Faculty Profiles - KASAHARA Shingo

Papers - KASAHARA Shingo

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Intracoronary autologous cardiac progenitor cell transfer in patients with hypoplastic left heart syndrome: the TICAP prospective phase 1 controlled trial. International journal

Shuta Ishigami, Shinichi Ohtsuki, Suguru Tarui, Daiki Ousaka, Takahiro Eitoku, Maiko Kondo, Michihiro Okuyama, Junko Kobayashi, Kenji Baba, Sadahiko Arai, Takuya Kawabata, Ko Yoshizumi, Atsushi Tateishi, Yosuke Kuroko, Tatsuo Iwasaki, Shuhei Sato, Shingo Kasahara, Shunji Sano, Hidemasa Oh

Circulation research 116 ( 4 ) 653 - 64 2015.2

Language：English Publishing type：Research paper (scientific journal)

RATIONALE: Hypoplastic left heart syndrome (HLHS) remains a lethal congenital cardiac defect. Recent studies have suggested that intracoronary administration of autologous cardiosphere-derived cells (CDCs) may improve ventricular function. OBJECTIVE: The aim of this study was to test whether intracoronary delivery of CDCs is feasible and safe in patients with hypoplastic left heart syndrome. METHODS AND RESULTS: Between January 5, 2011, and January 16, 2012, 14 patients (1.8±1.5 years) were prospectively assigned to receive intracoronary infusion of autologous CDCs 33.4±8.1 days after staged procedures (n=7), followed by 7 controls with standard palliation alone. The primary end point was to assess the safety, and the secondary end point included the preliminary efficacy to verify the right ventricular ejection fraction improvements between baseline and 3 months. Manufacturing and intracoronary delivery of CDCs were feasible, and no serious adverse events were reported within the 18-month follow-up. Patients treated with CDCs showed right ventricular ejection fraction improvement from baseline to 3-month follow-up (46.9%±4.6% to 52.1%±2.4%; P=0.008). Compared with controls at 18 months, cardiac MRI analysis of CDC-treated patients showed a higher right ventricular ejection fraction (31.5%±6.8% versus 40.4%±7.6%; P=0.049), improved somatic growth (P=0.0005), reduced heart failure status (P=0.003), and lower incidence of coil occlusion for collaterals (P=0.007). CONCLUSIONS: Intracoronary infusion of autologous CDCs seems to be feasible and safe in children with hypoplastic left heart syndrome after staged surgery. Large phase 2 trials are warranted to examine the potential effects of cardiac function improvements and the long-term benefits of clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01273857.

DOI： 10.1161/CIRCRESAHA.116.304671

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乳児期から特異な経過を示すDravet症候群の1例

小林由典, 岡牧郎, 小林勝弘, 吉永治美, 野坂宜之, 塚原紘平, 鵜川豊世武, 笠原真悟

脳と発達 47 ( 1 ) 60 - 60 2015.1

Novel Model of Pulmonary Artery Banding Leading to Right Heart Failure in Rats. International journal

Masataka Hirata, Daiki Ousaka, Sadahiko Arai, Michihiro Okuyama, Suguru Tarui, Junko Kobayashi, Shingo Kasahara, Shunji Sano

BioMed research international 2015 753210 - 753210 2015

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Congenital heart diseases often involve chronic pressure overload of the right ventricle (RV) which is a major cause of RV dysfunction. Pulmonary artery (PA) banding has been used to produce animal models of RV dysfunction. We have devised a new and easier method of constricting the PA and compared it directly with the partial ligation method. METHODS: Eight-week-old male Sprague-Dawley rats (240-260 g) were divided into three groups: sham operation, partial pulmonary artery ligation (PAL) procedure, and pulmonary artery half-closed clip (PAC) procedure. RV function and remodeling were determined by echocardiography and histomorphometry. RESULTS: Surgical mortality was significantly lower in the PAC group while echocardiography revealed significantly more signs of RV dysfunction. At the 8th week after surgery RV fibrosis rate was significantly higher in the PAC group. CONCLUSIONS: This procedure of pulmonary artery banding in rats is easier and more efficient than partial ligation.

DOI： 10.1155/2015/753210

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[Treatment strategy toward Fontan completion in hypoplastic left heart syndrome].

Shingo Kasahara, Shunji Sano

Kyobu geka. The Japanese journal of thoracic surgery 67 ( 4 ) 287 - 93 2014.4

Language：Japanese Publishing type：Research paper (scientific journal)

The Norwood procedure with right ventricle-pulmonary artery (RV-PA) conduit is thought to improve post-operative hemodynamics in hypoplastic left heart syndrome( HLHS). Prematurity( GA<37 weeks), body weight less than 2.5 kg and tricuspid regurgitation( TR)2+ or more were associated with mortality. For requiring better outcome, paralyzed ventilation, inherent N2 are indicated, to avoid preoperative high pulmonary blood flow followed by progressive TR. Rapid staged bilateral pulmonary artery banding( PAB) might improve the outcome for this high mortality group. As operative improvement, the distal neoaortic reconstruction was completed without any patch materials in most case. For achievement this, it is important that aortic arch and ascending aorta just opposite the site of the innominate artery were sutured inferiorly to extend the width of the aortic arch. Also we have developed a modified strategy to control RV-PA shunt flow, which is partial clipping on the ePTFE graft. Because significant TR associated with mortality, TR should be surgically treated at any sage of reconstruction. At bidirectional Glenn operation, 70% of patient were left the RV-PA conduit as additional flow. Hospital mortality after Fontan completion for HLHS is excellent with short averaging more than 95%. Extracardiac conduit with fenestration is indicated in all HLHS patients.

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Repair of Ebstein's anomaly in neonates and small infants: impact of right ventricular exclusion and its indications. International journal

Shunji Sano, Yasuhiro Fujii, Shingo Kasahara, Yosuke Kuroko, Atsushi Tateishi, Ko Yoshizumi, Sadahiko Arai

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 45 ( 3 ) 549 - 55 2014.3

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: In cases of severe Ebstein's anomaly, it is essential to determine whether biventricular repair (BVR) or single-ventricle palliation is feasible. Since 1999, in our institution, we have used the novel technique comprising tricuspid valve (TV) closure and right ventricular and right atrial (RV/RA) exclusion to reduce the deleterious effects of an enlarged RV in patients with severe Ebstein's anomaly. However, in cases with good RV function, primary BVR is performed. In the present study, we describe our surgical strategy in the treatment of severely symptomatic neonates with Ebstein's anomaly. METHODS: From June 1999 to October 2011, 12 neonates with a severely symptomatic Ebstein's anomaly underwent surgical repair. The mean age at the first operation was 29 ± 25 (range, 5-92) days; and the mean body weight was 2.8 ± 0.5 (range, 2.0-4.1) kg. The associated anomalies included pulmonary atresia with an intact ventricular septum in 7, critical pulmonary stenosis in 1, ventricular septal defect in 3 and coarctation of the aorta in 1 patient. The mean cardio-thoracic ratio (CTR) was 80 ± 14% (range, 57-98%). Preoperatively, 9 patients had grade IV tricuspid regurgitation (TR), as detected by echocardiography, and 6 required ventilator support. RESULTS: Five patients underwent primary BVR. Seven patients underwent staged palliation using a modified Blalock-Taussig shunt (BT shunt) with/without RV/RA exclusion. There was 1 case each of hospital death and late death. The median follow-up duration in the present study was 6.5 years. Among the 8 patients who underwent TV repair, postoperative TR was trivial or mild in 6 patients, moderate in 1 and absent in 1. After surgery, the mean CTR and serum B-type natriuretic peptide levels decreased to 59 ± 14% (range, 45-70%) and 46 ± 28 (range, 12-83) pg/dl, respectively. CONCLUSIONS: Critically ill neonates with Ebstein's anomaly can be successfully treated using RV/RA exclusion combined with a modified BT shunt in cases where RV function is poor. However, in cases of good RV function, we recommend the use of primary BVR.

DOI： 10.1093/ejcts/ezt465

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Directed differentiation of patient-specific induced pluripotent stem cells identifies the transcriptional repression and epigenetic modification of NKX2-5, HAND1, and NOTCH1 in hypoplastic left heart syndrome. International journal

Junko Kobayashi, Masashi Yoshida, Suguru Tarui, Masataka Hirata, Yusuke Nagai, Shingo Kasahara, Keiji Naruse, Hiroshi Ito, Shunji Sano, Hidemasa Oh

PloS one 9 ( 7 ) e102796 2014

Language：English Publishing type：Research paper (scientific journal)

The genetic basis of hypoplastic left heart syndrome (HLHS) remains unknown, and the lack of animal models to reconstitute the cardiac maldevelopment has hampered the study of this disease. This study investigated the altered control of transcriptional and epigenetic programs that may affect the development of HLHS by using disease-specific induced pluripotent stem (iPS) cells. Cardiac progenitor cells (CPCs) were isolated from patients with congenital heart diseases to generate patient-specific iPS cells. Comparative gene expression analysis of HLHS- and biventricle (BV) heart-derived iPS cells was performed to dissect the complex genetic circuits that may promote the disease phenotype. Both HLHS- and BV heart-derived CPCs were reprogrammed to generate disease-specific iPS cells, which showed characteristic human embryonic stem cell signatures, expressed pluripotency markers, and could give rise to cardiomyocytes. However, HLHS-iPS cells exhibited lower cardiomyogenic differentiation potential than BV-iPS cells. Quantitative gene expression analysis demonstrated that HLHS-derived iPS cells showed transcriptional repression of NKX2-5, reduced levels of TBX2 and NOTCH/HEY signaling, and inhibited HAND1/2 transcripts compared with control cells. Although both HLHS-derived CPCs and iPS cells showed reduced SRE and TNNT2 transcriptional activation compared with BV-derived cells, co-transfection of NKX2-5, HAND1, and NOTCH1 into HLHS-derived cells resulted in synergistic restoration of these promoters activation. Notably, gain- and loss-of-function studies revealed that NKX2-5 had a predominant impact on NPPA transcriptional activation. Moreover, differentiated HLHS-derived iPS cells showed reduced H3K4 dimethylation as well as histone H3 acetylation but increased H3K27 trimethylation to inhibit transcriptional activation on the NKX2-5 promoter. These findings suggest that patient-specific iPS cells may provide molecular insights into complex transcriptional and epigenetic mechanisms, at least in part, through combinatorial expression of NKX2-5, HAND1, and NOTCH1 that coordinately contribute to cardiac malformations in HLHS.

DOI： 10.1371/journal.pone.0102796

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The effect of pulmonary root translocation on the left ventricular outflow tract. International journal

Atsushi Tateishi, Shingo Kasahara, Takuya Kawabata, Yosuke Kuroko, Ko Yoshizumi, Masami Takagaki, Sadahiko Arai, Shunji Sano

The Annals of thoracic surgery 96 ( 4 ) 1469 - 1471 2013.10

Language：English Publishing type：Research paper (scientific journal)

We report the effect of pulmonary root translocation on the left ventricular outflow tract. A double switch operation with pulmonary root translocation was performed in a 6-year-old boy whose diagnosis was dextrocardia, congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. Postoperative magnetic resonance imaging showed more natural left ventricular outflow than preoperatively (19 mm vs 22 mm in length between the top of the interventricular septum and the aortic valve). This technique does not require coronary transfer and enables preservation of the aortic root structure. The long-term results, including left ventricular outflow tract morphology, should be evaluated.

DOI： 10.1016/j.athoracsur.2013.02.050

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Surgical Repair of a Congenital Right Ventricular Aneurysm : A Rapidly Enlarging Aneurysm in an Infant

HATTORI Shiteru, YOSHIZUMI Ko, KAWABATA Takuya, ARAI Sadahiko, KASAHARA Shingo, SANO Shunji

Ped Cardiol Card Surg 29 ( 4 ) 194 - 199 2013.7

Language：Japanese Publisher：Japanese Society of Pediatric Cardiology and Cardiac Surgery

Congenital ventricular aneurysm is a very rare heart anomaly，especially when it occurs in the right ventricle. It is associated with a poor prognosis and a risk of sudden death. We report a case of congenital right ventricular aneurysm that was successfully repaired by surgery. In this case，echocardiography at birth revealed an aneurysmal change at the right ventricular apex. Rapid enlargement of this aneurysm was detected during careful follow-up，and surgical repair was performed at six months of age. The postoperative course was uneventful，and the patient was free from symptoms at 10 months after surgery.

DOI： 10.9794/jspccs.29.194

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Usefulness of balloon angioplasty for the right ventricle-pulmonary artery shunt with the modified Norwood procedure. International journal

Naoki Ohno, Shinichi Ohtsuki, Koichi Kataoka, Kenji Baba, Yoshio Okamoto, Maiko Kondo, Shunji Sano, Shingo Kasahara, Osami Honjo, Tsuneo Morishima

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 81 ( 5 ) 837 - 42 2013.4

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: We sought to evaluate the efficacy of balloon angioplasty (BA) for severely desaturated patients due to a stenotic right ventricle (RV) to pulmonary artery (PA) shunt following modified Norwood procedure. METHODS: Of 87 patients who underwent a Norwood procedure with the RV-PA shunt between February 1998 through March 2010, 22 (25%) patients underwent BA. The efficacy of BA was assessed by angiographic measurement of the changes in the internal diameters of the stenotic portions of the shunt, changes in arterial saturation and clinical outcomes. RESULTS: BA was performed for stenotic RV-PA shunts following stage I palliation (n = 17, 77%), or those placed as an additional blood source (n = 5, 23%, 3 patients awaiting biventricular repair, 2 patients following stage II palliation). The location of the BA was at the distal anastomosis in 12 (54.5%), proximal anastomosis in 21 (95.4%) and in the mid-portion of the shunt in 11 (50%) cases. The diameters of these three shunt portions were measured from the anterior-posterior and lateral angiographic images, increasing significantly after BA (p < 0.0001) in all. Arterial saturation significantly improved after BA in all cases (66.5 ± 4.3% to 79.4 ± 3.4%, p < 0.0001). Freedom from reintervention was 100%. All patients underwent subsequent elective planned surgery at an appropriate age with no mortality. CONCLUSIONS: A BA-alone strategy for a stenotic RV-PA shunt was effective for all three shunt portions, minimizing shunt-related premature surgical intervention.

DOI： 10.1002/ccd.24576

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両大血管右室起始に対する手術術式の違いが体外循環法に及ぼす影響について二心室修復と単心室修復の比較

伊藤英史, 高寛, 堂口琢磨, 笠原真悟, 新井禎彦, 佐野俊二

体外循環技術 39 ( 4 ) 428 - 431 2012.12

Language：Japanese Publisher：(一社)日本体外循環技術医学会編集委員会

両大血管右室起始症に対する外科治療法の違いが体外循環法に及ぼす影響について考察した。当院で初回介入手術を行った両大血管右室起始と診断のついた39例を対象として、二心室修復群(n=16)と単心室修復群(n=23)を比較した。二心室修復群で体外循環時間、大動脈遮断時間、挿管時間が有意に長かった。二心室修復群は術後のヘマトクリット値、局所酸素飽和度、拡張期圧、総蛋白量、MUF中の中心静脈圧変化率が有意に高かった。単心室修復群の術前後で中心静脈圧が有意に高かった。無輸血体外循環達成率は二心室修復群44%、単心室修復群78%であった。単心室修復群は無輸血体外循環達成率が高かったが、容量負荷による血行動態の管理を必要としたためMUFの除水効率および血液濃縮効果は低く、局所酸素飽和度も低い傾向にあった。両大血管右室起始に対する単心室修復術は二心室修復術に比べて容量依存型循環エネルギーによる血行動態管理、水分バランス制御による体外循環管理を必要とした。(著者抄録)

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Aberrant Calcium Handling Inhibits Functional Maturation and Excitation in Factors-based Human Cardiomyocytes Differentiation Reviewed

Suguru Tarui, Junko Kobayashi, Masataka Hirata, Ken Takahashi, Gentaro Iribe, Keiji Naruse, Shingo Kasahara, Shunji Sano, Hidemasa Ou

JOURNAL OF CARDIAC FAILURE 18 ( 10 ) S146 - S146 2012.10

3D映像による臨床解剖学講義明日の臨床が見えてくる

大塚愛二, 武田吉正, 笠原真悟, 近藤喜太, 田中雅人, 土井原博義, 末次圭介

香川県医師会誌 65 ( 特別 ) 16 - 19 2012.9

Extracorporeal membrane oxygenation following pediatric cardiac surgery: development and outcomes from a single-center experience. International journal

Hideshi Itoh, S Ichiba, Y Ujike, S Kasahara, S Arai, S Sano

Perfusion 27 ( 3 ) 225 - 9 2012.5

Language：English Publishing type：Research paper (scientific journal)

Extracorporeal membrane oxygenation (ECMO) has emerged as an effective mechanical support following cardiac surgery with respiratory and cardiac failure. However, there are no clear indications for ECMO use after pediatric cardiac surgery. We retrospectively reviewed medical records of 76 pediatric patients [mean age, 10.8 months (0-86); mean weight, 5.16 kg (1.16-16.5)] with congenital heart disease who received ECMO following cardiac surgery between January 1997 and October 2010. Forty-five patients were treated with an aggressive ECMO approach (aggressive ECMO group, April 2005-October 2010) and 31 with a delayed ECMO approach (delayed ECMO group, January 1997-March 2005). Demographics, diagnosis, operative variables, ECMO indication, and duration of survivors and non-survivors were compared. Thirty-four patients (75.5%) were successfully weaned from ECMO in the aggressive ECMO group and 26 (57.7%) were discharged. Conversely, eight patients (25.8%) were successfully weaned from ECMO in the delayed ECMO group and two (6.5%) were discharged. Forty-five patients with shunted single ventricle physiology (aggressive: 29 patients, delayed: 16 patients) received ECMO, but only 15 (33.3%) survived and were discharged. The survival rate of the aggressive ECMO group was significantly better when compared with the delayed ECMO group (p<0.01). Also, ECMO duration was significantly shorter among the aggressive ECMO group survivors (96.5 ± 62.9 h, p<0.01). Thus, the aggressive ECMO approach is a superior strategy compared to the delayed ECMO approach in pediatric cardiac patients. The aggressive ECMO approach improved our outcomes of neonatal and pediatric ECMO.

DOI： 10.1177/0267659111434857

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肺高血圧症の有無が乳児期心室中隔欠損症に対する体外循環法に及ぼす影響

伊藤英史, 堂口琢磨, 笠原真悟, 新井禎彦, 佐野俊二

体外循環技術 39 ( 1 ) 6 - 11 2012.3

Language：Japanese Publisher：(一社)日本体外循環技術医学会編集委員会

心室中隔欠損症に対する肺高血圧症の合併の有無が体外循環法にどのような影響を与えるのかについて後方視的研究を行った。乳児期に心室中隔欠損症に対する手術を施行した28症例を対象とし、肺高血圧症合併群(PH群)14例と非合併群(N群)14例に分類し比較検討した。PH群では挿管時間、集中治療室の滞在時間が有意に長かった。PH群では体外循環中の限外濾過量が多かった。PH群では体外循環後の収縮期/拡張期血圧が低かった。PH群では術前に肺動脈弁輪径および左室拡張末期径が拡大し、術後には右室拡張末期径が拡大していた。PH群では術前に肺動脈弁が拡大し肺動脈血流の増加に伴う容量負荷が認められ、術後には容量負荷による右心不全傾向と呼吸不全の傾向が認められた。これらのことから、肺動脈圧を合併した心室中隔欠損症に対する乳児体外循環の際には、容量負荷に対応した体外循環法が求められ、体外循環後の肺高血圧危機の予防と右心不全対策、また術後の呼吸機能低下に対する対策を考慮した体外循環法の確立が望まれる。(著者抄録)

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心臓手術の実際外科医が語る術式、麻酔科医が語る心臓麻酔、臨床工学技士が語る体外循環法(第22回) 大動脈縮窄症・大動脈弓離断症に対する手術と体外循環法岡山大学病院

佐野俊二, 笠原真悟, 新井禎彦, 岩崎達雄, 森田潔, 伊藤英史

Clinical Engineering 23 ( 2 ) 151 - 159 2012.1

Atrioventricular valve repair for patient with heterotaxy syndrome and a functional single ventricle. International journal

Shunji Sano, Yasuhiro Fujii, Sadahiko Arai, Shingo Kasahara, Atsushi Tateishi

Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual 15 ( 1 ) 88 - 95 2012

Language：English Publishing type：Research paper (scientific journal)

Heterotaxy syndrome is a mortality risk factor for patients with complex heart disease. These patients often have common atrioventricular valve (CAVV) morphology and significant atrioventricular valve regurgitation - yet another mortality risk factor in congenital heart disease. Thus, patients with both heterotaxy syndrome and atrioventricular valve regurgitation are at highest risk of mortality. A large number of patients with heterotaxy syndrome have CAVV and a functional single ventricle. These patients are more difficult to operate than patients with biventricular morphology because in the former, the CAVV is often less adapted to systemic afterload than the mitral valve. Herein, we present the results of atrioventricular valve repair surgeries performed at the Okayama University Hospital on patients with heterotaxy syndrome, atrial isomerism, and a functional single ventricle. In addition, we review the current literature in this typically challenging patient population. In-depth understanding of reasonable management strategies and resolution of technical issues will help guide surgeons during this procedure.

DOI： 10.1053/j.pcsu.2012.01.014

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Sano Modification with a Right Ventricle-to-Pulmonary Artery Shunt

Shunji Sano, Shingo Kasahara

Operative Techniques in Thoracic and Cardiovascular Surgery 17 ( 2 ) 66 - 80 2012

Right ventricular exclusion for a neonatal patient with Ebstein anomaly: a free wall resection of the right ventricle. International journal

Takuya Kawabata, Shingo Kasahara, Sadahiko Arai, Shunji Sano

The Journal of thoracic and cardiovascular surgery 142 ( 6 ) 1582 - 4 2011.12

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. International journal

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 2011.1

Language：English Publishing type：Research paper (scientific journal)

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

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Extracorporeal membrane oxygenation following Norwood stage 1 procedures at a single institution. International journal

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

Artificial organs 34 ( 11 ) 898 - 903 2010.11

Language：English Publishing type：Research paper (scientific journal)

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

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< KASAHARA Shingo >

Papers - KASAHARA Shingo