Sakurabashi Watanabe Hospital

Ōsaka, Japan

Sakurabashi Watanabe Hospital

Ōsaka, 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.

Iwakura K.,Sakurabashi Watanabe Hospital
Current Pharmaceutical Design | Year: 2013

Coronary reperfusion using primary percutaneous coronary intervention (PCI) dramatically reduces morbidity and mortality among patients with acute myocardial infarction (AMI). Nevertheless, inadequate myocardial perfusion, known as the "no-reflow" phenomenon, is observed in approximately 15% of patients and is associated with poor outcomes. No-reflow is caused not only by mechanical occlusion of the microvasculature due to thromboembolism but also by myocardial injury. Transmural myocardial damage before PCI and the size of the associated area are major factors in the development of no-reflow. There is evidence indicating that inflammation, oxidative injury, morphological changes of endothelial cells, hyperglycemia, and absence of ischemic preconditioning also contribute to the development of no-reflow. Several strategies have been attempted to counteract these risk factors. To prevent microembolization related to PCI, thrombus aspiration appears promising, but distal protection devices have failed to demonstrate the expected results among patients with AMI. Most cardioprotective agents developed to modify the risk factors for no-reflow have been effective in animal experiments but have disappointed in clinical trials. Adjunctive treatments using statins, adenosine, atrial natriuretic peptide, nicorandil, or glycoprotein IIb/IIIa antagonists have been effective in reducing the infarct size or improving outcomes after AMI in clinical studies, although some have shown inconsistent results. It is probable that the relevance of each component associated with no-reflow is different for individual patients, and therefore the attempt to indiscriminately apply one treatment to all patients will not be as successful as expected. Individual susceptibility has to be evaluated when selecting an appropriate adjunctive treatment to prevent no-reflow in patients with AMI. © 2013 Bentham Science Publishers.

Fukuda S.,Osaka Ekisaikai Hospital | Watanabe H.,Heart Center | Iwakura K.,Sakurabashi Watanabe Hospital | Daimon M.,University of Tokyo | And 2 more authors.
Circulation Journal | Year: 2015

Background: Physical examination as an initial screening tool to diagnose abdominal aortic aneurysm (AAA) has lost favor over the past 20 years. This multicenter cohort study aimed to determine the prevalence of AAA in elderly Japanese patients with hypertension (HT) and to clarify the diagnostic accuracy of physical examination using a pocket-sized ultrasound imaging device (the “pocket-echo”). Methods and Results: A total of 1,731 patients with HT aged >60 years from 20 collaborating institutions were enrolled in this study. Abdominal palpation was performed on physical examination, and the pocket-echo was used to confirm the diagnosis of AAA. The abdominal aorta was well visualized in 1,692 patients (98%). AAA was discovered in 69 patients (4.1%), with advanced age and male sex identified as independent risk factors. The prevalence of AAA increased according to age regardless of sex, and reached 9.2% and 5.7%, respectively, in males and females ≥80 years. Overall, 33 cases of AAA were missed on abdominal palpation (sensitivity, 52%), whereas for AAAs >40 mm, the sensitivity was 75%. Conclusions: We assessed the utility of the pocket-echo and physical examination for diagnosing AAA in Japanese patients with HT aged over 60 years. Our findings highlight the importance of AAA screening programs in high-risk Japanese populations, and confirm the ability of physical examination to detect large, but not small, AAAs. © 2015, Japanese Circulation Society. All rights reserved.

Matsue H.,Sakurabashi Watanabe Hospital | Masai T.,Sakurabashi Watanabe Hospital | Yoshikawa Y.,Sakurabashi Watanabe Hospital | Kawamura M.,Sakurabashi Watanabe Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2010

A 72-year-old female underwent off-pump coronary bypass grafting one month after heparin exposure. Immediately after protamine administration, she developed hypotension due to acute graft failure. Grafting to left anterior descending branch was revised under intraaortic balloon pump insertion and she was transferred to intensive care unit under stable hemodynamic condition. However, she gradually developed low cardiac output syndrome and echocardiography showed new onset of myocardial infarction. Coronary angiography on the first postoperative day revealed diffuse serious coronary thrombosis involving all grafts and grafted native coronary arteries. Emergent percutaneous coronary intervention (PCI) was performed for native vessels. Laboratory examination revealed severe progressive thrombocytopenia and she was clinically diagnosed as heparin-induced thrombocytopenia (HIT). After cessation of all heparins and alternative anticoagulation with argatroban, thrombocytopenia was improved and some of occluded grafts were recanalized. She was discharged on the 51st postoperative day. Acute graft thrombosis, especially caused by HIT, is a serious complication, which sometimes results in mortality. This is a successful case treated by PCI followed by an alternative anticoagulation. © 2010 Published by European Association for Cardio-Thoracic Surgery.

Shirakawa T.,Kansai Rosai Hospital | Koyama Y.,Sakurabashi Watanabe Hospital | Mizoguchi H.,Kansai Rosai Hospital | Yoshitatsu M.,Kansai Rosai Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2016

We present a case of a double-chambered right ventricle in adulthood, in which we tried a detailed morphological assessment and preoperative simulation using 3-dimensional (3D) heart models for improved surgical planning. Polygonal object data for the heart were constructed from computed tomography images of this patient, and transferred to a desktop 3D printer to print out models in actual size. Medical staff completed all of the work processes. Because the 3D heart models were examined by hand, observed from various viewpoints and measured by callipers with ease, we were able to create an image of the complete form of the heart. The anatomical structure of an anomalous bundle was clearly observed, and surgical approaches to the lesion were simulated accurately. During surgery, we used an incision on the pulmonary infundibulum and resected three muscular components of the stenosis. The similarity between the models and the actual heart was excellent. As a result, the operation for this rare defect was performed safely and successfully. We concluded that the custom-made model was useful for morphological analysis and preoperative simulation. © 2016 The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Kurotobi T.,Sakurabashi Watanabe Hospital | Iwakura K.,Sakurabashi Watanabe Hospital | Inoue K.,Sakurabashi Watanabe Hospital | Kimura R.,Sakurabashi Watanabe Hospital | And 5 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2010

Background-The presence of multiple arrhythmogenic sources may be associated with the perpetuation of atrial fibrillation (AF). In this study, we investigated the hypothesis that multiple foci might be involved in the development of AF persistency. Methods and Results-Two hundred fourteen consecutive patients with AF undergoing catheter ablation were enrolled in this study. The location of the arrhythmogenic foci was determined using simultaneous recordings from multipolar catheters before and after pulmonary vein isolation during an isoproterenol administration. We detected 500 arrhythmogenic foci (263 foci as AF initiators, and 237 foci as non-AF initiators). High-dose isoproterenol infusions (ranging from 2 to 20 μg/min) revealed potential arrhythmogenic foci, especially non-pulmonary vein foci (55%). Persistent AF was more highly associated with an incidence of multiple (>2) foci than paroxysmal AF (88% versus 65%, P=0.002), and a multivariate analysis demonstrated that multiple foci (>2) were an independent contributing factor for persistent AF (odds ratio; 95% confidence interval, 4.69; 1.82 to 12.09, P<0.001). In paroxysmal AF, the number of foci was higher in patients with long-term AF (>24 hours) than in those with short-lasting AF (2.64 ±0.14 versus 1.77±0.16, P=0.001). In the persistent AF group, the patients with short-lasting AF (<12 months) had a greater number of foci than did those with long-term AF (>12 months) (3.62±0.15 versus 1.92±0.16, P=0.04). Conclusions-Multiple foci were likely to be involved in the development of persistent AF. However, if AF persisted for >12 months, they may not have had a significant effect on the AF perpetuation. © 2010 American Heart Association, Inc.

Okamura A.,Sakurabashi Watanabe Hospital | Iwakura K.,Sakurabashi Watanabe Hospital | Fujii K.,Sakurabashi Watanabe Hospital
Catheterization and Cardiovascular Interventions | Year: 2010

Terumo intravascular ultrasound (IVUS) ViewIT facilitates IVUS-guided wiring in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) due to its low profile and surface coating. In PCI for CTO, the first guidewire is sometimes inserted into the subintimal space, and observation by IVUS through the first guidewire in the subintima can allow the second guidewire to be led visually into the true lumen. We describe a case of CTO in which ViewIT was inserted into the subintimal space of the CTO lesion and scanning from the coronary ostium to the CTO subintimal space allowed the second guidewire to be led into the true lumen. © 2010 Wiley-Liss, Inc.

Nagai H.,Sakurabashi Watanabe Hospital | Ishibashi-Ueda H.,Japan National Cardiovascular Center Research Institute | Fujii K.,Sakurabashi Watanabe Hospital
Catheterization and Cardiovascular Interventions | Year: 2010

We report on two patients with sirolimus-eluting stent (SES) restenosis lesions who showed highly echolucent regions by optical coherence tomography (OCT) and who could be assessed histologically after removal by directional coronary atherectomy (DCA). One restenosis lesion had a bilayer structure of hyperechoic outer layers and highly echolucent inner layers on OCT images and histologically exhibited myxomatous neointima tissue in the highly echolucent regions; another restenosis case showed patchy and highly echolucent regions throughout the layers and its histology revealed fibrin thrombosis. We should be aware that patterns of echolucent on OCT images may have various histology. OCT allows the visualization of fine lesions that conventional intravascular ultrasound (IVUS) cannot provide. The OCT images of drug-eluting stent restenosis lesions often show echolucent regions [Shuzoh et al., EuroInterv 2006;1:484]. However, no histological study of the lesions has been reported to date. Here we report on two patients with SES restenosis lesions that showed highly echolucent regions by OCT and that could be assessed histologically after removal by DCA. © 2010 Wiley-Liss, Inc.

Sotomi Y.,Sakurabashi Watanabe Hospital | Kikkawa T.,Sakurabashi Watanabe Hospital | Inoue K.,Sakurabashi Watanabe Hospital | Tanaka K.,Sakurabashi Watanabe Hospital | And 8 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2014

Optimal Contact Force for AF Ablation. Background: Regional differences in optimal contact force (CF) to prevent acute pulmonary vein reconnection (APVR) during catheter ablation for atrial fibrillation (AF) remain unclear.Methods: This single-center observational study evaluated data from 57 consecutive drug-refractory AF patients (mean age, 62 ± 11 years; 43 males) who underwent initial pulmonary vein isolation (PVI) using the THERMOCOOL® SMARTTOUCH™ (Biosense Webster, Diamond Bar, CA, USA) catheter from June to August 2013. APVR was defined as the time-dependent reconnection >20 minutes after initial PVI and/or reconnection evoked by intravenous adenosine administration (20 mg). Point-by-point relationships between the reconnected points and their CF values were evaluated.Objective: The purpose of this study was to evaluate regional difference in optimalCFduringAFablation.Results: Total 72 gaps causing APVR were observed. Of a total of 4,421 ablation points, 285 (6.4%) were associated with APVR. The average CF value of the points with APVR was significantly lower than that of those without (APVR vs. no APVR; 7.5 ± 6.7 g vs. 9.9 ± 8.4 g; P < 0.0001). The areas under the curve and optimal CF values differed between segments (range 0.593-0.761 and 10-22 g, respectively). The optimal CF value was highest in bottom of the right PV and posterosuperior right PV segments (22 g) and lowest in posteroinferior right PV segment (10 g).Conclusions: There was a regional difference in optimal CF values to prevent APVR, and the optimal CF value to prevent APVR with >95% probability was 10-22 g, depending on the individual peri-PV segments.

Tsuchikane E.,Toyohashi Heart Center | Yamane M.,Sayama Hospital | Mutoh M.,Saitama Prefecture Cardiovascular and Respiratory Center | Matsubara T.,Toyohashi Heart Center | And 6 more authors.
Catheterization and Cardiovascular Interventions | Year: 2013

Objectives This registry evaluated the current trends and outcomes associated with retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Background Since its introduction, several techniques and technologies have been introduced for retrograde PCI for CTO. Methods Eight hundred and one patients who underwent retrograde PCI for CTO in 28 Japanese centers between January 2009 and December 2010 were enrolled in this registry. Results Overall procedural and clinical success rates were 84.8 and 83.8%, respectively, of which, retrograde procedures accounted for 71.2 and 70.3%, respectively. The use of channel dilators increased in 2010 compared to that in 2009 (36 vs. 95.3%, P < 0.0001), attributed improving collateral channel crossing using a wire and catheter (70.6% vs. 81.1%, P = 0.0005) and increased availability of epicardial channels (27.6% vs. 36.9%). The use of the reverse controlled antegrade and retrograde tracking technique also increased (41.9 vs. 66.5%). Although these changes decreased procedure time (203.3 min vs. 187.9 min, P = 0.024), they did not significantly improve overall procedural success rate (84.1% vs. 85.3%, P = 0.63). Multivariate analysis identified age 65 years or more and lesion calcification as unfavorable factors and the use of a channel dilator as a favorable factor for retrograde procedural success. Conclusions Increased availability of channel dilators has altered strategies for retrograde PCI for CTO. However, retrograde PCI for CTO could be improved by overcoming its main obstacle of severe calcification. © 2013 Wiley Periodicals, Inc.

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