Publications by authors named "Jiro Esaki"

Background: Fatal arrhythmic events (FAEs), such as sudden cardiac death (SCD) and fatal ventricular arrhythmias, are a devastating complication in patients with coronary artery disease (CAD). Therefore, in this study we aimed to assess the incidence of FAEs in more recent Japanese patients with CAD and to examine whether risk stratification of FAEs can still be feasible using the left ventricular ejection fraction (LVEF).

Methods And Results: In the CREDO Kyoto PCI/CABG registry cohorts-2 and -3, there were 25,843 patients with LVEF data who received a first coronary revascularization (LVEF ≤35% group: N=1,671, 35%45%: N=21,503).

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A 51-year-old man with a history of antibiotic therapy for syphilis 1 month ago presented with syncope. Computed tomography revealed circumferential aortic wall thickening complicating severe stenosis of left main coronary ostium. Abnormalities in serologic and cerebrospinal fluid tests led to the diagnosis of syphilitic aortitis and neurosyphilis.

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Article Synopsis
  • The study aimed to compare the outcomes of open total arch repair versus endovascular arch repair for aortic arch disease across multiple centers from 2008 to 2019.
  • A total of 1,052 patients were analyzed, with no significant difference in in-hospital mortality between the two methods, but open total arch repair showed a lower long-term risk of death overall and due to aorta-related complications.
  • Specifically, for patients with proximal landing zones 0/1, open repair had both better overall survival and fewer aorta-related deaths, while outcomes were similar for those with landing zone 2.
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Background: We aimed to investigate the incidence and risk factors of postoperative acute pancreatitis (PAP) following thoracic aortic surgery with circulatory arrest.

Methods: One hundred fifty-two patients who underwent thoracic aortic surgery with circulatory arrest between February 2015 and March 2023 were retrospectively reviewed. Postoperative acute pancreatitis was defined as the presence of two or more of the following criteria: (1) abdominal pain, (2) postoperative amylase or lipase levels greater than three times the upper limit of normal, and (3) evidence of pancreatitis on postoperative computed tomography (CT) scan.

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  • The study examined the impact of very low levels of low-density lipoprotein cholesterol (LDL-C) on patients with coronary artery disease, using data from over 39,000 patients who underwent coronary revascularization.
  • It was found that patients with very low LDL-C levels (<85 mg/dL) had more health issues and a higher risk of all-cause mortality compared to those with higher levels, revealing significant risks for various types of death and heart failure.
  • Overall, the research suggests that lower LDL-C levels correlate with more serious health problems and increased mortality risk, highlighting the need for careful management of cholesterol levels in at-risk patients.
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  • Prophylactic embolization of the inferior mesenteric artery (IMA) during endovascular aneurysm repair (EVAR) aims to prevent type 2 endoleaks (T2ELs), but the effect of patent lumbar arteries (LAs) on these complications and aneurysm size is unclear.
  • In a study of 57 patients undergoing EVAR, T2ELs occurred in 22.8% of cases, with 64.6% experiencing aneurysm sac shrinkage over four years.
  • The number of postoperative patent LAs was identified as a significant risk factor for T2ELs and a predictor for both aneurysm enlargement and shrinkage, suggesting their importance in post-E
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  • The study investigates life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS), highlighting a lack of existing data on this topic.
  • Data from 3815 patients in the CURRENT AS registry revealed that those who underwent AVR had better survival rates than those using a conservative treatment strategy, especially among younger patients.
  • The findings suggest that assessing surgical risk based on age and STS score can help estimate life expectancy post-AVR, which is crucial for deciding between surgical and transcatheter approaches.
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Background: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization.

Objectives: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.

Methods: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry.

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Article Synopsis
  • - The study compares the long-term outcomes of percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in 2,464 patients with multi-vessel coronary artery disease.
  • - Although the 5-year risk of combined events like death, heart attack, or stroke was not significantly different between the two groups, adjusted analysis showed that PCI had a higher risk of myocardial infarction and the need for additional revascularization compared to CABG.
  • - The findings suggest that while both procedures have similar outcomes regarding death and stroke, PCI with new-generation DES may carry a greater long-term risk for major cardiovascular issues in patients requiring complex multi-vessel treatments
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Objective: We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease.

Methods: From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376).

Results: The median and interquartile range of patient's age was 82 (81-84) in the CABG group and 83 (81-85) in the PCI group (P = 0.

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The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081).

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Objectives: Pulmonary hypertension during cardiac surgery is associated with increased morbidity and mortality. Inhaled nitric oxide serves as a selective pulmonary vasodilator and has other potential extrapulmonary protective roles. Its effects on pulmonary hypertension and organ functions after adult valve surgeries were evaluated.

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There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]).

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Background: There is no large-scale study comparing postoperative mortality after aortic valve replacement (AVR) for asymptomatic severe aortic stenosis (AS) between initial treatment with AVR vs. eventual AVR after conservative management.

Methods and results: We analyzed data from a multicenter registry enrolling 3,815 consecutive patients with severe AS.

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Aims: Tricuspid regurgitation (TR) has been reported to be associated with worse survival in various heart diseases, but there are few data in aortic stenosis (AS).

Methods And Results: In the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) Registry enrolling 3815 consecutive patients with severe AS, there were 628 patients with moderate or severe TR (TR group) and 3187 patients with no or mild TR (no TR group). The study patients were subdivided into the initial aortic valve replacement (AVR) stratum (n = 1197) and the conservative stratum (n = 2618) according to treatment strategy.

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Objectives: Reoperative aortic root replacement is a challenging procedure associated with significant mortality and morbidity. The purpose of this study was to investigate the outcomes of reoperative aortic root replacement when performed in a number of complex clinical settings and to identify risk factors for operative mortality and long-term survival.

Methods: From 2006 to 2015, 280 consecutive patients at an academic center underwent reoperative aortic root replacement after a variety of previous aortic or cardiac operations.

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Background: Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. However, late aortic valve dysfunction requiring reoperation remains a primary concern of this procedure. This study examines risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) after David V VSRR.

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Background: Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. Limited insight exists when the results of VSRR are compared with those of conventional root replacement with use of a bioprosthetic composite conduit (BIO). This study compares the operative and midterm results of VSRR and BIO.

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Background: Valve-sparing root replacement (VSRR) is an attractive therapy for aortic root aneurysms; however, there is a paucity of data comparing VSRR with conventional root replacement using a mechanical valve-conduit (MECH). This study evaluates and compares outcomes of VSRR and MECH.

Methods: A retrospective review from 2002 to 2015 at a US academic center identified 444 patients who underwent VSRR (282 patients) or MECH (162 patients).

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Objective: The objective of this investigation was to establish the effectiveness of sustained-release platelet-rich plasma (PRP) on perfusion and neovascularization in diabetic murine hind limb ischemia.

Methods: After surgery in streptozotocin-induced diabetic mice, the mice were randomly assigned to the following 4 experimental groups: control (C), 100 μl of the sustained-release form of platelet-poor plasma (PPP), 100 μl of the solution form of PRP (PRP-sol), and 100 μl of the sustained-release form of PRP (PRP-sr). Endpoint evaluations were: blood perfusion by laser Doppler perfusion imaging (LDPI), vascular density by anti-vWF, and mature vessel density by anti-smooth muscle actin antibody.

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Background: While single growth factor has limitation to induce optimal neovascularization, platelet-rich plasma (PRP) is an autologous reserver of various growth factors. However, little is known about the mechanism of PRP-related neovascularization.The objective of this investigation was to characterize the angiogenic and growth factor content of PRP and to determine, in vitro, its effect on endothelial cell proliferation.

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Background: Although intravenous administration of prostaglandin E(1) (PGE(1)) is commonly used in the treatment of peripheral arterial disease, it rapidly becomes inactivated in the lung. Whether local administration of sustained-release (SR) PGE(1) enhances neovascularization in murine hindlimb ischemia was investigated.

Methods And Results: Poly lactide-co-glycolide (PLGA) microspheres were the 4-week SR carrier of PGE(1).

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Background: Basic fibroblast growth factor (bFGF) is a potent mitogen; however, diabetes mellitus might impair its angiogenic property. Prostaglandin E1 (PGE1) is a potent vasodilator and improves endothelial function. Thus, PGE1 could potentiate the angiogenic properties of bFGF in patients with diabetes mellitus.

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