regurgitation in children with hypoplastic left heart syndrome and variants 査読国際誌

Chetan D, Kotani Y, Jacques F, Poynter JA, Benson LN, Lee KJ, Chaturvedi RR, Friedberg MK, Van Arsdell GS, Caldarone CA, Honjo O

Circulation 128 ( 11 Suppl 1 ) S205-12 - S212 2013年9月

Current Cardioplegia Practice in Pediatric Cardiac Surgery: A North American Multi Institutional Survey 査読国際誌

Kotani Y, Tweddell J, Gruber P, Pizarro C, Austin III EH, Woods RK, Gruenwald C, Caldarone CA

Ann Thorac Surg 96 ( 3 ) 923 - 9 2013年9月

Medical errors: The performance gap in hypoplastic left heart syndrome and physiologic equivalents? 査読国際誌

Jacques F, Anand V, Hickey EJ, Kotani Y, Yadava M, Alghamdi A, Caldarone CA, Redington AN, Schwartz S, Van Arsdell GS

J Thorac Cardiovasc Surg 145 ( 6 ) 1465 - 73 2013年6月

Late functional outcomes after repair of tetralogy of Fallot with atrioventricular septal defect: A double case-match control study 査読国際誌

Kotani Y, Chetan D, Ono N, Mertens LL, Caldarone CA, Van Arsdell GS, Honjo O

J Thorac Cardiovasc Surg 145 ( 6 ) 1477 - 84 2013年6月

Evolution of technology, establishment of program, and clinical outcomes in pediatric extracorporeal membrane oxygenation: the "Sickkids" experience 査読国際誌

Kotani Y, Honjo O, Davey L, Chetan D, Guerguerian AM, Gruenwald C

Artif Organs 37 ( 1 ) 21 - 8 2013年1月

Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: current strategy and clinical outcomes 査読国際誌

Kotani Y, Chetan D, Rodrigues W, Sivarajan VB, Gruenwald C, Guerguerian AM, Van Arsdell GS, Honjo O

Artif Organs 37 ( 1 ) 29 - 36 2013年1月

Aortopulmonary collateral flow volume affects early postoperative outcome after Fontan completion: a multimodality study 査読国際誌

Grosse-Wortmann L, Drolet C, Dragulescu A, Kotani Y, Chaturvedi R, Lee KJ, Mertens L, Taylor K, La Rotta G, van Arsdell G, Redington A, Yoo SJ

J Thorac Cardiovasc Surg 144 ( 6 ) 1329 - 36 2012年12月

Longevity and durability of atrioventricular valve repair in single-ventricle patients 査読国際誌

Kotani Y, Chetan D, Atlin CR, Mertens LL, Jegatheeswaran A, Caldarone CA, Van Arsdell GS, Honjo O

Ann Thorac Surg 94 ( 6 ) 2061 - 9 2012年12月

Is indexed preoperative superior vena cava blood flow a risk factor in patients undergoing bidirectional cavopulmonary shunt? 査読国際誌

Kotani Y, Honjo O, Shani K, Merklinger SL, Caldarone C, Van Arsdell GS

Ann Thorac Surg 94 ( 5 ) 1578 - 83 2012年11月

Modes of Failure and Cause of Death in Children with Functional Single Ventricle Physiology Following Contemporary Total Cavopulmonary Connection Completion 査読

Yasuhiro Kotani, Devin Chetan, Jiaquan Zhu, Lisa Zhao, Luc Mertens, Andrew Redinoton, John Coles, Christopher Caldarone, Glen Van Arsdell, Osami Honjo

CIRCULATION 126 ( 21 ) 2012年11月

Hybrid versus Norwood strategies for single-ventricle palliation 査読国際誌

Baba K, Kotani Y, Chetan D, Chaturvedi RR, Lee KJ, Benson LN, Grosse-Wortmann L, Van Arsdell GS, Caldarone CA, Honjo O

Circulation 126 ( 11 Suppl 1 ) S123-31 - S131 2012年9月

Analysis of Code Division Multiplexing Technique Using a 2 Gchip/s Parallel CCD Matched Filter for 16-Channel ECDM-PON 査読

Yasuhiro Kotani, Hideyuki Iwamura, Masahiro Sarashina, Hideaki Tamai, Masayuki Kashima

IEICE TRANSACTIONS ON COMMUNICATIONS E95B ( 8 ) 2568 - 2575 2012年8月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：IEICE-INST ELECTRONICS INFORMATION COMMUNICATIONS ENG

In this paper, a novel charge coupled device matched filter (CCD-MF) for Electrical code division multiplexing (ECDM) decoder is proposed and experimentally demonstrated. Simulation results clarify the influence of low charge transfer efficiency (CTE) and the validity of a parallel CCD-MF we proposed. A 15-channel ECDM system using a 2 Gchip/s, 2-parallel CCD-MF is experimentally demonstrated.

DOI： 10.1587/transcom.E95.B.2568

Left main coronary artery compression long term after repair of conotruncal lesions: the bow string conduit 査読国際誌

Jacques F, Kotani Y, Deva DP, Moller T, Oechslin E, Horlick E, Osten M, Crean A, Benson LN, Wintersperger BJ, Caldarone CA

Ann Thorac Surg 94 ( 1 ) 283 - 5 2012年7月

The Dynamic Characteristics of LIM Using Disc-Shaped Secondary Side Converted into Linear Motion 査読

Yasuhiro Kotani, Toshimitsu Morizane, Kosuke Tsujikawa, Noriyuki Kimura, Hideki Omori

2012 15TH INTERNATIONAL CONFERENCE ON ELECTRICAL MACHINES AND SYSTEMS (ICEMS 2012) 2012年

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（国際会議プロシーディングス）出版者・発行元：IEEE

Linear motors have many applications because of their unique characteristic which are different from rotary machines. In particular, Linear Induction Motors (LIMs) have a simple and strong structure, a flexible mechanism, and so on. The most popular application of LIMs is in transportation systems. It is important to investigate the dynamic characteristics of LIMs in order for them to be successfully applied in transportation systems. However, it is difficult to measure the dynamic characteristics of LIMs. Long enough span or large enough diameter of a cylindrical drum is necessary for the secondary side in the ordinary measurement system.In this paper, the use of a disc-shaped secondary side to measure the dynamic characteristics of LIMs are proposed. The rotating dynamic characteristics of disc-shaped LIMs are converted into linear motion.

Double-barrel Damus-Kaye-Stansel operation is better than end-to-side Damus-Kaye-Stansel operation for preserving the pulmonary valve function: the importance of preserving the shape of the pulmonary sinus. 査読国際誌

Yasuhiro Fujii, Shingo Kasahara, Yasuhiro Kotani, Masami Takagaki, Sadahiko Arai, Shin-ichi Otsuki, Shunji Sano

The Journal of thoracic and cardiovascular surgery 141 ( 1 ) 193 - 9 2011年1月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: The Damus-Kaye-Stansel operation sometimes results in deteriorating semilunar valve insufficiency. We verified the semilunar valve function after the Damus-Kaye-Stansel operation and compared the end-to-side Damus-Kaye-Stansel with the double-barrel Damus-Kaye-Stansel. METHODS: Forty-seven patients who underwent the Damus-Kaye-Stansel operation between June 1993 and August 2008 were retrospectively reviewed. Any patient who underwent a Norwood-type operation was excluded. The median age at operation was 19 months (range, 0-276 months). Forty-five patients were Fontan candidates. Thirty-nine patients underwent pulmonary artery banding before the Damus-Kaye-Stansel operation. Twenty-two patients had undergone an arch repair previously. The semilunar valve function was evaluated by echocardiography. RESULTS: Thirteen patients underwent the end-to-side Damus-Kaye-Stansel operation, and 34 patients underwent the double-barrel Damus-Kaye-Stansel operation. The mean follow-up period was 71 ± 50 months (range, 1-188 months). Although there were 4 deaths, no death was related to the Damus-Kaye-Stansel procedure. Two of the patients with early death could not undergo a postoperative evaluation of the semilunar valves. The semilunar valve regurgitation mildly deteriorated in 7 patients (pulmonary regurgitation in 5 patients and aortic regurgitation in 2 patients). Pulmonary regurgitation deteriorated from none to mild in 1 patient, none to trivial in 2 patients, and trivial to mild in 2 patients. Both deteriorations in aortic regurgitation ranged from none to trivial. Semilunar valve regurgitation did not affect patients' circulatory condition. The end-to-side Damus-Kaye-Stansel operation more frequently caused a deterioration in pulmonary regurgitation than the double-barrel Damus-Kaye-Stansel operation (4/11 vs 1/34, P = .001). No surgical intervention for a systemic ventricular outflow obstruction was observed in the follow-up period. CONCLUSIONS: The double-barrel Damus-Kaye-Stansel operation was found to be superior to the end-to-side Damus-Kaye-Stansel operation for the prevention of postoperative pulmonary regurgitation.

DOI： 10.1016/j.jtcvs.2010.06.007

Evaluation of the appropriate root pressure for maintaining heartbeat during an aortic cross-clamp for primary repair of the aortic arch in premature infants with associated cardiac anomalies. 査読

Takanori Suezawa, Kozo Ishino, Osami Honjo, Satoru Osaki, Yasuhiro Kotani, Shunji Sano

Acta medica Okayama 64 ( 6 ) 391 - 7 2010年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

We developed a new cardiopulmonary bypass (CPB) method to minimize myocardial damage during aortic arch reconstruction. In this method, coronary flow and heartbeat were stabilized by maintaining the aortic root pressure with an adjusted preload of the ventricle during aortic cross-clamping. This study was performed to determine the appropriate root pressure to maintain the heartbeat without causing deterioration of ventricular function. Study 1. Under partial CPB, the ascending aorta was cross-clamped in 6 pigs (group 1). Experimental data at various systolic aortic root pressures was analysed to determine the appropriate root pressure. Study 2. In group 2 (control, n＝6), the aorta was not clamped, while in group 3 (n＝6), the aorta was cross-clamped for 60 min and the systolic aortic root pressure was maintained at the pressure determined in study 1. Study 1. The diastolic coronary flow was stabilized at values comparable to that before initiation of CPB (6.6±1.4 ml/beat) when the systolic aortic root pressure was above 80 mmHg. Intracardiac pressure and the myocardial oxygen consumption (MvO2) seemed to be acceptable when the systolic aortic root pressure was below 100 mmHg. Therefore, 90 mmHg was selected for study 2. Study 2. Perioperative cardiac function did not differ between the groups. We concluded that 90 mmHg was the systolic aortic root pressure appropriate for this method.

Extracorporeal membrane oxygenation following Norwood stage 1 procedures at a single institution. 査読国際誌

Shinya Ugaki, Shingo Kasahara, Yasuhiro Kotani, Mahito Nakakura, Takuma Douguchi, Hideshi Itoh, Sadahiko Arai, Shunji Sano

Artificial organs 34 ( 11 ) 898 - 903 2010年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Extracorporeal membrane oxygenation (ECMO) is an important circulatory assist for children with refractory cardiopulmonary dysfunction, but its role and indications after a stage 1 Norwood procedure are controversial. We assessed outcomes and risk factors in patients who underwent a Norwood palliation and ECMO at our institution. We retrospectively reviewed all patients who underwent a Norwood procedure and were supported with ECMO between January 1998 and January 2010. Of the 91 children who underwent a Norwood procedure during the study period, there were 15 postoperative runs of ECMO in 12 patients. The diagnoses of the patients included five with hypoplastic left heart syndrome, five with a hypoplastic left heart syndrome variant, and two with critical aortic stenosis. A total of four patients underwent bilateral pulmonary artery banding, and two patients underwent aortic valvuloplasty before the stage 1 Norwood procedure. The mean age of the patients was 28±30 days, and mean body weight was 2.6±0.5kg at the induction of ECMO. The indications for ECMO were low cardiac output in six children, circulatory collapse needing cardiopulmonary resuscitation in six children, and hypoxemia in three children. Five of the 12 patients were successfully weaned from ECMO. The significant risk factors for the inability to be weaned from ECMO were a history of circulatory collapse requiring cardiopulmonary resuscitation, and the induction of ECMO in the intensive care unit. Induction of ECMO may be considered earlier when hemodynamics are unstable in impaired patients following a stage 1 Norwood procedure to avoid circulatory collapse.

DOI： 10.1111/j.1525-1594.2010.01141.x

Growth of the lateral tunnel in patients who underwent a total cavopulmonary connection at less than 5 years of age. 査読国際誌

Yasuhiro Fujii, Yasuhiro Kotani, Masami Takagaki, Sadahiko Arai, Shingo Kasahara, Shin-ichi Otsuki, Shunji Sano

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 38 ( 1 ) 66 - 70 2010年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: A lateral tunnel-total cavopulmonary connection (LT-TCPC) using a right atrial (RA) free wall is the first choice of treatment for patients with a small body weight in this institute. Whether the growth of the LT is appropriate or not according to the growth of the body remains controversial. In addition, the optimal initial diameter of an LT is unknown. The purpose of this study was to verify the growth of the LT. METHODS: Ninety-one patients of a total of 267 TCPC cases underwent an LT-TCPC at less than 5 years of age in this institute between March 1991 and June 2008. The data on 47 of the 91 patients, which were available to investigate the LT growth, were retrospectively reviewed. The mean age at LT-TCPC was 37+/-11 months (16-57 months). The mean body weight at TCPC was 12.4+/-2.4 kg (7.6-20.0 kg). The initial LT diameter was determined with Hegar's sizer of the estimated half-pulmonary arterial (PA) diameter, which is a diameter that results in half of the dimension of the normal pulmonary valve. The measured maximum LT diameter (mm) divided by the estimated half-PA diameter (mm) was considered as the LT index. The size of the LT was evaluated using either echocardiography or angiography. RESULTS: The mean follow-up period was 7.4+/-3.5 years (1.6-13.5 years). The LT index was initially 2.0+/-0.7 (1.3-4.5), 2.0+/-0.4 (1.3-3.2) at 1 year after operation, 2.1+/-0.5 (1.5-3.2) at 5 years after operation, 1.9+/-0.4 (1.5-2.8) at 10 years after operation and 2.1+/-0.5 (1.6-2.5) at 13 years after operation, respectively. CONCLUSIONS: LT growth suitable for the body growth can be expected. Although there was some variation in the initial LT diameter, the LT index tended to converge at 2.0 with growth.

DOI： 10.1016/j.ejcts.2010.01.014

Fontan completion in patient with pulmonary artery sling associated with hypoplastic left heart syndrome. 国際誌

Yasuhiro Kotani, Kozo Ishino, Osami Honjo, Shunji Sano

The Journal of thoracic and cardiovascular surgery 140 ( 1 ) e12-3 2010年7月

The impact of the length between the top of the interventricular septum and the aortic valve on the indications for a biventricular repair in patients with a transposition of the great arteries or a double outlet right ventricle. 査読国際誌

Yasuhiro Fujii, Yasuhiro Kotani, Masami Takagaki, Sadahiko Arai, Shingo Kasahara, Shin-ichi Otsuki, Shunji Sano

Interactive cardiovascular and thoracic surgery 10 ( 6 ) 900 - 5 2010年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

The purpose of this study was to establish a useful cut-off level for performing an original Rastelli-type operation in patients with transposition of the great arteries (TGA)/ventricular septal defect (VSD) or double outlet right ventricle (DORV). A total of 43 patients with TGA/VSD or DORV who underwent an original Rastelli-type operation in this institute between March 1993 and January 2009 were reviewed retrospectively. These patients were divided into two groups using the length between the top of the interventricular septum and the aortic valve (IVS-AV length); Group A; IVS-AV length <80% of normal left ventricular end-diastolic diameter (LVDd). Group B; IVS-AV length > or =80% of normal LVDd. Group A had a significantly better survival than Group B (100% vs. 56%, P=0.001). The cardiac event-free survival were 89.1% at 7.2 years in Group A and 26.3% at 8.4 years in Group B (P<0.0001). The Group B had a higher incidence of left ventricular outflow tract obstruction (LVOTO; 3% vs. 33%, P=0.02). The IVS-AV length was found to be a significant risk factor for mortality and LVOTO. The IVS-AV length should, therefore, be taken into consideration when selecting the optimal surgical procedures for these patients.

DOI： 10.1510/icvts.2009.223982

Demonstration of 1.25 Gb/s x 8-Channels ECDM Using Eight-Chip Electrical Coding 査読

Yasuhiro Kotani, Hideyuki Iwamura, Hideaki Tamai, Masahiro Sarashina, Masayuki Kashima

IEEE PHOTONICS TECHNOLOGY LETTERS 22 ( 12 ) 875 - 877 2010年6月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC

In this letter, 1.25 Gb/s x 8-channels simultaneous multiplexing using 8-chip electrical codes is experimentally demonstrated for the downlink of a 10-Gb/s electrically code-division-multiplexing passive optical network (ECDM-PON) system. For electrical encoding and decoding, 10-Gb/s multilevel signal generation and 10 Gchip/s correlator as a decoder are utilized. We demonstrate 10-Gb/s ECDM error-free optical transmission over 20 km of single-mode fiber.

DOI： 10.1109/LPT.2010.2047010

Diagnosis-based differences in response of global ventricular performance to modified ultrafiltration in children.

Osami Honjo, Satoru Osaki, Yasuhiro Kotani, Teiji Akagi, Shunji Sano

Circulation journal : official journal of the Japanese Circulation Society 74 ( 1 ) 86 - 92 2010年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: To determine diagnosis-based differences in the response of global ventricular performance to modified ultrafiltration (MUF) using transesophageal echocardiography during congenital heart surgery. METHODS AND RESULTS: The study included 38 children with atrial septal defect (n=10), ventricular septal defect (VSD) (n=8), tetralogy of Fallot (TOF) (n=9), or a single ventricle (n=11). Arteriovenous MUF was performed for 10-15 min after cardiopulmonary bypass (CPB). The myocardial performance index (MPI) of the systemic ventricles and the % change in MPI before and after MUF were assessed. Impairment of MPI was noted at termination of CPB compared with baseline values in the VSD and TOF groups (P<0.05). MUF resulted in an improvement in MPI in all groups (P<0.01). There was a weak correlation between aortic cross-clamping or CPB time, and the degree of improvement in MPI (r= 0.385, P=0.019; r= 0.348, P=0.037, respectively). MUF improved fractional shortening in all groups (P<0.05) and reversed abnormal relaxation in the VSD and TOF groups. CONCLUSIONS: Modified ultrafiltration ameliorated MPI in all groups, indicating improved systemic ventricular function with MUF. The MPI recovery rate differed among the groups. MUF may be particularly useful for restoring the global ventricular performance of patients undergoing longer CPB and may have minimal advantages for simple open-heart surgery. (Circ J 2010; 74: 86 - 92).

Demonstration of 8-channels Simultaneous Multiplexing Using 8-chip Electrical Codes for 10 Gbit/s ECDM-PON 査読

Yasuhiro Kotani, Hideyuki Iwamura, Hideaki Tamai, Masahiro Sarashina, Masayuki Kashima

2010 CONFERENCE ON OPTICAL FIBER COMMUNICATION OFC COLLOCATED NATIONAL FIBER OPTIC ENGINEERS CONFERENCE OFC-NFOEC 2010年

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（国際会議プロシーディングス）出版者・発行元：IEEE

First time 8-channels electrically code division multiplexing technique for optical access networks is demonstrated at a chip-rate of 10 Gchip/s. The technique enables error-free transmission of 1.25 Gbit/s x 8-channels over 20 km single-mode-fiber. (C) 2010 Optical Society of America

Demonstration and Investigation of 1.25-Gbps per Subscriber Upstream Transmission Using 10G ECDM-PON Technology 査読

Yasuhiro Kotani, Hideyuki Iwamura, Hideaki Tamai, Masahiro Sarashina, Masayuki Kashima

2010 36TH EUROPEAN CONFERENCE AND EXHIBITION ON OPTICAL COMMUNICATION (ECOC), VOLS 1 AND 2 2010年

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（国際会議プロシーディングス）出版者・発行元：IEEE

First time, we have experimentally demonstrated 1.25-Gbps/subscriber 10-Gchip/s ECDM-PON upstream transmission over 20-km SSMF using WDM light sources. Additionally, optical beating induced performance degradation was investigated by varying WDM channel spacing from 100-GHz to 10-GHz.

The potential of disproportionate growth of tricuspid valve after decompression of the right ventricle in patients with pulmonary atresia and intact ventricular septa. 査読国際誌

Shu-Chien Huang, Kozo Ishino, Shingo Kasahara, Ko Yoshizumi, Yasuhiro Kotani, Shunji Sano

The Journal of thoracic and cardiovascular surgery 138 ( 5 ) 1160 - 6 2009年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Tricuspid valve size is the major determinant of outcomes for patients with pulmonary atresia with intact ventricular septum. Lack of right ventricle-pulmonary artery continuity is associated with poor tricuspid valve growth (decrement in Z-value). However, most reports did not show evidence for disproportionate growth of the tricuspid valve after establishment of right ventricle-pulmonary artery continuity. METHODS: We studied 40 patients with pulmonary atresia with intact ventricular septum who underwent initial right ventricular decompression for planned staged repair. The initial Z-value of the tricuspid valve diameter (Zt1) was obtained from the echocardiography-derived normal value. The late Z-value (Zt2) was measured before definitive repair or the last available Z-value, if definitive repair was not yet reached. The factors associated with the changes of Z-values (Zt2 - Zt1) were analyzed. RESULTS: The mean initial tricuspid Z-value (Zt1) was -6.2 +/- 3.5. After treatment (Zt2), the mean Z-value was -6.0 +/- 3.4 (n = 34). Overall, the tricuspid Z-values did not change. Individually, the change in Z-value (Zt2 - Zt1) was larger than +2 in 11 (32%) patients and smaller than -2 in 6 (18%) patients. Increases in Z-value (Zt2 - Zt1) were significantly associated with right ventricular pressure/left ventricular pressure ratio measured after initial palliation (r = -0.54; P = .001) and the initial tricuspid valve Z-value (Zt1) (r = -0.40; P = .02). CONCLUSIONS: Disproportional growth of the tricuspid valve can occur, especially in patients with small tricuspid valves and lower right ventricular pressures after decompression. The findings support the possibility of neonates with small tricuspid valves undergoing biventricular repair after right ventricular decompression surgery.

DOI： 10.1016/j.jtcvs.2009.05.015

Effect of a miniaturized cardiopulmonary bypass system on the inflammatory response and cardiac function in neonatal piglets. 査読国際誌

Ko Yoshizumi, Kozo Ishino, Shinya Ugaki, Hironori Ebishima, Yasuhiro Kotani, Shingo Kasahara, Shunji Sano

Artificial organs 33 ( 11 ) 941 - 6 2009年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

The cognitive impairment and hemodynamic instability after neonatal cardiac surgery with cardiopulmonary bypass (CPB) might be exacerbated by hemodilution. Therefore, this study investigated the impact of different bloodless prime volumes on the hemodynamics and the inflammatory response by a miniaturized CPB system in neonatal piglets. The bypass circuit consisted of a Capiox RX05 (Capiox Baby RX, Terumo Corp., Tokyo, Japan) oxygenator and 3/16 internal diameter arterial and venous polyvinyl chloride tubing lines, with a minimum 75 mL prime volume. Twelve 1-week-old piglets were placed on a mild hypothermic CPB (32 degrees C) at 120 mL/kg/min for 2 h. The animals were divided into two groups, based on the volume of the prime solution. The priming volume was 75 mL in Group I and 175 mL in Group II. No blood transfusions were performed, and no inotropic or vasoactive drugs were used. The interleukin-6 (IL-6) and thrombin-antithrombin (TAT) complex levels, as well as right ventricular and pulmonary functions, were measured before and after CPB. Group I had low levels of IL-6 and TAT immediately after CPB (4370 +/- 2346 vs. 9058 +/- 2307 pg/mL, P < 0.01 and 9.9 +/- 7.7 vs. 25.1 +/- 8.8 ng/mL, P < 0.01, respectively). Group I had significantly improved cardiopulmonary function, cardiac index (0.22 +/- 0.03 vs. 0.11 +/- 0.05 L/kg/min, P < 0.001), and pulmonary vascular resistance index (7366 +/- 2860 vs. 28 620 +/- 15 552 dynes/cm(5)/kg, P < 0.01) compared with Group II. The miniaturized bloodless prime circuit for neonatal CPB demonstrated that the influence of hemodilution can reduce the subsequent inflammatory response. In addition, a low prime volume could therefore be particularly effective for attenuating pulmonary vascular resistance and right ventricular dysfunction in neonates.

DOI： 10.1111/j.1525-1594.2009.00922.x

The benefits of high-flow management in children with pulmonary atresia. 査読国際誌

Yasuhiro Fujii, Yasuhiro Kotani, Takuya Kawabata, Shinya Ugaki, Shigeru Sakurai, Hironori Ebishima, Hideshi Itoh, Mahito Nakakura, Sadahiko Arai, Shingo Kasahara, Shunji Sano, Tatsuo Iwasaki, Yuichiro Toda

Artificial organs 33 ( 11 ) 888 - 95 2009年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

The high-flow management of cardiopulmonary bypass (CPB; >or=2.4 L/min/m(2)) is a standard strategy used at this institute for children with pulmonary atresia (PA) due to a fear that the blood flow may be diverted by the major/minor aortopulmonary-collateral-arteries and hypervascularization due to long-term hypoxia. The purpose of this study was to describe the validity of high-flow management in children with PA. The CPB records of 23 children with PA who underwent a definitive biventricular repair between Feb 2006 and Nov 2008 were retrospectively reviewed. The mean age at the operation was 33 +/- 22 months. The blood-pressure during bypass was controlled with the same protocol. The mean cooling-temperature was 28.4 +/- 3.7 degrees C. The mean minimum hematocrit was 25.0 +/- 3.4%. The mean maximum bypass flow index at the initiation, the mean maximum flow index during aortic cross-clamping, the mean minimum flow index during aortic cross-clamping, and the mean maximum flow index after rewarming were 3.1 +/- 0.5, 3.1 +/- 0.5, 2.6 +/- 0.4, and 3.2 +/- 0.4 L/min/m(2), respectively. The higher bypass flow indexes significantly correlated with the lower serum lactate levels. The lowest oxygen delivery during CPB had significant influences on the urine output during bypass (R = 0.547, P = 0.007), the serum lactate levels at the end of CPB (R = -0.442, P = 0.035), and the postoperative thoracic effusion (R = -0.459, P = 0.028). A bypass flow index of 2.4 L/min/m(2) may not be sufficient and the maximum requirement of bypass flow index may be 3.2 L/min/m(2) or more in this patient population.

DOI： 10.1111/j.1525-1594.2009.00895.x

Clinical outcome of the Fontan operation in patients with impaired ventricular function. 査読国際誌

Yasuhiro Kotani, Shingo Kasahara, Yasuhiro Fujii, Ko Yoshizumi, Yu Oshima, Shin-Ichi Otsuki, Teiji Akagi, Shunji Sano

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 36 ( 4 ) 683 - 7 2009年10月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Although a staged Fontan strategy allows for an excellent outcome in high-risk patients, an impaired ventricular function remains a significant factor of early/late mortality and morbidity. This study evaluated the clinical outcome of the Fontan operation in patients with impaired ventricular function. METHODS: A retrospective review was performed on 217 patients who had undergone the Fontan operation between 1991 and 2007. RESULTS: Twenty-nine (13%) of the 217 patients had an impaired ventricular function (ejection fraction (EF) <50%). The median age at the time of the operation was 3 (range: 1-31 years) years. There were five adult patients. The ventricular morphology was right in 20 patients (including five hypoplastic left heart syndrome (HLHS)) and others (left and two-ventricle) in nine patients. Heterotaxy syndrome was present in eight patients. Previous surgical interventions included bidirectional Glenn anastomoses in 24, modified Blalock-Taussig shunts in two and pulmonary artery banding in two. The preoperative EF was 43+/-6%. Significant (moderate or severe) atrioventricular valve regurgitation was noted in four patients. The percutaneous oxygen saturation (SpO(2)) was 82+/-5%. The pulmonary artery pressure and pulmonary artery index were 11+/-3 mmHg and 296+/-102 mm(2)m(-2), respectively. All 29 patients underwent the Fontan operation without any early mortality. There were two late mortalities and two re-operations. EF was maintained at 59+/-15% at a median follow-up of 7.5 (range: 1-19) years. The percent normal systemic ventricular end-diastolic volume decreased from 174+/-95% to 124+/-39% (p<0.05). The SpO(2) increased to 92+/-2%. The mean cardiothoracic ratio in chest X-ray and B-type natriuretic peptide were 51% (range: 35-68%) and 22 pgml(-1) (range: 9-382 pgml(-1)), respectively. Three patients developed congestive heart failure, seven had arrhythmia and two developed protein-losing enteropathy. The New York Heart Association (NYHA) class functional class is I in 21 patients, II in five and III in one. CONCLUSIONS: Acceptable clinical outcomes were observed at an intermediate follow-up of the Fontan operation in patients with an impaired ventricular function.

DOI： 10.1016/j.ejcts.2009.04.042

Single center experience with a low volume priming cardiopulmonary bypass circuit for preventing blood transfusion in infants and small children

Yasuhiro Kotani, Osami Honjo, Mahito Nakakura, Yasuhiro Fujii, Shinya Ugaki, Yu Oshima, Ko Yoshizumi, Shingo Kasahara, Shunji Sano

ASAIO Journal 55 ( 3 ) 296 - 299 2009年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

This retrospective study analyzed the current practice of blood transfusion-free open-heart surgery in 536 children weighing 5-20 kg undergoing surgery between 2004 and 2007. A miniaturized cardiopulmonary bypass (CPB) circuit was used (priming volume
300 ml for the flow rate &lt
1,500 ml/min
550 ml for the flow rate of 1500-2300 ml/min). Modified ultrafiltration was routinely performed. Criteria for blood transfusion during CPB included a hematocrit of &lt
20% and/or mixed venous oxygen saturation of &lt
65%. Transfusion during CPB was avoided in 264 (49.3%) of the 536 patients (5-10 kg group, 29.0%
11-15 kg group, 67.4%
16-20 kg group, 80.8%). There was no neurological complication related to hemodilution. Multiple logistic regression analysis revealed that body weight, preoperative hematocrit, priming volume of CPB circuit, CPB time, and lowest hematocrit during CPB predict requirement of blood transfusion (p &lt
0.01). Transfusion rate was lowest in the atrial septal defect group (5.6%) and highest in tetralogy of Fallot group (78.7%), being associated with complexity of diagnosis and procedure required. Blood transfusion-free open-heart surgery may be achieved in the half of the patients weighing 5-20 kg, and further miniaturization of CPB circuit and refinement of perfusion strategy might reduce transfusion rate in patients &lt
10 kg and/or with complex congenital heart disease. ©2009Amercian Society of Artificial Internal Organs.

DOI： 10.1097/MAT.0b013e31819742f0

Ultrafiltration of priming blood before cardiopulmonary bypass attenuates inflammatory response and maintains cardiopulmonary function in neonatal piglets

Shinya Ugaki, Osami Honjo, Yasuhiro Kotani, Mahito Nakakura, Takuma Douguchi, Yu Oshima, Ko Yoshizumi, Shingo Kasahara, Shunji Sano

ASAIO Journal 55 ( 3 ) 291 - 295 2009年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Blood priming is necessary for cardiopulmonary bypass (CPB) in neonates to avoid excessive hemodilution
however, transfusion-related inflammation affects postCPB outcomes in neonatal open-heart surgery. We hypothesized that ultrafiltration of priming blood before CPB may reduce inflammatory mediators in priming blood and postCPB inflammatory responses, thereby improving cardiopulmonary function. Twelve 1-week-old piglets (3.5 ± 0.2 kg) were divided into two groups. Group U (n = 6) employed the priming blood ultrafiltrated before CPB, but group N (n = 6) used the nonultrafiltrated blood. Cardiopulmonary bypass was performed for 2 hours and then modified ultrafiltration (MUF) was conducted. Data were acquired before CPB and after MUF. The values of K, serotonin, and IL-8 in priming blood was significantly decreased after ultrafiltration (8.2 ± 2.6 vs. 4.2 ± 0.8 mEq/L, p &lt
0.01, 234 ± 96 vs. 74 ± 42 ng/ml, p &lt
0.01, 78.4 ± 5.1 vs. 64.5 ± 59.1 pg/ml, p &lt
0.05). Group U after MUF had lower thrombin-antithrombin complex levels (23.9 ± 5.1 vs. 33.7 ± 4.6 ng/ml, p &lt
0.01) and lower IL-8 levels in airway fluid (925 ± 710 vs. 2495 ± 1207 pg/ml, p &lt
0.05) than group N. Cardiac output and arterial PO2 after MUF in group U were also higher (1.13 ± 0.21 vs. 0.69 ± 0.22, p &lt
0.01, 340 ± 190 vs. 149 ± 84 mm Hg, p &lt
0.05). The ultrafiltration of blood priming before CPB attenuated activation of the coagulation pathway and inflammatory responses and preserved cardiopulmonary function in neonatal piglets. ©2009Amercian Society of Artificial Internal Organs.

DOI： 10.1097/MAT.0b013e31819b00c2

Modified low-flow ultrafiltration ameliorates hemodynamics and early graft function and reduces blood loss in living-donor lobar lung transplantation. 国際誌

Yasuhiro Kotani, Osami Honjo, Keiji Goto, Yasufumi Fujita, Atsushi Ito, Mahito Nakakura, Masaaki Kawada, Shunji Sano, Kazutoshi Kotani, Hiroshi Date

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 28 ( 4 ) 340 - 6 2009年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: This study analyzed the clinical application of modified low-flow ultrafiltration (MUF) to minimize cardiopulmonary bypass (CPB)-related adverse effects in patients undergoing living-donor lobar lung transplantation (LDLLT). METHOD: The study enrolled 33 consecutive patients who underwent LDLLT from 1999 to 2004: 8 patients underwent conventional CPB without MUF (control group), and 15 underwent arteriovenous MUF (MUF-treated group). Hemodynamics, graft function, blood loss and blood transfusion requirements, and clinical outcomes were analyzed. RESULTS: There was a significant increase in systolic blood pressure and a decrease in pulmonary to systemic pressure ratio in the MUF-treated group (p < 0.05). No hemodynamic changes occurred in the control group. MUF resulted in significant improvements in arterial oxygen tension/fraction of inspired oxygen ratio (PaO(2)/FiO(2;) 411 +/- 107 vs 272 +/- 107 mm Hg, p < 0.05) and the alveolar-arterial oxygen difference (a-aDO(2); 158 +/- 84 vs 315 +/- 127 mm Hg, p < 0.05) at 15 minutes after CPB. There were no differences in PaO(2)/FiO(2) and A-aDO(2) between the groups beyond 6 hours post-operatively. Post-operative blood loss and blood transfusion requirements were lower in the MUF-treated group than in the control group (p < 0.05). There were no differences in survival, duration of ventilation, intensive care unit stay, and hospital stay between the groups. CONCLUSIONS: The low-flow MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT.

DOI： 10.1016/j.healun.2009.01.004

Circulatory load during hypoxia impairs post-transplant myocardial functional recovery in donation after cardiac death. 国際誌

Satoru Osaki, Kozo Ishino, Yasuhiro Kotani, Osami Honjo, Takanori Suezawa, Takushi Kohmoto, Shunji Sano

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 28 ( 3 ) 266 - 72 2009年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Circulatory load during hypoxia is unavoidable in donation after cardiac death (DCD) hearts, but it causes severe myocardial damage. The impact of circulatory load on donor heart function has not been investigated. The purpose of this study was to evaluate its effect on post-transplant functional recovery of DCD hearts. METHODS: Twelve donor pigs (20 kg) were used. Cardiac arrest was induced by asphyxiation (turning off the ventilator) in the load group (n = 6) and by exsanguination (dividing the vena cava) in the unload group (n = 6). Left ventricle end-diastolic volume (LDEDV) and end-systolic pressure (LVESP) were monitored until cardiac arrest. Orthotopic transplantation was performed after 30-minute warm ischemia following cardiac arrest. After weaning from cardiopulmonary bypass, left ventricular end-diastolic pressure-volume ratio (LV Emax) and creatine kinase (CK-MB) were measured while on 0.1 microg/kg/min epinephrine. RESULTS: During the agonal period, the maximum LVEDV and LVESP in the load group were 132 +/- 1% of baseline at 10 minutes and 148 +/- 16% of baseline at 4 minutes, respectively. Recovery rates of post-transplant cardiac function in the load group were worse than in the unload group (LV Emax: 64 +/- 8 vs 84 +/- 5%, p < 0.05). Levels of post-transplant CK-MB in the load group were higher than in the unload group (639 +/- 119 vs 308 +/- 70 IU/liter, p < 0.05). CONCLUSIONS: Cardiac arrest with circulatory load by asphyxiation caused more myocardial damage than unloaded arrest. This difference between the modes of death should be considered when evaluating the DCD hearts for clinical application.

DOI： 10.1016/j.healun.2008.12.002

Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. 査読国際誌

Yasuhiro Fujii, Shunji Sano, Yasuhiro Kotani, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Teiji Akagi

The Annals of thoracic surgery 87 ( 2 ) 562 - 70 2009年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Adult patients who do not fulfill the classical Fontan criteria now undergo total cavopulmonary connection (TCPC). However, limited information is available on the results for high-risk adult TCPC. METHODS: Twenty-five consecutive adult patients (aged 16 years or more) who underwent TCPC were retrospectively reviewed. The mean age at operation was 27 +/- 9 years (range, 16 to 52). The following items were considered as the potential risk factors according to previous reports: (1) aged more than 30 years (7 of 25); (2) heterotaxy (9 of 25); (3) systemic ventricular ejection fraction less than 50% (6 of 25); (4) atrioventricular valve regurgitation moderate or greater (6 of 25); (5) pulmonary arterial index less than 200 (7 of 25); (6) mean pulmonary arterial pressure 15 mm Hg or greater (3 of 25); (7) pulmonary arterial resistance 2.0 wood units or greater (11 of 25); (8) arrhythmias (13 of 25); (9) protein-losing enteropathy (3 of 25); (10) New York Heart Association (NYHA) functional class III or greater (9 of 25); (11) previous Fontan procedure (10 of 25); (12) systemic ventricular outflow obstruction (1 of 25); and (13) end-diastolic pressure of the systemic ventricle 11 mm Hg or higher (4 of 25). RESULTS: The mean follow-up period was 57 +/- 45 months (range, 0 to 154). All patients had at least 2 risk factors (range, 2 to 8). There was 1 early death and 2 late deaths. Comparing the late survivors and nonsurvivors, no statistical significance was identified in the above risk factors. However, the patients with 6 or more risk factors had a significantly higher mortality rate than patients with fewer than 6 risk risk factors (p < 0.01). Age (p = 0.08), NYHA class (p = 0.13), and protein-losing enteropathy (p = 0.08) may be risk factors for late death. CONCLUSIONS: The majority of the adult TCPC candidates tolerated the TCPC procedure in the early postoperative period. However, the accumulation of risk factors influences late mortality.

DOI： 10.1016/j.athoracsur.2008.10.040

Risk factors for mortality after the Norwood procedure using right ventricle to pulmonary artery shunt. 査読国際誌

Shunji Sano, Shu-Chien Huang, Shingo Kasahara, Ko Yoshizumi, Yasuhiro Kotani, Kozo Ishino

The Annals of thoracic surgery 87 ( 1 ) 178 - 85 2009年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The purpose of this study was to describe the experience with staged surgical reconstruction of the hypoplastic left heart syndrome (HLHS) with a right ventricle to pulmonary artery conduit and to identify the risk factors that influence late outcome. METHODS: Between February 1998 and June 2007, 62 patients with HLHS underwent a Norwood procedure by using right ventricle to pulmonary artery conduit (median age, 9 days [range, 1 to 57]; median body weight 2.7 kg [range, 1.6 to 3.9 kg]). The subsequent 47 patients underwent a bidirectional Glenn procedure (stage 2). Thirty-two patients underwent a modified Fontan procedure (stage 3). Follow-up was complete (median, 32 months; range, 1 to 101). RESULTS: Hospital mortality after the Norwood procedure was 8% (5 of 62 patients). Between stages, 9 patients died, 3 before stage 2 and 6 before stage 3. There was 1 late death after stage 3. Overall survival was 76% (47 of 62). The estimated 1-year and and 5-year survival rates were 80% and 73%, respectively. Using the any-mortality as the endpoint, prematurity (gestational age <37 weeks), body weight less than 2.5 kg at stage 1 operation, and tricuspid regurgitation 2+ or more were associated with mortality. Using Cox regression analysis, body weight less than 2.5 kg and tricuspid regurgitation 2+ or more were two independent factors associated with midterm survival. CONCLUSIONS: From 9 years of experience, despite good early survival after Norwood stage 1 palliation, low body weight and tricuspid valve regurgitation were still associated with worse outcome. More efforts should be made to improve the late results for patients with hypoplastic left heart syndrome.

DOI： 10.1016/j.athoracsur.2008.08.027

Effect of modified ultrafiltration on postoperative course in neonates with complete transposition of the great arteries undergoing arterial switch operation.

Yasuhiro Kotani, Osami Honjo, Satoru Osaki, Takuya Kawabata, Shinya Ugaki, Yasuhiro Fujii, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Shunji Sano

Circulation journal : official journal of the Japanese Circulation Society 72 ( 9 ) 1476 - 80 2008年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The purpose of the present study was to evaluate the effect of modified ultrafiltration (MUF) on neonates with transposition of the great arteries (TGA) undergoing arterial switch operation. METHODS AND RESULTS: The current study included 36 neonates who underwent an arterial switch operation between 1998 and 2006. Arterio-venous MUF was done in 15 patients (MUF-treated group) and the other 21 patients were controls. Parameters included hematocrit, hemodynamics, pulmonary function, drain loss, leak of peritoneal fluid, length of intubation, and intensive care unit (ICU) stay. The hematocrit increased from 34+/-2% to 47+/-4% in the MUF-treated group. Blood pressure in the MUF-treated group was significantly increased without any change of central venous or left atrial pressure. Post-operative oxygenation in the MUF-treated group was greater than that of the control group (P/F ratio: 258+/-92 vs 170+/-100 mmHg, p<0.05), which did not contribute to decrease in intubation time (54+/-33 vs 52+/-29 h, p=NS). Post-operative chest drain loss and peritoneal fluid leak were comparable. The ICU stay in the MUF-treated group was significantly shorter than that in the controls (101+/-34 vs 139+/-42 h, p<0.05). CONCLUSIONS: MUF brought improvement in blood pressure and gas exchange capacity and subsequent shorter ICU stay. MUF did not have significant impact on intubation time and capillary leak.

Clinical outcome of Fontan operation in the patients with impaired cardiac function

Yasuhiro Kotani, Shingo Kasahara, Yasuhiro Fujii, Ko Yoshizumi, Yu Oshima, Shin-Ichi Otsuki, Teiji Akagi, Shunji Sano

JOURNAL OF CARDIAC FAILURE 14 ( 7 ) S151 - S151 2008年9月

Clinical implication of early ventricular volume reduction for hypoplastic left heart syndrome with significant tricuspid valve regurgitation

Yasuhiro Kotani, Teiji Akagi, Shingo Kasahara, Ko Yoshizumi, Yu Ohshima, Shunji Sano

INTERNATIONAL JOURNAL OF CARDIOLOGY 122 73 - 73 2007年12月

Tolerance of the developing cyanotic heart to ischemia-reperfusion injury: Impact of hypoxia from birth

Yasuhiro Fujii, Kozo Ishino, Tomoko Tomii, Yasuhiro Kotani, Yoshinori Miyahara, Shingo Kasahara, Shunji Sano, Teiji Akag, Yuki Katanosaka, Satoru Mori

INTERNATIONAL JOURNAL OF CARDIOLOGY 122 47 - 47 2007年12月

Right ventricular outflow tract reconstruction in patients with persistent truncus arteriosus: a 15-year experience in a single Japanese center.

Osami Honjo, Yasuhiro Kotani, Teiji Akagi, Satoru Osaki, Masaaki Kawada, Kozo Ishino, Shunji Sano

Circulation journal : official journal of the Japanese Circulation Society 71 ( 11 ) 1776 - 80 2007年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The present study analyzes a 15-year experience of repairing persistent truncus arteriosus (PTA) with a consistent policy of right ventricular outflow tract (RVOT) reconstruction (ie, direct anastomosis). METHODS AND RESULTS: This retrospective study included 13 consecutive patients with PTA (8 type I PTA, 5 type II) who underwent primary repair from September 1992 to December 2006. Median age and body weight at surgery were 21 days and 2.9 kg, respectively. All but 1 patient underwent RVOT reconstruction by direct anastomosis with a monocusp patch. There were 2 operative deaths (12%). No patient had a pulmonary hypertensive crisis. The median duration of ventilation was 5 days. Another patient died from cardiogenic shock resulting from late cardiac tamponade 2 months after surgery. Four patients (40%) required balloon angioplasty and 5 (50%) required re-operation for branch pulmonary artery and/or conduit obstruction during the median follow-up period of 70 months (44-174 months). Freedom from all re-interventions and re-operation at 5 years was 50% (95% confidence limits, 19-81%) and 60% (95% confidence limits, 30-91%), respectively. CONCLUSIONS: Reasonable early and long-term results can be achieved with direct anastomosis. Further reduction of the re-intervention rate could be attained by refining the surgical techniques and catheter intervention strategies.

Efficacy of a miniature centrifugal rotary pump (TinyPump) for transfusion-free cardiopulmonary bypass in neonatal piglets

Shinya Ugaki, Kozo Ishino, Satoru Osaki, Yasuhiro Kotani, Osami Honjo, Hideo Hoshi, Naoyuki Yokoyama, Katsuhiro Ohuchi, Setsuo Takatani, Shunji Sano

ASAIO JOURNAL 53 ( 6 ) 675 - 679 2007年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

We have developed a miniaturized semiclosed cardiopulmonary bypass (CPB) circuit incorporating a centrifugal blood pump (TinyPump) with a volume of 5 ml. The current study was undertaken to evaluate the hemolytic performance of the TinyPump in comparison with the BioPump and to investigate the impact of different CPB circuit volumes on hemodilution, coagulation, and the inflammatory response. Twelve 1-week-old piglets (3.4 +/- 0.2 kg) were used. The circuit comprised a centrifugal pump, a membrane oxygenator, and a cardiotomy reservoir. Cardiopulmonary bypass was conducted with mild hypothermia at 150 ml/kg/min for 3 hours. Transfusion was not performed. Priming volume was 68 ml for the circuit with the TinyPump and 111 nil for the circuit with the BioPump. Although the TinyPump required higher speed, plasma free hemoglobin levels after CPB were not different between the groups. After CPB, the TinyPump group had a significantly higher hematocrit (27% +/- 3% vs. 23% +/- 3%) and lower platelet reduction rate, lower thrombin-antithrombin complex levels, and lower interleukin-6 levels. Better lung compliance with less water content was observed in the TinyPump group. The TinyPump maintained CPB with acceptable hemolysis and lower inflammatory responses. This miniaturized CPB circuit may make transfusion-free open heart surgery feasible in neonates and would help to prevent postoperative organ dysfunction.

DOI： 10.1097/MAT.0b013e3181590719

Impact of miniaturization of cardiopulmonary bypass circuit on blood transfusion requirement in neonatal open-heart surgery

Yasuhiro Kotani, Osami Honjo, Mahito Nakakura, Shinya Ugaki, Takuya Kawabata, Yosuke Kuroko, Satoru Osaki, Ko Yoshizumi, Shingo Kasahara, Kozo Ishino, Shunji Sano

ASAIO JOURNAL 53 ( 6 ) 662 - 665 2007年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

This study was undertaken to determine the impact of miniaturization of a cardiopulmonary bypass (CPB) circuit on blood transfusion and hemodynamics in neonatal open-heart surgery. Neonates (n = 102) undergoing open-heart surgery between 2002 and 2006 were included and divided into three groups: group 1 (n = 28), Dideco 902 oxygenator + 5/16 '' line; group 2 (n = 29), Dideco 901 oxygenator + 1/4 '' line; group3 (n = 45), Dideco 901 oxygenator + 3/16 '' arterial + 1/4 '' venous line. Amount of priming volume, blood and bicarbonate sodium use during CPB, and hemodynamics were compared. Priming volume in the groups 2 and 3 was significantly less compared with the group 1 (group 1, 575 37 ml; group 2, 328 +/- 12 ml, group 3, 326 +/- 5 ml, p < 0.05). Blood transfusion and bicarbonate sodium use during CPB in groups 2 and 3 were significantly less compared with group 1. Hemodynamics during CPB was comparable. There were no differences between groups 2 and 3 in any parameter. Miniaturization of the CPB circuit resulted in decrease in priming volume and subsequent reduction in blood and bicarbonate sodium use. Downsizing the lines had minimal impact on any of the parameters studied, and further efforts should be made to achieve neonatal open-heart surgery without blood transfusion.

DOI： 10.1097/MAT.0b013e318158ddf6

Efficacy of MCI-186, a free-radical scavenger and antioxidant, for resuscitation of nonbeating donor hearts. 査読国際誌

Yasuhiro Kotani, Kozo Ishino, Satoru Osaki, Osami Honjo, Takanori Suezawa, Kazushige Kanki, Chikao Yutani, Shunji Sano

The Journal of thoracic and cardiovascular surgery 133 ( 6 ) 1626 - 32 2007年6月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: Oxygen-derived free radicals are responsible in part for reperfusion injury in globally ischemic myocardium. In this study, the efficacy for resuscitation of nonbeating donor hearts of MCI-186, a free-radical scavenger and antioxidant, was investigated in a pig transplantation model. METHODS: Cardiac arrest was induced by asphyxiation. After 30 minutes of global ischemia, the hearts were excised and immediately reperfused from the aortic root with normoxemic blood cardioplegia (PO2 100 mm Hg) for 20 minutes, followed by perfusion with hyperoxemic blood (PO2 300 mm Hg). MCI-186 (3 mg/kg) was administered into the aortic root for the first 30 minutes of reperfusion in the treated group (n = 6), and untreated hearts were used as a control group (n = 6). Transplantation was performed with the heart beating. RESULTS: Posttransplantation recovery of cardiac output, end-systolic pressure-volume ratio, and first derivative of pressure of the left ventricle in the treated group were significantly better than those in the control group. The coronary sinus-aortic root difference in malondialdehyde levels remained low throughout reperfusion in the treated group but abruptly increased after initiation of oxygenated blood perfusion in the control group. The MCI-186-treated hearts showed low degree of edema and well-preserved ultrastructure with normal-appearing organelles, whereas the untreated hearts had marked swelling of mitochondria and scant glycogen granules. CONCLUSION: MCI-186 exerts a cardioprotective action at least partly by inhibition of lipid peroxidation. Antioxidant therapy at the initial reperfusion is essential to successful resuscitation of nonbeating hearts by continuous myocardial perfusion.

Feasibility of a tiny centrifugal blood pump (TinyPump) for pediatric extracorporeal circulatory support. 国際誌

Katsuhiro Ohuchi, Hideo Hoshi, Yasuhiko Iwasaki, Kazuhiko Ishihara, Masaharu Yoshikawa, Shinya Ugaki, Kozo Ishino, Satoru Osaki, Yasuhiro Kotani, Shunji Sano, Setsuo Takatani

Artificial organs 31 ( 5 ) 408 - 12 2007年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

In this study, the performances of the TinyPump (priming volume 5 mL) system including the pediatric cannulae (Stöckert Pediatric Arterial Cannulae 2.6, 3.0, and 4.0 mm, Stöckert Instruments GmbH, Munich, Germany; Polystan 20-Fr Venous Catheter, MAQUET GmbH, Rastatt, Germany) and an oxygenator (Terumo Capiox RX05 Baby-RX, Terumo Cardiovascular Systems Co., Tokyo, Japan) were studied in vitro followed with preliminary ex vivo studies in 20-kg piglets. In vitro results revealed that the TinyPump system met the requirements for pump speed, pump flow, and pressure drop as extracorporeal circulatory support during open heart surgery and extracorporeal membrane oxygenation (ECMO) in pediatric patients. In 2-h ex vivo studies using 20-kg piglets where the blood contacting surface of the TinyPump was coated with a biocompatible phospholipid polymer, the plasma-free hemoglobin levels remained less than 5.0 mg/dL and no thrombus formation was observed inside the pump. The TinyPump system including the oxygenator and connecting circuits resulted in an overall priming volume of 68 mL, the smallest ever reported. The TinyPump can be a safe option for pediatric circulatory support during open heart surgery and ECMO without requiring blood transfusion.

Left ventricular retraining and anatomic correction in teenage patient with congenitally corrected transposition of the great arteries.

Osami Honjo, Masaaki Kawada, Teiji Akagi, Yasuhiro Kotani, Kozo Ishino, Shunji Sano

Circulation journal : official journal of the Japanese Circulation Society 71 ( 4 ) 613 - 6 2007年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Left ventricular (LV) retraining followed by anatomical repair would be a superior alternative in patients with congenitally corrected transposition (ccTGA) having a deconditioned morphologically left ventricle (MLV); however, LV retraining in older children is a challenging task. A retraining process of the MLV in a teenage patient with ccTGA is reported here. Cardiac catheterization at 7 years of age revealed low pressure of the MLV (33/4 mm Hg) and a LV to right ventricular pressure ratio (LVp/RVp ratio) of 0.32. The first pulmonary artery banding (PAB) was performed at 10 years of age. Although the LVp/RVp ratio reached 0.68, there was no evidence of adequate LV hypertrophy. The second PAB was performed 2 years after the initial PAB, resulting in an increase in the LVp/RVp ratio to 0.93 and an adequate LV hypertrophy. The double switch procedure was successfully performed at 13 years of age. Although the ejection fraction of the MLV mildly decreased, the patient has been doing well during a follow-up period of 4 years. The MLV in the teenage patient with ccTGA was successfully trained using a retraining strategy and has sustained systemic circulation after anatomical repair.

Discrepancy between intraoperative transesophageal echocardiography and postoperative transthoracic echocardiography in assessing congenital valve surgery. 査読国際誌

Osami Honjo, Yasuhiro Kotani, Satoru Osaki, Yasufumi Fujita, Takanori Suezawa, Atsushi Tateishi, Kozo Ishino, Masaaki Kawada, Teiji Akagi, Shunji Sano

The Annals of thoracic surgery 82 ( 6 ) 2240 - 6 2006年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair. METHODS: Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months). RESULTS: Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 +/- 0.8 versus 1.4 +/- 0.9; p < 0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 +/- 0.8 versus 1.1 +/- 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients. CONCLUSIONS: There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.

Advantages of temporary venoatrial shunt using centrifugal pump during bidirectional cavopulmonary shunt

Yasuhiro Kotani, Osami Honjo, Kozo Ishino, Satoru Osaki, Yosuke Kuroko, Takuya Kawabata, Shinya Ugaki, Ko Yoshizumi, Shingo Kasahara, Masaaki Kawada, Shunji Sano

ASAIO JOURNAL 52 ( 5 ) 549 - 551 2006年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

Single-ventricle palliation without the use of cardiopulmonary bypass carries advantages that reduce systemic edema and inflammatory responses; however, simple clamping of the superior vena cava (SVC) without a temporary shunt leads to increase in cerebral venous pressure and subsequent decrease in cerebral blood flow during bidirectional cavopulmonary shunt (BCPS). We report our experience of BCPS, using a centrifugal pump-assisted temporary shunt.The criteria included an unrestrictive interatrial communication, the absence of atrioventricular valve regurgitation, and the existence of an antegrade pulmonary blood flow. From August 2000, 14 children with single-ventricle physiology met the criteria. The mean age was 1.0 +/- 0.9 years, and the mean weight was 8.4 +/- 2.6 kg. A temporary shunt was established between the SVC and the right atrium with right-angle cannulae, which were connected to a centrifugal pump to accelerate the blood flow from the SVC to the right atrium.All patients tolerated the procedure. Mean central venous pressure was 17 +/- 4 mm Hg, and transcutaneous oxygen saturation was maintained at 77 +/- 8% during anastomosis. No patients required blood transfusion. There were no postoperative neurological complications.The centrifugal pump-assisted temporary shunt offered safer and more effective circulatory support than other shunt systems, with excellent venous drainage in pediatric patients undergoing BCPS.

DOI： 10.1097/01.mat.0000235454.64316.f3

Continuous cerebral and myocardial perfusion during aortic arch repair in neonates and infants

Yasuhiro Kotani, Kozo Ishino, Shingo Kasahara, Ko Yoshizumi, Osami Honjo, Masaaki Kawada, Shunji Sano

ASAIO JOURNAL 52 ( 5 ) 536 - 538 2006年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

To minimize myocardial ischemia, we repaired aortic arch obstruction with ventricular septal defect, using two different techniques of cerebral and myocardial perfusion.Seventy-one infants, ages 3 to 137 days, underwent primary repair of coarctation of the aorta (n = 49)/interruption of the aortic arch (n = 22) with ventricular septal defect. In 65 patients, an end-to-end arch anastomosis was performed with cerebral and myocardial perfusion through the innominate or the ascending arterial cannula (non-working beating heart: NWBH). In the remaining 6 patients, an arterial cannula was placed into the innominate artery. With partial cardiopulmonary bypass, the innominate artery was snared proximal to the cannulation site and the ascending aorta was cross-clamped. An extended arch anastomosis was carried out with cerebral perfusion and a working beating heart (WBH).Ten patients (15%) undergoing aortic arch repair with the NWBH technique required cardioplegic arrest to complete a proximal anastomosis, whereas in all 6 repairs with the WBH technique, the extended anastomoses were completed without myocardial ischemia. One hospital death and late death occurred, with an overall survival of 98%.End-to-end arch reconstruction is feasible without myocardial ischemia, using the NWBH technique in patients without hypoplastic arch and using the WBH technique in patients with hypoplastic arch.

DOI： 10.1097/01.mat.0000235276.77489.bb

Resuscitation of non-beating donor hearts using continuous myocardial perfusion: the importance of controlled initial reperfusion. 国際誌

Satoru Osaki, Kozo Ishino, Yasuhiro Kotani, Osami Honjo, Takanori Suezawa, Kazushige Kanki, Shunji Sano

The Annals of thoracic surgery 81 ( 6 ) 2167 - 71 2006年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Warm ischemia is a major cause of cardiac allograft failure in transplants from non-heart-beating donors. To minimize myocardial ischemia, we used a continuous myocardial perfusion technique for resuscitation of donor hearts. The purpose of the present study was to investigate an optimal duration of controlled initial reperfusion. METHODS: Cardiac arrest was induced by asphyxia in 18 donor pigs. The hearts were harvested 30 minutes after global warm ischemia. Continuous myocardial reperfusion was immediately commenced from the aortic root with blood cardioplegic solution (20 degrees C, 40 mm Hg) and then with oxygenated blood (20 degrees to 37 degrees C, 40 to 60 mm Hg). Animals were divided into three groups according to the duration of the initial reperfusion: group I = 5 minutes, group II = 20 minutes, and group III = 60 minutes. Orthotopic transplantation was performed while keeping the heart beating by continuous myocardial perfusion. Cardiac function was evaluated before anoxia and after transplantation. Lactate extractions were determined during reperfusion. Myocardial edema was assessed by heart weight and posterior wall thickness of the left ventricle. RESULTS: Recovery rates of cardiac function in group II hearts after transplantation were better than in groups I and III (cardiac output, 61% +/- 9% versus 41% +/- 5% versus 44% +/- 4%, respectively; p < 0.05; left ventricular end-systolic pressure-volume ratio, 64% +/- 8% versus 36% +/- 9% versus 42% +/- 6%, respectively; p < 0.05). Lactate extractions in groups II and III returned to 0 within 20 minutes of reperfusion. Myocardial edema after transplantation in group II hearts was less than in groups I and III. CONCLUSIONS: The best recovery was observed in the non-beating donor hearts resuscitated by continuous myocardial perfusion when the initial controlled reperfusion with lukewarm blood cardioplegic solution at 40 mm Hg lasted for 20 minutes.

Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm.

Yukio Kioka, Atsusi Tanabe, Yasuhiro Kotani, Nobuyuki Yamada, Makoto Nakahama, Toshiyuki Ueda, Tetsusi Seitou, Masahiko Maruyama

Circulation journal : official journal of the Japanese Circulation Society 66 ( 12 ) 1110 - 2 2002年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

In the process of establishing a less invasive assessment strategy for coronary artery disease (CAD) in patients with infrarenal abdominal aortic aneurysm (AAA), the incidence of CAD and the surgical and mid-term outcomes were reviewed. From January 1994 through September 2001, 94 elective surgical repairs of AAA were carried out. Preoperative coronary angiography showed 43 patients (45.7%) had CAD: 29 (67.4%) were asymptomatic, 23 had single-vessel disease (1VD), 12 had 2VD and 8 had 3VD. Of the 43 patients with CAD, 19 (44.2%) underwent coronary interventional therapy before aortic surgery (11 percutaneous transluminal coronary angioplasty (PTCA), 8 coronary artery bypass grafting). Eight asymptomatic patients underwent coronary interventional therapy. None of the patients died of cardiac causes or experienced a postoperative cardiac event. During the follow-up period, 10 late deaths occurred: 7 patients with CAD, and 3 cerebrovascular or cardiac deaths. There was no statistical difference in the survival rate between the groups with and without CAD. Two patients with CAD underwent PTCA during the follow-up period. The findings confirm the need for a less invasive assessment strategy of CAD that does not overlook asymptomatic myocardial ischemia, because the incidence of CAD in patients with AAA is high.

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