Journal articles: 'Cardiovascular system Surgery Patients Japan'

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Watanabe, Go. "Successful Intracardiac Robotic Surgery Initial Results from Japan." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 5, no. 1 (January 2010): 48–50. http://dx.doi.org/10.1097/imi.0b013e3181c46db6.

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Objective The purpose of this study is to report our 2-year experience of performing endoscopic intracardiac procedures using the da Vinci Surgical System. Our teams at Kanazawa University and Tokyo Medical University groups began using the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA) in 2005. This series represents the first Japanese application of robotic technology for totally endoscopic open-heart surgery. Methods From January 2008 to February 2009, 10 patients (mean age: 46.8 ± 16.3 years, 70% women) underwent endoscopic atrial septal defect closure and resection of the left atrial myxoma using the da Vinci Surgical System and peripheral cardiopulmonary bypass technique. Of the 10 patients, nine were classified as New York Heart Association class II and 1 patient exhibited atrial arrhythmias. In addition, two patients required mitral valve plasty (n = 2) and tricuspid annuloplasty (n = 1). Results Mean da Vinci Surgical System working time was 140.7 ± 57.4 minutes. Mean cardiopulmonary bypass and aortic cross clamp times were 103.1 ± 37.1 and 30.0 ± 16.9 minutes, respectively. There were no conversions to sternotomy or small thoracotomy. There were no hospital deaths. Mean intensive care unit and hospital stays were 1 day and 3.1 ± 0.3 days, respectively. All patients appreciated the cosmetic result and fast recovery. Conclusions Closed-chest atrial septal defect closure and myxoma resection performed using robotic techniques achieved excellent results and rapid postoperative recovery and provided an attractive cosmetic advantage over median sternotomy.

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Ohtsu, Hiroshi, Akihiko Shimomura, Sakiko Miyazaki, Naohiro Yonemoto, Shinichiro Ueda, Chikako Shimizu, and Kazuhiro Sase. "Cardiotoxicity of adjuvant chemotherapy with trastuzumab: a Japanese claim-based data analysis." Open Heart 9, no. 2 (August 2022): e002053. http://dx.doi.org/10.1136/openhrt-2022-002053.

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ObjectiveAdjuvant chemotherapy with trastuzumab improves the postoperative life expectancy of women with early-stage breast cancer. Although trastuzumab is reportedly cardiotoxic, quantification based on real-world evidence is lacking. Therefore, in this study, we aimed to analyse trastuzumab cardiotoxicity using a nationwide claim-based database.MethodsIn this retrospective study, we used data from a nationwide claims database (Japan Medical Data Center, Tokyo, Japan) under the universal healthcare system. Women with breast cancer who underwent initial surgery were included. Patients with recurrent or advanced-stage breast cancer, with a history of heart failure, receiving neoadjuvant chemotherapy or a preoperative history of less than 6 months were excluded. Propensity score (PS) was calculated using logistic regression based on age, cardiovascular risk factors, radiotherapy and concomitant anthracyclines (AC).ResultsWe identified 12 060 eligible patients (mean age 50.8±8.56 years) between January 2010 and December 2019. After 1:2 PS matching (trastuzumab users, TZ, n=1005; non-users, NT, n=2010), Cox proportional hazards model analysis showed that the rate of heart failure development within 18 months postoperative was significantly higher in the TZ group than in the NT group (adjusted HR 2.28, 95% CI 1.38 to 3.77). Baseline cardiac evaluation in the combined AC/TZ cases was 27.2% preoperative, 66.0% pre-AC and 86.6% pre-TZ, respectively.ConclusionTrastuzumab cardiotoxicity remained relevant in the claim-based analysis adjusted for AC effects. Further collaborative studies in cardio-oncology with real-world data are warranted to improve the rate of baseline cardiovascular risk assessment in patients with cancer scheduled for cardiotoxic cancer treatment.

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Yamamoto, Taira, Daisuke Endo, Hironobu Yamaoka, Akie Shimada, Satoshi Matsushita, and Atsushi Amano. "Rapid-Deployment Aortic Valve Replacement for a Hemodialysis Patient with Prior Coronary Artery Bypass Grafting." Heart Surgery Forum 24, no. 3 (June 11, 2021): E530—E533. http://dx.doi.org/10.1532/hsf.3535.

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Background: Aortic valve reoperation increases the risk of mortality and morbidity. The 2017 European Society of Cardiology guidelines for managing valvular heart disease with a previous heart surgery and intact bypass grafts consider patients with high surgical risk to be injury-prone during sternotomy. In high-risk patients with prior coronary artery bypass grafting, several authors have reported the noninferiority or superiority of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement; however, in Japan, TAVR cannot be performed for patients on hemodialysis. In this study, we report a case of successful implantation of the new rapid-deployment bioprosthesis in a 65-year-old Japanese man on dialysis with prior coronary artery bypass grafting. Methods: The rapid-deployment aortic valve system has demonstrated excellent hemodynamic performance, durability, and safety. However, implantation requires speciﬁc training and the analysis of preoperative 3D computed tomographic imaging. The cineangiography revealed patency of all grafts, and the saphenous vein graft (SVG) had overlapped the planned aortotomy position. By avoiding the anastomotic part of the SVG, we could perform rapid-deployment aortic valve replacement efficiently even if the aortic incision was repositioned, and the incision was smaller than planned. Results: We used the 23-mm Intuity valve without an additional stitch, and the cardiopulmonary bypass and aortic cross-clamp times were only 52 and 39 minutes, respectively. Conclusion: This novel valve may be beneﬁcial in complex combinational procedures for hemodialysis patients with prior coronary artery bypass grafting.

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Ochiai, Ryota, Arata Murakami, Tomohiko Toyoda, Keiko Kazuma, and Koichiro Niwa. "Opinions of Physicians Regarding Problems and Tasks Involved in the Medical Care System for Patients with Adult Congenital Heart Disease in Japan." Congenital Heart Disease 6, no. 4 (July 2011): 359–65. http://dx.doi.org/10.1111/j.1747-0803.2011.00548.x.

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Nakamura, Shinichi, Taku Rokutanda, Hirofumi Kurokawa, and Yoshirou Onoue. "Endovascular Treatment of Long Superficial Femoral Artery–Chronic Total Occlusions Using the Gogo Catheter With IVUS Via a Popliteal Puncture Method Is Effective, Safe, and Useful." Vascular and Endovascular Surgery 54, no. 3 (January 3, 2020): 225–32. http://dx.doi.org/10.1177/1538574419896735.

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Objectives: We aimed to investigate the usefulness of inserting a 6Fr sheath guided by duplex ultrasonography via a popliteal artery puncture. We also aimed to demonstrate endoluminal tracking using a retrograde approach using the Gogo catheter with intravascular ultrasound (IVUS). Background: The bidirectional approach is useful for increasing the success rate of the procedure for long superficial femoral artery–chronic total occlusions (SFA-CTOs). However, this procedure becomes somewhat complicated. Since the proximal blood vessel diameter is clearly larger than the distal end of the CTO and the body surface duplex guide can also be used in the proximal part, it is easier to introduce a retrograde guidewire (GW) into the proximal end. Methods: We performed endovascular treatment for long SFA-CTOs with a Gogo catheter + IVUS guide in 31 consecutive cases (male 20/female 11; mean age, 75.6 ± 7.6) from May 2017 to November 2018. We advanced the IVUS until the true lumen could be confirmed and advanced the Gogo catheter toward the IVUS for reinforcement. We attempted to approach the long CTO by repeating this procedure. We named this procedure the GIP method (GIP: Gogo catheter with IVUS via a popliteal puncture). Hemostasis of the popliteal artery was achieved using a commercially available compression hemostatic kit (Tometa-kun, XEMEX, Japan). Results: Successful revascularization was achieved in all cases (in 2 cases, a femoral artery puncture was added, and a bidirectional approach was used, and in 1 case, a CROSSER system was used). On average, the fluoroscopy time was 42.2 ± 30.4 minutes, radiation dose 93.7 ± 78.7 mGy, and amount of contrast medium used 15.0 ± 9.6 mL. The procedure time was defined as from the start of the popliteal artery puncture to the time the GW passed through the CTO lesion, including the posture transformation time from prone to the supine position. The procedure time was 42.1 ± 40.2 minutes. There were no major adverse events or other major complications, such as a distal embolism, rupture of the CTO lesion, arteriovenous fistula, or major hematoma requiring a transfusion or surgical treatment. Only 2 small hematomas occurred at the popliteal artery puncture site. The patients were treated conservatively and were discharged as usual. Conclusions: Endovascular treatment of long SFA-CTOs via the popliteal approach was effective and safe. Using the GIP method to address long SFA-CTOs is recommended.

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Miyairi, Takeshi, Hiroaki Miyata, Tsuyoshi Taketani, Daigo Sawaki, Tohru Suzuki, Yasunobu Hirata, Hideyuki Shimizu, Noboru Motomura, and Shinichi Takamoto. "Risk Model of Cardiovascular Surgery in 845 Marfan Patients Using the Japan Adult Cardiovascular Surgery Database." International Heart Journal 54, no. 6 (2013): 401–4. http://dx.doi.org/10.1536/ihj.54.401.

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Kurazumi, Hiroshi, Masaya Takahashi, and Shigeru Ikenaga. "Outcomes of cardiovascular surgery for chronic dialysis patients in current Japan." Asian Cardiovascular and Thoracic Annals 27, no. 6 (June 19, 2019): 464–70. http://dx.doi.org/10.1177/0218492319859147.

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Background The number of dialysis patients in Japan is rising, with an increasing number requiring cardiovascular surgery. Methods We investigated the short- and long-term outcomes in 70 dialysis patients among a total of 1124 who underwent cardiovascular surgery in our hospital between 2004 and 2016. We investigated outcomes following open surgery and identified factors that affected the prognosis. We also compared the long-term survival rate with the survival rate of the Japanese dialysis population. Results The long-term survival rate was 70.6%, 51.1%, and 19.2% after 3, 5, and 10 years, respectively. The causes of long-term death were heart disease in 8 patients, cerebrovascular disease in 7, cachexia in 3, infection in 2, and other causes in 3. The freedom from cardiac death was 88.7%, 77.9%, and 54.9% after 3, 5, and 10 years, respectively. Multivariate analysis using Cox’s proportional hazard model showed that a history of atherosclerosis obliterans (hazard ratio 5.4, p = 0.05) and mediastinitis (hazard ratio 10.2, p = 0.03) were risk factors for death in long-term follow-up, and a history of atherosclerosis obliterans was an independent risk factor for cardiac death in long-term follow-up (hazard ratio 5.3, p = 0.01). Five-year survival of the study subjects was comparable to that of the Japanese dialysis population. Conclusions The prognosis for dialysis patients after open surgery was equivalent to that of Japanese dialysis patients in general. A high proportion of late postoperative deaths were due to heart disease. Patients with atherosclerosis obliterans had a poor prognosis.

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Abe, Tomonobu, Hiraku Kumamaru, Kiyoharu Nakano, Noboru Motomura, Hiroaki Miyata, and Shinichi Takamoto. "Status of cardiovascular surgery in Japan between 2017 and 2018: A report based on the Japan Cardiovascular Surgery Database. 3. Valvular heart surgery." Asian Cardiovascular and Thoracic Annals 29, no. 4 (January 10, 2021): 300–309. http://dx.doi.org/10.1177/0218492320981459.

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Objectives We aimed to present data regarding the current status and trends of valvular heart surgeries in Japan from the Japan Cardiovascular Surgery Database for the 2017–2018. Methods We extracted data on cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We determined the trend in the number of aortic valve replacement procedures from 2013 to 2018. The operative mortality rates were calculated for representative valve procedures stratified by age group. Data regarding minimally invasive procedures and transcatheter aortic valve replacement in the Japan Cardiovascular Surgery Database are also presented. Results In conjunction with the dramatic increase in the number of transcatheter aortic valve replacements in 2017 and 2018, surgical aortic valve replacement also increased from 26,054 to 28,202. The operative mortality rate in first-time valve procedures was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, and 8.2% and 4.6% in mitral valve replacement with biological prostheses and with mechanical prostheses, respectively. Regarding minimally invasive procedures, 30.8% of first-time isolated mitral valve plasty procedures were performed by a right thoracotomy. Although patients who underwent surgery by a right thoracotomy had better clinical outcomes, it was also apparent that patients who underwent surgery by a right thoracotomy had lower operative risk profiles. The overall mortality rates after transcatheter aortic valve replacement and surgical aortic valve replacement were 1.5% and 1.8%, respectively. Conclusion We have reported benchmark data on heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.

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Kobayashi, Junjiro. "Discrepancy of Future Cardiovascular Surgery and Current Board Certification System in Japan." Japanese Journal of Cardiovascular Surgery 45, no. 4 (2016): m4—m4_2. http://dx.doi.org/10.4326/jjcvs.45.m4.

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Fujita, Tomoyuki, Hiroyuki Yamamoto, Junjiro Kobayashi, Satsuki Fukushima, Hiroaki Miyata, Kizuku Yamashita, and Noboru Motomura. "Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database." General Thoracic and Cardiovascular Surgery 68, no. 12 (June 25, 2020): 1439–46. http://dx.doi.org/10.1007/s11748-020-01418-y.

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Abstract Background Ischemic papillary muscle rupture (PMR) is a catastrophic complication following acute myocardial infarction (AMI). We evaluated early outcomes of PMR by using data from the Japan Cardiovascular Surgery Database, a nationwide Japanese registry. Methods We retrospectively analyzed data from 196 patients diagnosed with PMR following AMI in Japan between January 2014 and December 2017. Risk factors for operative mortality and severe complications following mitral valve surgery were analyzed. Results The 30-day and hospital mortality rates were 20% and 26%, respectively. Chronic hemodialysis, abrupt rupture after AMI, resuscitation before surgery, and preoperative venoarterial extracorporeal membrane oxygenation were associated with mortality. Mitral valve replacement was chosen mainly (90%) for surgical correction of mitral regurgitation in these patients. There was no significant difference in short-term outcomes between mitral valve replacement versus mitral valve repair, despite non-matched characteristics in background between the treatment groups. Concomitant coronary artery bypass grafting had no impact on short-term outcomes. Conclusions Information derived from the nationwide database of patients with AMI-associated PMR show that PMR is a rare condition in the modern era. However, PMR is a severe disease with a mortality rate as high as 26%. The severity of the condition is associated with the risk for poor outcomes.

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Takai, Koji, Masaru Sawazaki, Shiro Tomari, Koji Yamana, and Yutaka Ogawa. "Development of a new data entry system suitable for the Japan Adult Cardiovascular Surgery Database." General Thoracic and Cardiovascular Surgery 57, no. 4 (April 2009): 192–96. http://dx.doi.org/10.1007/s11748-008-0363-3.

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Kalinin, R. E., I. A. Suchkov, N. D. Mzhavanadze, and V. O. Povarov. "Hemostatic system in patients with cardiovascular implantable electronic devices." Kardiologiya i serdechno-sosudistaya khirurgiya 14, no. 4 (2021): 292. http://dx.doi.org/10.17116/kardio202114041292.

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Saito, Aya, Hiraku Kumamaru, Noboru Motomura, Hiroaki Miyata, and Shinichi Takamoto. "Status of cardiovascular surgery in Japan between 2017 and 2018: A report based on the Cardiovascular Surgery Database. 2. Isolated coronary artery bypass surgery." Asian Cardiovascular and Thoracic Annals 29, no. 4 (January 10, 2021): 294–99. http://dx.doi.org/10.1177/0218492320981499.

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Background Clinical outcomes (as national clinical data) of isolated coronary artery bypass grafting have been successively reported, based on data registered in the Japan Cardiovascular Surgery Database, since 2013. In this study, we analysed the clinical results of isolated coronary artery bypass from 2017 to 2018 as a biannual report. Methods Data from the Japan Cardiovascular Surgery Database on isolated coronary artery bypass performed in 2017 and 2018 were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery. Results Isolated off-pump coronary artery bypass was performed in 54.6% ( n = 14,684) of all coronary artery bypass cases ( n = 26,913), and graft material for the left anterior descending artery was the left internal thoracic artery in 76.4% of cases and the right internal thoracic artery in 19.0% of cases. Operative mortality was 1.5% in elective cases (on-pump coronary artery bypass 1.9% and off-pump 1.2%, p < 0.001), 7.4% in emergency cases (on-pump 10.2% and off-pump 4.3%, p < 0.001), and 2.5% overall. Postoperative morbidity was generally lower in off-pump coronary artery bypass. The severity of surgery with expected mortality, evaluated using JapanSCORE II, is increasing every year. Conclusions Our findings suggest that short-term operative results for isolated coronary artery bypass are stable, and operative candidates are shifting to higher-risk patients.

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Gupta, A., C. Wroe, H. Mi, J. Asher, M. A. Gok, B. K. Shenton, M. Ward, and D. Talbot. "Cardiovascular Risk Assessment Scoring System for the Determination of Cardiovascular Mortality in Renal Transplant Patients." Transplantation Proceedings 37, no. 8 (October 2005): 3290–91. http://dx.doi.org/10.1016/j.transproceed.2005.09.070.

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Okuno, Takuya, Susumu Kunisawa, Kiyohide Fushimi, and Yuichi Imanaka. "Intra-operative autologous blood donation for cardiovascular surgeries in Japan: A retrospective cohort study." PLOS ONE 16, no. 3 (March 10, 2021): e0247282. http://dx.doi.org/10.1371/journal.pone.0247282.

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Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016–2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32,433 and 4,267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients.

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Daimon, Masahiro, Hiroaki Miyata, Noboru Motomura, Yutaka Okita, Shinichi Takamoto, Sachiko Kanki, and Takahiro Katsumata. "Outcomes of Thoracic Aortic Surgery in Patients With Coronary Artery Disease ― Based on the Japan Adult Cardiovascular Surgery Database ―." Circulation Journal 83, no. 5 (April 25, 2019): 978–84. http://dx.doi.org/10.1253/circj.cj-18-0703.

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Yamauchi, Takashi, Hiroyuki Yamamoto, Hiroaki Miyata, Junjiro Kobayashi, Takafumi Masai, and Noboru Motomura. "Surgical Aortic Valve Replacement for Aortic Stenosis in Dialysis Patients ― Analysis of Japan Cardiovascular Surgery Database ―." Circulation Journal 84, no. 8 (July 22, 2020): 1271–76. http://dx.doi.org/10.1253/circj.cj-20-0042.

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Weinmann, Eran E., Natan Poluksht, David Chayen, and Arie Bass. "Surgery of the Superficial Venous System in Elderly Patients." Vascular and Endovascular Surgery 37, no. 2 (March 2003): 111–15. http://dx.doi.org/10.1177/153857440303700205.

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Yoshida, Masahiro, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Miho Sekimoto, Masahiko Hirota, et al. "Health insurance system and payments provided to patients for the management of severe acute pancreatitis in Japan." Journal of Hepato-Biliary-Pancreatic Surgery 13, no. 1 (February 2006): 7–9. http://dx.doi.org/10.1007/s00534-005-1046-4.

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Ueno, Tatsuya, Haruo Nishijima, Hiroki Hikichi, Rie Haga, Akira Arai, Chieko Suzuki, Jin-ichi Nunomura, Kyoji Saito, and Masahiko Tomiyama. "Helicopter Transport for Patients with Cerebral Infarction in Rural Japan." Journal of Stroke and Cerebrovascular Diseases 28, no. 9 (September 2019): 2525–29. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.010.

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Leca, Bianca Maria, Ionuț Stanca, Suzana Florea, Simona Fica, and Anca Elena Sîrbu. "Impact of weight loss on the cardiovascular system after bariatric surgery." Problems of Endocrinology 62, no. 5 (September 22, 2016): 43. http://dx.doi.org/10.14341/probl201662543.

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Introduction. Obesity is a chronic disease with a great impact on the cardiovascular system through its association with type II diabetes, hypertension, dyslipidemia, metabolic syndrome (MetS) and also through direct alterations in cardiac performance and morphology. Recent long term studies prove that substantial weight loss obtained via bariatric surgery is capable of improving cardiac risk factors associated with severe obesity, decreasing the mortality rates.Aim: to assess the long-term changes in cardiovascular risk and cardiac structure in obese patients who had lost weight after laparoscopic sleeve gastrectomy (LSG).Methods. Fifty-two severe obese patients (44±9 years, 57.7% women, BMI=45±8 kg/m2) underwent clinical and biochemical examination and Doppler echocardiograms before and 5 years after LSG.Results. Pre-operatively, 78.4% of patients were hypertensive, 46.2% had diabetes, 73.1% MetS and 44.2% presented left ventricle hypertrophy (LVH), reflecting high cardio-metabolic risk. The patients reassessment was made 61.7±10.5 months after LSG, when a decrease in BMI of 21.9±10% was achieved (p<0.001). The prevalence of hypertension (64.7%), diabetes (32.7%) and MetS (28.8%) decreased compared to the pre-operative examination (p=0.019, p<0.001, p=0.036). An increase in left ventricle mass and left ventricle mass index (LVMI) (p<0.001) and in the prevalence of LVH (57.7%-p=0.001) was recorded. Patients were divided into two groups based on the decrease in LVMI (positive response-38.5%) or increase in LVMI post-surgery (negative response-61.5%), compared with pre-operative values. The group of patients with negative response had lost less weight (p=0.006), had a poor glycemic control (p=0.022), and higher systolic (p=0.004) and diastolic (p=0.030) pressure values compared to the first evaluation.Conclusion. The increase of LVMI after LSG indicates that this study should continue, including a larger number of patients. It is important to identify the factors that can predict an inappropriate response to surgery, in order to prevent and treat them.

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Abe, Tomonobu, Hiroyuki Yamamoto, Hiroaki Miyata, Noboru Motomura, Yoshiyuki Tokuda, Kazuo Tanemoto, Akihiro Usui, and Shinichi Takamoto. "Patient trends and outcomes of surgery for type A acute aortic dissection in Japan: an analysis of more than 10 000 patients from the Japan Cardiovascular Surgery Database." European Journal of Cardio-Thoracic Surgery 57, no. 4 (December 3, 2019): 660–67. http://dx.doi.org/10.1093/ejcts/ezz323.

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Abstract OBJECTIVES To evaluate the background trends and surgical outcomes for more than 10 000 patients with acute type A dissection in Japan in a recent 8-year period. METHODS Data on replacement of the ascending aorta and/or aortic arch for acute type A dissection were collected from the Japan Cardiovascular Surgery Database from 2008 to 2015. Linear-by-linear association tests or Cuzick’s test for trend was used to evaluate group trends over time. The results were calculated for ascending or hemiarch replacement and arch replacement. A multivariable logistic regression model was used to calculate the risk-adjusted operative mortality rate. RESULTS A total of 11 843 patients were included. The overall 30-day mortality and operative mortality rates were 7.6% and 9.5%, respectively. The number of surgically treated cases increased from 2436 patients in 2008–2009 to 3533 in 2014–2015, a 45.0% increase. A trend analysis revealed significant changes in patient characteristics with time, including increasing age and rate of preoperative renal failure. Despite worsening risk factors, the unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01; test of trend). The risk-adjusted mortality rate showed a downward trend both in ascending aorta or hemiarch replacement and arch replacement, although the trend was not statistically significant (P > 0.05). CONCLUSIONS Unadjusted and adjusted operative deaths have shown a decreasing trend, although patients undergoing surgery for acute type A dissection have demonstrated worsening of risk factors, such as age and renal failure. The number of surgeries performed for acute type A dissection significantly increased throughout the study period in Japan.

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Ozisik, Kanat, Muge Misirlioglu, Tulga A. Ulus, Serdar Tuncer, Mustafa Emir, and Fehmi Katircioglu. "Renin-Angiotensin System Polymorphisms and Coronary Artery Surgery Patients." Asian Cardiovascular and Thoracic Annals 13, no. 2 (June 2005): 153–56. http://dx.doi.org/10.1177/021849230501300212.

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The frequencies of angiotensin-converting enzyme gene insertion/deletion, angiotensinogen-M253T, and angiotensin II type 1 receptor-A1166C polymorphisms were analyzed in 105 patients undergoing coronary artery bypass grafting (group 1) and a control group of 105 non-cardiac patients (group 2). Blood samples were obtained for biochemical analyses and DNA extraction. Genotyping was performed by polymerase-chain-reaction-based restriction analysis. According to the angiotensin-converting enzyme gene insertion/deletion polymorphism, 36.3% of patients in group 1 and 30.7% in group 2 were homozygous for the DD allele. This difference was not statistically significant. Angiotensin II type 1 receptor-A1166C genotype polymorphism was also not significantly different between the groups. The results showed the angiotensinogen-M235T polymorphism to be heterogenous. The MM homozygote frequency was significantly higher in controls (72.3%), whereas 80% of the TT homozygote frequency was in the surgical group ( p = 0.001). These results show that although there were no significant differences in angiotensin-converting enzyme gene insertion/deletion and angiotensin II type 1 receptor-A1166C genotype polymorphisms between the groups, angiotensinogen-M235T polymorphism of TT homozygote frequency was significantly associated with patients undergoing coronary artery bypass surgery.

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Obitsu, Y., S. Ishimaru, and H. Shigematsu. "The Education System to Master Endovascular Aortic Repair in Japan – The Japanese Committee for Stentgraft Management." European Journal of Vascular and Endovascular Surgery 39 (March 2010): S5—S9. http://dx.doi.org/10.1016/j.ejvs.2009.12.024.

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Vestergaard Kvist, Annika, Junaid Faruque, Enriqueta Vallejo-Yagüe, Stefan Weiler, Elizabeth M. Winter, and Andrea M. Burden. "Cardiovascular Safety Profile of Romosozumab: A Pharmacovigilance Analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS)." Journal of Clinical Medicine 10, no. 8 (April 13, 2021): 1660. http://dx.doi.org/10.3390/jcm10081660.

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Background: Cardiovascular safety concerns for major cardiovascular events (MACE) were raised during the clinical trials of romosozumab. We aimed to evaluate the cardiovascular safety profile of romosozumab in a large pharmacovigilance database. Methods: All cases reported between January 2019 and December 2020 where romosozumab was reported were extracted from the Food and Drug Administration Adverse Event Reporting System (FAERS). The outcome of interest was MACE (myocardial infarction (MI), stroke, or cardiovascular death). A disproportionality analysis was conducted by estimating the reporting odds ratios (RORs) and 95% confidence intervals. Disproportionality analyses were stratified by sex and reporting region (US, Japan, other). Results: Of the 1995 eligible cases with romosozumab, the majority (N = 1188; 59.5%) originated from Japan. Overall, 206 suspected MACE reports were identified, of which the majority (n = 164; 13.8%) were from Japan, and 41 (5.2%) were from the United States (US). Among Japanese reports, patients were older and more frequently male than reports from the US. Similarly, cases with a reported MACE were older and had higher reports of cardioprotective drugs than those without cardiovascular events. Elevated reports for MACE (ROR 4.07, 95% CI: 2.39–6.93) was identified overall, which was primarily driven by the significant disproportionality measures in the Japanese reports. Conclusions: The current pharmacovigilance study identified a potential signal for elevated MACE, particularly in Japan. The results support the current safety warnings from the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to avoid use in high-risk patients.

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Okura, Yuji, Tsugumi Takayama, Kazuyuki Ozaki, Hiroshi Tanaka, Akira Kikuchi, Toshihiro Saito, Toshiki Tanigawa, et al. "Future projection of cancer patients with cardiovascular disease in Japan by the year 2039: a pilot study." International Journal of Clinical Oncology 24, no. 8 (March 22, 2019): 983–94. http://dx.doi.org/10.1007/s10147-019-01426-w.

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Sekine, Ikuo, Yutaka Nishiwaki, Tomoyuki Yokose, Kanji Nagai, Kenji Suzuki, and Tetsuro Kodama. "Young lung cancer patients in Japan: different characteristics between the sexes." Annals of Thoracic Surgery 67, no. 5 (May 1999): 1451–55. http://dx.doi.org/10.1016/s0003-4975(99)00171-x.

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Fukasawa, Mizuya. "Current status of vascular access in Japan—from Dialysis Access Symposium 2017." Journal of Vascular Access 20, no. 1_suppl (April 28, 2019): 38–44. http://dx.doi.org/10.1177/1129729818762982.

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At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

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Kusagawa, Hitoshi, Naoki Haruta, Ryo Shinhara, Yuji Hoshino, Atsushi Tabuchi, Hiromitsu Sugawara, Koji Shinozaki, et al. "Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan." Phlebology: The Journal of Venous Disease 33, no. 10 (January 4, 2018): 678–86. http://dx.doi.org/10.1177/0268355517750523.

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Objectives To clarify the surgical methods and the clinical results of subfascial endoscopic perforator surgery in Japan. Methods This study included 1287 limbs of 1091 patients who underwent subfascial endoscopic perforator surgery in 14 hospitals. Simultaneous saphenous vein treatment was performed in 1079 limbs (83.8%), and 118 limbs (9.2%) had deep venous lesions. The venous clinical severity score was calculated before and 6 to 12 months after surgery. The ulcer healing rate and ulcer recurrence rate were calculated cumulatively. Results Preoperative venous clinical severity score was significantly decreased from 10.0 ± 6.6 to 3.1 ± 3.4 ( P < .0001) postoperatively. The primary ulcer healing rate was 96.2% (332/345 C6 limbs) at an average follow-up of 47.7 months, and the ulcer recurrence rate was 12.0% (49/393 C5, C6 limbs) at the average follow-up of 46.0 months after the ulcer healed. Conclusion These results indicate that subfascial endoscopic perforator surgery is an alternative to improve the long-lasting disease severity and/or clinical outcome.

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Noguchi, Yoshihiro, Shunsuke Yoshizawa, Tomoya Tachi, and Hitomi Teramachi. "Effect of Dipeptidyl Peptidase-4 Inhibitors vs. Metformin on Major Cardiovascular Events Using Spontaneous Reporting System and Real-World Database Study." Journal of Clinical Medicine 11, no. 17 (August 25, 2022): 4988. http://dx.doi.org/10.3390/jcm11174988.

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Background: Metformin had been recommended as the first-line treatment for type 2 diabetes since 2006 because of its low cost, high efficacy, and potential to reduce cardiovascular events, and thus death. However, dipeptidyl peptidase-4 (DPP-4) inhibitors are the most commonly prescribed first-line agents for patients with type 2 diabetes in Japan. Therefore, it is necessary to clarify the effect of DPP-4 inhibitors on preventing cardiovascular events, taking into consideration the actual prescription of antidiabetic drugs in Japan. Methods: This study examined the effect of DPP-4 inhibitors on preventing cardiovascular events. The Japanese Adverse Drug Event Report (JADER) database, a spontaneous reporting system in Japan, and the Japanese Medical Data Center (JMDC) Claims Database, a Japanese health insurance claims and medical checkup database, were used for the analysis. Metformin was used as the DPP-4 inhibitor comparator. Major cardiovascular events were set as the primary endpoint. Results: In the analysis using the JADER database, a signal of major cardiovascular events was detected with DPP-4 inhibitors (IC: 0.22, 95% confidence interval: 0.03–0.40) but not with metformin. In the analysis using the JMDC Claims Database, the hazard ratio of major cardiovascular events for DPP-4 inhibitors versus metformin was 1.01 (95% CI: 0.84–1.20). Conclusions: A comprehensive analysis using two different databases in Japan, the JADER and the JMDC Claims Database, showed that DPP-4 inhibitors, which are widely used in Japan, have a non-inferior risk of cardiovascular events compared to metformin, which is used as the first-line drug in the United States and Europe.

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Takahashi, Masamichi, Yuko Watanabe, Takafumi Koyama, Kuniko Sunami, Takashi Kubo, Hourin Cho, Makoto Hirata, et al. "COT-16 NATION-WIDE LANDSCAPE OF GENOMIC ANALYSIS OF ADULT CENTRAL NERVOUS SYSTEM TUMORS IN JAPAN." Neuro-Oncology Advances 4, Supplement_3 (December 1, 2022): iii26. http://dx.doi.org/10.1093/noajnl/vdac167.103.

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Abstract Background Comprehensive genomic profiling (CGP) testing has been covered by public health insurance and its clinical application has started in Japan since June 2019. All the results of CGP testing are sent to the Center for Cancer Genomics and Advanced Therapeutics (C-CAT) and shared with clinicians after discussion at the Expert Panel (EP). Here we report the results of analysis of adult central nervous system (CNS) tumors registered in Japan. Methods C-CAT registry data as of April 2022 (ver. 20220406) was used. Patient background, diagnosis, type of CGP testing, genetic alterations and treatment status after EP were analyzed. Results 1042 patients with CNS tumors were enrolled, 338 (32.4%) were younger than 20 years old and 704 (67.6%) were older. Among 704 adult patients, mean age was 47.6 years and median ECOG PS was 1. Top tumor diagnosis included glioblastoma (42.8%), anaplastic astrocytoma (11.8%) and anaplastic oligodendroglioma (5.0%), and 634 (90.0%) were tested with FoundationOne CDx(R). Regarding genomic alterations, 278 had TP53 mutation, 242 had CDKN2A deletion, 221 had TERT mutation, 218 had CDKN2B deletion, 136 had IDH1 mutation, and 39 had TMB high (>10Mb) and no NTRK gene fusion was observed. EP recommended treatment options in 187 cases (26.6%) and 60 cases (8.5%) reached therapeutic agents, including 25 Patient-Proposed Healthcare Services, 16 approved drugs, 8 pharmaceutical clinical trials, 7 investigator-initiated clinical trials and 4 others. Conclusion This is the first report of nation-wide results of CNS tumors analyzed by CGP in Japan. Although some patients were able to reach therapeutic agents under the Patient-Proposed Healthcare Services system, little number of patients reached clinical trial. Development of new drugs is urgently warranted.

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Kondo, Kazuya, and Yasumasa Monden. "Thymoma and Myasthenia Gravis: A Clinical Study of 1,089 Patients From Japan." Annals of Thoracic Surgery 79, no. 1 (January 2005): 219–24. http://dx.doi.org/10.1016/j.athoracsur.2004.06.090.

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Tanaka, Koji, Toshiyuki Uehara, Kazumi Kimura, Yasushi Okada, Yasuhiro Hasegawa, Norio Tanahashi, Akifumi Suzuki, et al. "Features of Patients with Transient Monocular Blindness: A Multicenter Retrospective Study in Japan." Journal of Stroke and Cerebrovascular Diseases 23, no. 3 (March 2014): e151-e155. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.09.017.

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Kovacevic-Kostic, Natasa, Radmila Karan, Mile Vranes, Dejan Markovic, Milos Velinovic, and Zivan Maksimovic. "Preoperative preparation of vascular patients undergoing nonvascular surgery." Acta chirurgica Iugoslavica 58, no. 2 (2011): 55–61. http://dx.doi.org/10.2298/aci1102055k.

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Patients with vascular diseases mainly caused by atherosclerosis, that are undergoing nonvascular surgery, often have co-existing conditions which affect their cardiovascular system. Cardiovascular complications are among the most common perioperative complications including respiratory complications and infections. These include coronary disease, hypertension, heart insufficiency, pulmonary hypertension, and renovascular hypertension, among others. Preoperative preparation must include the use of ?blocker therapy, antihypertensive, antithrombotic and antilipogenic therapy. Electrocardiogram (ECG) and trans-thoracic echocardiography are the minimum preoperative diagnostic evaluations that should be performed, because complications may arise even in patients without prior cardiovascular symptomatology. Venous diseases are the most common contemporary diseases affecting people of all age groups and races. Invasive-diagnostic-therapeutic procedures may cause lesions of venous endothelium, hence perioperative prevention of deep vein thrombosis (DVT) with the use of heparin or low-molecular -weight heparin (LMWH) should be undertaken.

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Kantekin, Çiğdem Unal, Müjgan Ercan, Esra Firat Oğuz, Ertan Demirdaş, Kıvanç Atılgan, Mesut Sipahi, and Ferit Çiçekçioğlu. "Evaluation of the i-STAT Blood Gas Analysis System in Cardiovascular Surgery." Medical Laboratory Technology Journal 4, no. 2 (December 27, 2018): 35. http://dx.doi.org/10.31964/mltj.v4i2.190.

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The aim of this study was toinvestigate the compatibility of the parameters measured with the i-STAT blood gas analyser and the conventional blood gas analyser Rapid Point 500 (Siemens Healthcare Diagnostics, USA) in patients who underwent cardiovascular surgery. This clinical study included fifty patients undergoing coronary artery bypass surgery. Fifty whole blood samples were portioned and measured on the i-STAT and RP500 laboratory analyzers. The compatibility between pH, pCO2, pO2, Hb, Na+, K+, iCa2+ and glucose values was investigated.There was a good correlation of the i-STAT analyser with the RP500 analyser, with the exception Hb and Na+. Also all parameters except for Hb and ionized calcium were found to be within acceptable range in terms of clinical decision limits. It is very important that the point-of-care devices give accurate results as well as quick results. For this reason, we absolutely think that the point of care devices should be subjected to external and internal quality control programs, users should be trained regularly and feedback studies should be done.

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Stoliński, Jarosław, Robert Musiał, Dariusz Plicner, and Janusz Andres. "Respiratory System Function in Patients after Minimally Invasive Aortic Valve Replacement Surgery." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 12, no. 2 (March 2017): 127–36. http://dx.doi.org/10.1097/imi.0000000000000349.

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Objective The aim of the study was to comparatively analyze respiratory system function after minimally invasive, through right minithoracotomy aortic valve replacement (RT-AVR) to conventional AVR. Methods Analysis of 201 patients scheduled for RT-AVR and 316 for AVR between January 2010 and November 2013. Complications of the respiratory system and pulmonary functional status are presented. Results Complications of the respiratory system occurred in 16.8% of AVR and 11.0% of RT-AVR patients ( P = 0.067). The rate of pleural effusions, thoracenteses, pneumonias, or phrenic nerve dysfunctions was not significantly different between groups. Perioperative mortality was 1.9% in AVR and 1.0% in RT-AVR ( P = 0.417). Mechanical ventilation time after surgery was 9.7 ± 5.9 hours for AVR and 7.2 ±3.2 hours for RT-AVR patients ( P < 0.001). Stroke (odds ratio [OR] = 13.4, P = 0.008), increased postoperative blood loss (OR = 9.6, P <0.001), and chronic obstructive pulmonary disease (OR = 7.7, P < 0.001) were risk factors of prolonged mechanical lung ventilation. A week after surgery, the results of most pulmonary function tests were lower in the AVR than in the RT-AVR group ( P < 0.001 was seen for forced expiratory volume in the first second, vital capacity, total lung capacity, maximum inspiratory pressure and maximum expiratory pressure, P = 0.377 was seen for residual volume). Conclusions Right anterior aortic valve replacement minithoracotomy surgery with single-lung ventilation did not result in increased rate of respiratory system complications. Spirometry examinations revealed that pulmonary functional status was more impaired after AVR in comparison with RT-AVR surgery.

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MIURA, Keiko, Kiyoshi MATSUMURA, Yoshito NAKAMURA, Hideo KUROKAWA, Minoru KAJIYAMA, and Yutaka TAKATA. "Suppression of Cardiac Sympathetic Nervous System during Dental Surgery in Hypertensive Patients." Hypertension Research 23, no. 3 (2000): 207–12. http://dx.doi.org/10.1291/hypres.23.207.

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Rayan, Sunil S., Thomas T. Terramani, Victor J. Weiss, and Elliot L. Chaikof. "The LifeSite Hemodialysis Access System in patients with limited access." Journal of Vascular Surgery 38, no. 4 (October 2003): 714–18. http://dx.doi.org/10.1016/s0741-5214(03)00793-6.

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Yamamoto, Hiroyuki, Hiroaki Miyata, Kazuo Tanemoto, Yoshikatsu Saiki, Hitoshi Yokoyama, Eriko Fukuchi, Noboru Motomura, Yuichi Ueda, and Shinichi Takamoto. "Quality improvement in cardiovascular surgery: results of a surgical quality improvement programme using a nationwide clinical database and database-driven site visits in Japan." BMJ Quality & Safety 29, no. 7 (November 20, 2019): 560–68. http://dx.doi.org/10.1136/bmjqs-2019-009955.

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BackgroundIn 2015, an academic-led surgical quality improvement (QI) programme was initiated in Japan to use database information entered from 2013 to 2014 to identify institutions needing improvement, to which cardiovascular surgery experts were sent for site visits. Here, posthoc analyses were used to estimate the effectiveness of the QI programme in reducing surgical mortality (30-day and in-hospital mortality).MethodsPatients were selected from the Japan Cardiovascular Surgery Database, which includes almost all cardiovascular surgeries in Japan, if they underwent isolated coronary artery bypass graft (CABG), valve or thoracic aortic surgery from 2013 to 2016. Difference-in-difference methods based on a generalised estimating equation logistic regression model were used for pre-post comparison after adjustment for patient-level expected surgical mortality.ResultsIn total, 238 778 patients (10 172 deaths) from 590 hospitals, including 3556 patients seen at 10 hospitals with site visits, were included from January 2013 to December 2016. Preprogramme, the crude surgical mortality for site visit and non-site visit institutions was 9.0% and 2.7%, respectively, for CABG surgery, 10.7% and 4.0%, respectively, for valve surgery and 20.7% and 7.5%, respectively, for aortic surgery. Postprogramme, moderate improvement was observed at site visit hospitals (3.6%, 9.6% and 18.8%, respectively). A difference-in-difference estimator showed significant improvement in CABG (0.29 (95% CI 0.15 to 0.54), p<0.001) and valve surgery (0.74 (0.55 to 1.00); p=0.047). Improvement was observed within 1 year for CABG surgery but was delayed for valve and aortic surgery. During the programme, institutions did not refrain from surgery.ConclusionsCombining traditional site visits with modern database methodologies effectively improved surgical mortality in Japan. These universal methods could be applied via a similar approach to contribute to achieving QI in surgery for many other procedures worldwide.

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Lidén, Katarina, Torbjörn Ivert, and Ulrik Sartipy. "Death in low-risk cardiac surgery revisited." Open Heart 7, no. 1 (March 2020): e001244. http://dx.doi.org/10.1136/openhrt-2020-001244.

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BackgroundA systematic review of low-risk death has been shown successful in identifying system weaknesses. The aim was to analyse early mortality in low-risk patients undergoing cardiac surgery and to determine the cause of death, classify if they were unavoidable or potentially preventable as a result of technical or system errors.MethodsWe included all low-risk patients who underwent cardiac surgery at our institution from 1 September 2009 to 31 August 2019. In patients operated between 2009 and 2011, we defined low risk as an additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) I less than or equal to 3, and from 2012 and onwards as a EuroSCORE II less than or equal to 1.5. The medical records for the patients who died within 30 days of surgery were thoroughly examined and the cause of death was classified as cardiac or non-cardiac. Furthermore, deaths were categorised as not preventable, preventable (technical error) or preventable (system error).ResultsDuring the study period 3103 low-risk patients underwent surgery, and 11 patients died within 30 days of the operation (0.35%). Six of these (55%) were classified as preventable and five non-preventable. Four of the preventable deaths were classified as technical errors and two were due to system errors.ConclusionsA repeated systematic review of deaths in patients with a low preoperative risk showed that a majority of deaths were preventable, and therefore potentially avoidable. Similar to the previous assessment at our unit, mortality was very low and failure to communicate remains a modifiable factor that should be addressed.

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Tournis, Symeon, Konstantinos Makris, Etienne Cavalier, and George Trovas. "Cardiovascular Risk in Patients with Primary Hyperparathyroidism." Current Pharmaceutical Design 26, no. 43 (December 22, 2020): 5628–36. http://dx.doi.org/10.2174/1381612824999201105165642.

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Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders characterized by parathyroid hormone (PTH)-dependent hypercalcemia. Cardinal features include low trauma fractures, nephrolithiasis, and chronic kidney disease. Several experimental studies established that parathyroid hormone exerts actions on the cardiovascular (CV) system, including vasodilatation and positive inotropic and chronotropic effects. Observational studies, especially in severe cases, report a higher prevalence of hypertension, diabetes mellitus, lipid abnormalities, endothelial dysfunction, arrhythmias, and left ventricular hypertrophy in patients with PHPT, while the risk of CV events seems to be increased in severe cases. However, the effect of surgery is inconsistent on CV abnormalities and, more importantly, on CV disease (CVD) events, especially in mild cases. In the current review, we describe the available evidence linking PHPT and CVD, as well as the effect of surgical management and pharmacological treatment on CVD manifestations in patients with PHPT. Based on the current evidence, CVD is not considered an indication for surgery.

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Okura, Yuji, Tsugumi Takayama, Kazuyuki Ozaki, Hiroshi Tanaka, Akira Kikuchi, Toshihiro Saito, Toshiki Tanigawa, et al. "Correction to: Future projection of cancer patients with cardiovascular disease in Japan by the year 2039: a pilot study." International Journal of Clinical Oncology 24, no. 8 (April 22, 2019): 995. http://dx.doi.org/10.1007/s10147-019-01444-8.

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Hamada, Jun-ichiro, Motohiro Morioka, Shigetoshi Yano, Yutaka Kai, and Yukitaka Ushio. "Incidence and Early Prognosis of Aneurysmal Subarachnoid Hemorrhage in Kumamoto Prefecture, Japan." Neurosurgery 54, no. 1 (January 1, 2004): 31–38. http://dx.doi.org/10.1227/01.neu.0000097196.55204.0b.

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Abstract OBJECTIVE We analyzed the community incidence and early prognosis of first-ever aneurysmal subarachnoid hemorrhages (SAHs) to obtain the same prognostic information used by physicians and families in a defined geographic area in Japan. METHODS During the 5-year period from January 1, 1996, to December 31, 2000, 2115 patients were registered in the Data Bank for Cerebral Aneurysms of Kumamoto Prefecture, a defined area in Japan with a population of 1.86 million. Registration was based on a comprehensive referral system for SAH patients; computed tomographic scans were available for all patients, including those who were moribund or dead on arrival. We compared the treatment outcomes at 3 months after the first-ever SAH in surgically and conservatively treated patients. RESULTS The age-adjusted annual incidence of SAH for men, women, and both sexes was 15.9, 26.6, and 21.6 per 100,000 person-years, respectively. In men, the incidence reached a plateau after age 40 years. In women, conversely, it rose after age 40 and peaked in the 9th decade of life. Of the 1634 surgically treated patients, 1153 (70.6%) had a favorable outcome; this was true for only 27 of 477 (5.7%) conservatively treated patients. Four patients were lost to follow-up. The clinical outcome did not differ between patients treated by open surgery and those treated endovascularly. Approximately 30% of our patients were older than 70 years at the time they experienced their first SAH. CONCLUSION The incidence of SAH obtained in this study was similar to earlier Japanese reports and Finnish studies. The importance of managing elderly patients with cerebral aneurysms will continue to increase.

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Koga, Masatoshi, Toshiyuki Uehara, Nobuyuki Yasui, Yasuhiro Hasegawa, Kazuyuki Nagatsuka, Yasushi Okada, and Kazuo Minematsu. "Factors Influencing Cooperation Among Healthcare Providers in a Community-Based Stroke Care System in Japan." Journal of Stroke and Cerebrovascular Diseases 20, no. 5 (September 2011): 413–23. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2010.02.012.

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Kondo, Kazuya, and Yasumasa Monden. "Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan." Annals of Thoracic Surgery 76, no. 3 (September 2003): 878–84. http://dx.doi.org/10.1016/s0003-4975(03)00555-1.

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Kunihara, Takashi, Nao Ichihara, Hiroaki Miyata, Noboru Motomura, Kenichi Sasaki, Minoru Matsuhama, and Shinichi Takamoto. "Valve-sparing root replacement and composite valve graft replacement in patients with aortic regurgitation: From the Japan Cardiovascular Surgery Database." Journal of Thoracic and Cardiovascular Surgery 158, no. 6 (December 2019): 1501–11. http://dx.doi.org/10.1016/j.jtcvs.2019.01.122.

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Kitamura, Hideki, Hitoshi Okabayashi, Michiya Hanyu, Jota Nakano, Satoshi Kono, Takuya Nomoto, Atsushi Nagasawa, Hisashi Sakaguchi, Hiroyuki Johno, and Takehiko Matsuo. "Early Results and Problems with St. Jude Medical Symmetry Bypass System in Japan." Asian Cardiovascular and Thoracic Annals 12, no. 3 (September 2004): 236–38. http://dx.doi.org/10.1177/021849230401200312.

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Ballegaard, Søren. "Acupuncture and the Cardiovascular System: A Scientific Challenge." Acupuncture in Medicine 16, no. 1 (May 1998): 2–9. http://dx.doi.org/10.1136/aim.16.1.2.

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In acupuncture research two main issues have to be addressed. One is whether the needle has a biological effect of its own. The other is whether acupuncture is of help to patients in their daily lives. With reference to this, acupuncture is a complex form of treatment in which the needles modulate physiological mechanisms of the body and the doctor supports the patient to achieve a life-style that assists with this. To evaluate the biological effects of needling, a randomised, controlled trial group of 49 patients with angina pectoris had acupuncture while cardiological, neurophysiological and psychological observations were made in a mutually independent manner. Needling was found to improve the working capacity of the heart. In addition, acupuncture was found to activate cardiovascular autoregulatory mechanisms in 24 healthy persons. To evaluate the effect of acupuncture in daily life, a controlled trial group of 69 patients with severe angina pectoris were followed for 2 years after treatment. The incidence of cardiac death or myocardial infarction was 7%, compared to 15–21% for the control group of published results concerning invasive treatments. Due to clinical improvement, surgery was postponed in 61% of the patients. The annual number of in-hospital days was reduced by 90%, leading to a US$ 12,000 saving for each patient.

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Nicol, S., and C. Narkowicz. "Learning physiology from cardiac surgery patients." Advances in Physiology Education 274, no. 6 (June 1998): S74. http://dx.doi.org/10.1152/advances.1998.274.6.s74.

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A number of pressures have led to a very great reduction or complete abandonment of the use of animals in the teaching of physiology in most medical schools. Often animal experiments have been replaced by computer simulations, but a simulation is only as good as the model or algorithm on which it is based and can never contain the depth of information or unpredictability displayed by real animals or patients. We used a computer-based system to collect cardiovascular data from patients instrumented for cardiac surgery, allowing students to "replay" an operation. These recordings were annotated with notes, diagrams and video clips, and a student workbook was written. The resulting package contained a wealth of physiological data and was perceived by students to be very clinically relevant. The very wealth of information, however, tended to overwhelm students, and so a series of introductory Computer tutorials were written to provide students with the background necessary to cope with the clinical data.

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Yamasaki, Mami, Norio Arita, Shoju Hiraga, Shuichi Izumoto, Kazuyoshi Morimoto, Susumu Nakatani, Ken Fujitani, Noriko Sato, and Toru Hayakawa. "A clinical and neuroradiological study of X-linked hydrocephalus in Japan." Journal of Neurosurgery 83, no. 1 (July 1995): 50–55. http://dx.doi.org/10.3171/jns.1995.83.1.0050.

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✓ To clarify the clinicopathological features of X-linked hydrocephalus, the authors studied 30 affected males from 15 families. In utero ultrasonography, performed at 21 to 40 weeks of gestation, revealed 18 fetuses with hydrocephalus. Computerized tomography (CT) revealed bilateral enlargement of the lateral ventricle with preponderant dilation of the posterior horn. In five patients with complete magnetic resonance (MR) imaging data, the most specific finding was localized atrophy of the anterior vermian lobe. Other MR imaging findings included a large massa intermedia, flat corpora quadrigemina, a small brainstem, and diffuse hypoplasia of the cerebral white matter. In all cases, the corpus callosum was hypoplastic or aplastic. The aqueduct was patent in four of five cases. Asymmetrical reduction of the ventricular size and a rippled ventricular wall were characteristic postshunt CT findings. Progressive macrocephaly and symptoms due to increased intracranial pressure were ameliorated by the shunt; however, the neurological outcome was not improved by shunting. Of 14 patients who lived to be between 2 and 18 years of age, all are retarded. These results indicate that X-linked hydrocephalus is not a disease of simple ventriculomegaly due to aqueduct stenosis alone but involves other complicated central nervous system anomalies.

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Journal articles on the topic 'Cardiovascular system Surgery Patients Japan'

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