Nagoya-shi, Japan
Nagoya-shi, Japan

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Hasegawa K.,Higashi Takarazuka Satoh Hospital | Tsuchikane E.,Toyohashi Heart Center | Okamura A.,Sakurabashi Watanabe Hospital | Fujita T.,Sapporo Cardio Vascular Clinic | And 6 more authors.
EuroIntervention | Year: 2017

Aims: The aim of this study was to assess the incidence and impact on midterm outcomes of intimal versus subintimal tracking with both antegrade and retrograde approaches in patients undergoing successful percutaneous coronary intervention for chronic total occlusion (CTO). Methods and results: In 2012, a total of 1,573 CTO cases from 30 hospitals were enrolled in the Japanese CTO registry. Successful guidewire crossing was performed in 1,411 cases (89.7%). Among them, the guidewire penetration position was clearly identified using intravascular ultrasound (IVUS) imaging in 352 cases, and clinical follow-up at 12 months was performed in 323 cases. These 323 cases were enrolled in this retrospective study: 242 cases were treated with the antegrade approach (antegrade group) and 81 cases were treated with the retrograde approach (retrograde group). The endpoint of this study was target vessel revascularisation (TVR) and major adverse cardiac events (MACE) at 12-month follow-up. Subintimal tracking occurred more frequently in the retrograde group (11.6% vs. 30.9%, p<0.01). TVR was more frequent in the subintimal tracking group in the retrograde group (7.1% vs. 16.0%, p=0.03) but not in the antegrade group (2.8% vs. 3.6%, p=0.99). Although the occlusion length was similar, the subintimal tracking group required a longer stent length compared to the intimal tracking group in the retrograde approach (59.7±24.4 mm vs. 74.0±24.4 mm, p<0.01). Conclusions: Subintimal tracking was more frequent in the retrograde approach. Intimal tracking should be recommended in the retrograde approach to reduce stent length and to improve follow-up outcomes. © Europa Digital & Publishing 2017. All rights reserved.


Yamane M.,Sayama Hospital | Muto M.,Cardiovascular and Respiratory Center | Matsubara T.,Nagoya Heart Center | Nakamura S.,Kyoto Katsura Hospital | And 6 more authors.
EuroIntervention | Year: 2013

Aims: The retrograde approach to CTO is promising, but questions remain with regard to its wider application and the potential risks. This study evaluated the feasibility and efficacy of retrograde recanalisation of chronic total occlusion (CTO) of the coronary arteries. Methods and results: A total of 378 consecutive patients (previously failed PCI 32.0%) who enrolled in 27 institutions in Japan underwent retrograde recanalisation for CTO. We analysed the data on lesion characteristics, procedural materials, technique used, complications and clinical outcomes. Successful retrograde recanalisation was achieved in 70.4% and the overall procedural success was 83.6%. Collateral crossing was achieved via a septal route in 68.9%, epicardial in 27.2% and bypass grafts in 2.6%, respectively. The retrograde approach was completed with implementation of reverse CART in 42.5%, direct wire crossing in 23.1%, bilateral wiring in 22.7%, and CART in 11.7%. Major and minor collateral injuries and coronary perforations were noted in 1.3%, 10.3% and 2.9% of cases, respectively. Stroke occurred in 0.3%, QWMI and emergency PCI in 0.3% of patients with successful recanalisation. Conclusions: Wider application of retrograde CTO PCI achieved a high rate of success in recanalisation with an acceptable rate of complications in Japan. © Europa Digital & Publishing 2013. All rights reserved.


PubMed | Nagoya Heart Center, Kokura Memorial Hospital, Toyohashi Heart Center, Sendai Kousei Hospital and 4 more.
Type: | Journal: International journal of cardiology | Year: 2016

This study aimed to assess the effectiveness of preparatory coronary protection (CP) in patients considered at high risk of acute coronary obstruction (ACO) after transcatheter aortic valve implantation (TAVI).The Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) Japanese multicenter registry enrolled 666 consecutive patients. All patients were assessed by preprocedural multidetector computed tomography. CP using a guide wire with or without a balloon was prospectively performed according to the following criteria: 1) coronary height length from the annulus <10mm, 2) evidence of ACO during balloon aortic valvuloplasty with simultaneous aortic injection, and 3) shallow valsalva or bulky calcification on the leaflet. The incidence of ACO and other procedural outcomes were compared between the CP and non-CP groups.CP was performed in 14.1% of all patients (94/666). ACO had an incidence of 1.5% (10/666) and mainly occurred in women (70%) and the left coronary artery (70%). The ACO rate was significantly higher in the CP group than in the non-CP group (7.4% [7/94] vs. 0.5% [3/572]; p<0.001), although notably 30% of ACO were occurred in non-CP group. All 10 ACO cases were successfully treated by catheter intervention, although periprocedural myocardial injury occurred in 42.9% of patients with CP group and 33.3% of those without CP group. Mortality and other periprocedural complications did not significantly differ between the 2 groups.The preparatory CP strategy was feasible for the management of ACO during TAVI, but the complication of ACO was difficult to predict completely.


Teramoto T.,Toyohashi Heart Center | Tsuchikane E.,Toyohashi Heart Center | Matsuo H.,Gifu Heart Center | Suzuki Y.,Nagoya Heart Center | And 10 more authors.
JACC: Cardiovascular Interventions | Year: 2014

Objectives This study sought to compare the initial success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in a native coronary artery (NCA) in patients with and without previous coronary artery bypass grafting (CABG) and to assess predictive factors. Background Landmark novel wiring techniques for CTO-PCI have contributed to improvement in the initial success of CTO-PCI. However, challenges persist in CTO-PCI in NCA in pCABG patients. Methods Patients who underwent CTO-PCI in an NCA were selected and classified into 2 groups: pCABG (206 PCIs in 153 patients) and nCABG (1,431 PCIs in 1,139 patients). Results CTO was located more often in the left anterior descending artery (p = 0.0003), and severe calcified lesions were observed more frequently in the pCABG group (p < 0.0001). Although the retrograde attempt was tried more frequently in the pCABG group, the CTO-PCI success rate was significantly lower in the pCABG patients than in the nCABG patients (71% vs. 83%). Longer procedural time and greater radiation exposure were needed in the pCABG patients. Logistic regression analysis among the pCABG patients revealed that intravascular ultrasound use and parallel wiring were positive factors, and lesion tortuosity was a negative factor. Conclusions The initial success rate of CTO-PCI of an NCA in the pCABG group was significantly decreased compared with that in the nCABG group. Anatomic complexity and unstable hemodynamic state were unfavorable conditions. This study reveals that the issues to be overcome are lying with CTO revascularization in an NCA in pCABG patients. © 2014 by the American College of Cardiology Foundation.


Kinoshita Y.,Toyohashi Heart Center | Katoh O.,Toyohashi Heart Center | Matsubara T.,Nagoya Heart Center | Ehara M.,Toyohashi Heart Center | And 3 more authors.
JACC: Cardiovascular Interventions | Year: 2010

Objectives: We sought to report the results of both bench-testing and our first clinical experience with this novel technique. Background: The optimal stenting technique for bifurcation lesions has yet to be defined. Methods: This technique works by flaring the proximal side of the stent in side branch out like a flower petal. We tested it in vitro and the resultant stent structure and stent polymer damage was observed in both main branch and side branch with an optical microscopy, multislice computer tomography, intravascular ultrasound, endoscopy, and by electron microscopy. We also applied this technique in 33 patients and assessed patient outcomes up to 9 months prospectively. Drug-eluting stents were used for the bench tests and for all patients. Results: Bench-testing showed complete coverage of the bifurcation with minimal stent-layer overlapping. There was little polymer damage by electron microscopy. Procedural success was achieved in all cases and restenosis occurred in 2 cases. In both restenosis cases, "petal" stenting technique was done reluctantly after another stent had already been deployed in the main branch before any stenting of the side branch. There were no incidences of restenosis when this technique was used electively. Conclusions: In terms of damage to the polymer and ostial strut coverage, this new "flower petal stenting" technique is effective for treatment of bifurcation lesion and it may well be superior to other available techniques. © 2010 American College of Cardiology Foundation.


Ikeno F.,Stanford University | Suzuki Y.,Nagoya Heart Center | Yeung A.C.,Stanford University
Journal of Biomedicine and Biotechnology | Year: 2011

To improve human health, scientific discoveries must be translated into practical applications. Inherent in the development of these technologies is the role of preclinical testing using animal models. Although significant insight into the molecular and cellular basis has come from small animal models, significant differences exist with regard to cardiovascular characteristics between these models and humans. Therefore, large animal models are essential to develop the discoveries from murine models into clinical therapies and interventions. This paper will provide an overview of the more frequently used large animal models, especially porcine models for preclinical studies. © 2011 Yoriyasu Suzuki et al.


Komeda M.,Nagoya Heart Center
General Thoracic and Cardiovascular Surgery | Year: 2013

Finite element analysis method (FEM) provides suitable methodology to analyze a target with complex shape such as VSP patch. In this study, by employing the FEM, Ito and colleagues showed the importance of using a large patch to eliminate the dead space between the patch and LV endocardium. Intuitionally many surgeons believed the same way, but it now has been proven mathematically. Although the FEM model has some limitation in part due to too much simplified model, I believe that the study provides useful information to the patch mechanics for VSP closure and that it will help improving the outcome of surgical treatment of VSP. © 2013 The Japanese Association for Thoracic Surgery.


Murase S.,Nagoya Heart Center | Suzuki Y.,Nagoya Heart Center | Yamaguchi T.,Nagoya Heart Center | Matsuda O.,Nagoya Heart Center | And 2 more authors.
Catheterization and Cardiovascular Interventions | Year: 2014

Background Several studies have reported re-endothelialization and endothelial function after drug-eluting stent (DES) implantation; however, the relationship between re-endothelialization and endothelial function after DES implantation has not been investigated yet. Methods A total of 14 patients underwent evaluation of re-endothelialization by optical coherence tomography (OCT) and endothelial function by incremental Ach infusion at 9 months after DES implantation (ZES: N = 7, PES: N = 7). The neointimal thickness (NIT) inside each strut, strut coverage, and malapposition at every 1 mm cross-section were evaluated by OCT and the endothelial function was estimated by measuring the coronary vaso-reactivity in response to acetylcholine (Ach) infusion into coronary arteries. Results Zotarolims eluting stent (ZES), compared with paclitaxcel eluting stent (PES), showed more homogeneous neointimal coverage of stent struts and low rate of malapposition. Vasoconstriction in response to Ach in the peri-stent region was also less pronounced in ZES than PES. In particular, vasoconstriction was more often observed in cases with inhomogeneous neointimal coverage of stent struts in the PES group. Conclusions Our findings suggest that endothelial function seems to be better preserved with ZES than PES, and homogeneous neointimal coverage of stent struts seem to be associated with the preserved endothelial function. © 2013 Wiley Periodicals, Inc. © 2013 The Authors. Wiley Periodicals, Inc.


PubMed | Toyohashi Heart Center, Gifu Heart Center and Nagoya Heart Center
Type: | Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions | Year: 2016

Despite development of drug eluting stents (DES), percutaneous coronary intervention (PCI) for bifurcation lesions using DES alone remains challenging. The aim of this study was to report on the initial clinical experience with a novel directional coronary atherectomy (DCA) catheter.Patients with de novo bifurcation lesions were entered into a prospective registry and a novel DCA catheter was used. Device, procedural success and in-hospital outcomes were evaluated. A total of 14 patients with bifurcation lesions were enrolled. DCA was performed successfully in all cases without any major procedure-related events (device success rate: 100%, procedural success rate: 100%). Four patients (29%) were treated without stent implantation and simple stenting was achieved in the other 10 patients. No in-hospital major adverse cardiac event was observed.PCI with a novel DCA catheter for bifurcation lesions may be safe and effective. The clinical significance of these findings needs to be determined in future studies. This study was performed to evaluate the safety and efficacy of a novel directional coronary atherectomy catheter for bifurcation lesions. Both the device and procedural success rates were 100%. Complex stenting could be avoided in all cases. No inhospital major adverse cardiac event was observed. The novel directional coronary atherectomy catheter may be safe and effective for bifurcation lesions, even in this drug eluting stent era. 2016 Wiley Periodicals, Inc.


PubMed | Nagoya Heart Center
Type: Case Reports | Journal: Interactive cardiovascular and thoracic surgery | Year: 2016

Oesophageal complications after endovascular aortic stent repair are rare, but may lead to catastrophic consequences. Early detection is mandatory, but is sometimes difficult because of a lack of specific signs in the early stages. We report 2 cases with opposing results of oesophageal complications after aortic stent graft repair, and discuss the early signs of this disastrous complication and potential methods for early detection.

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