Endoscopic surgery in Japan: The 12th national survey(2012-2013) by the Japan Society for Endoscopic Surgery.

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and usefulness of endoscopic surgery have been evaluated. With the acceptance of endoscopic surgery as less invasive than open surgery, the number of the endoscopic procedures continues to increase in all surgical domains.

AVJ-514 Trial - Baseline Characteristics and 30-Day Outcomes Following MitraClip Treatment in a Japanese Cohort.

Background: The MitraClipsystem is a transcatheter-based therapeutic option for patients with chronic mitral regurgitation (MR) who are at high risk for surgery. A prospective, multicenter, single-arm study was initiated to confirm the transferability of this system to Japan.Methods and Results:Patients with symptomatic chronic moderate-to-severe (3+) or severe (4+) functional or degenerative MR with a Society of Thoracic Surgery (STS) score ≥8%, or the presence of 1 predefined risk factor were enrolled.

Mitral Valve Repair via a Minithoracotomy in a Patient With Pectus Excavatum.

Cardiac surgery in patients with pectus excavatum is challenging because of the difficulty associated with achieving optimal surgical exposure and postoperative sternal fixation by using standard instruments. To solve these problems, mitral valve repair was performed via a right minithoracotomy in a 48-year-old man with severe mitral valve regurgitation and pectus excavatum. With the use of conventional median sternotomy, an optimal surgical field was difficult to achieve because of his thoracic deformity.

Preservation of Mobility of the Posterior Mitral Leaflet After Mitral Valve Repair With Neochordae Using Loop Technique.

Background: Recently, the loop technique has been standardized for mitral valve repair, with excellent long-term outcomes reported. This study thus analyzed whether the loop technique could preserve mitral leaflet mobility on trans-thoracic echocardiography.

Methods and results: Among 367 concomitant patients who underwent mitral valve repair at Keio University Hospital between January 2007 and December 2014, 304 patients had a prolapse of the posterior leaflet.

Designing innovative retractors and devices to facilitate mitral valve repair surgery.

Various devices have been developed to facilitate mitral valve surgery, including those that improve mitral valve exposure and assist surgeons with associated procedures. Choosing appropriate supporting devices when performing minimally invasive mitral valve surgery (MIMVS) through a minithoracotomy with endoscopic assistance is critical. Depending on the surgeon's preference, trans-thoracic or trans-working-port left atrial retractors can be utilized.

Cerebral Protection During Mitral Valve Repair in a Patient With Moyamoya Syndrome.

In patients with moyamoya syndrome requiring heart surgery, the brain blood flow during the low perfusion state under cardiopulmonary bypass is a concern. We report on a successful mitral valve repair and tricuspid repair in a patient with moyamoya syndrome, performed using an integrated cerebral protection strategy with cerebral oxygen saturation monitoring, intraaortic balloon pumping, and cardiopulmonary bypass perfusion at a relatively high pressure. An integrated approach with a thorough discussion among cardiac surgeons, anesthesiologists, and perfusionists was invaluable to protect brain perfusion in a patient with moyamoya syndrome.

Minimally invasive surgery of mitral valve (MIS-MV).

Following the revision of the therapeutic guideline of ACC/AHA in (Circulation 114:450-527, 2006), the incidence of mitral valve repair in asymptomatic patients with moderate or severe mitral valve regurgitation has increased. For mitral valve repair, the quality and outcomes as well as lower invasive procedure are important to obtain the confidence of cardiologists and ensure request of early phase operation from cardiologists. With recent innovations of technologies and the development of revolutionary techniques, minimally invasive surgery of the mitral valve (MIS-MV) has become a widespread surgical option of mitral valve repair.

Benefit of minimally invasive treatment of concomitant multiple aortic aneurysms, atrial septal defect and colon cancer.

Minimally invasive treatment of cardiovascular disease might decrease the risk of morbidity and mortality for high-risk patients. We describe a patient with concomitant large thoracic and abdominal aortic aneurysms, atrial septal defect (ASD) with heart failure and colon cancer with bleeding. We applied minimally invasive, transcatheter closure of the ASD and a hybrid approach to treat two aortic aneurysms, followed by colectomy.

Negative pressure therapy for post-sternotomy wound infections in young children.

Objectives: Post-sternotomy wound infection remains a significant morbidity in congenital and paediatric cardiac surgery. However, the techniques used for this complication in children are not optimal in terms of mortality, morbidity and the use of medical resources. Negative pressure therapy is an effective modality in the treatment in adults, but reports of its use in children are limited.

Recurrent mitral regurgitation due to ruptured ePTFE neochordae after mitral valve repair by the loop technique: a report of case.

Mitral valve (MV) repair with expanded polytetrafluoroethylene (ePTFE) sutures has proven to simple, versatile, and durable technique for the treatment of mitral valve regurgitation (MR). The ePTFE is known for its strong resistance to tension, and is judged to be unbreakable under physiological condition. The loop technique using premeasured ePTFE neochordae was employed from August 2005 for 290 consecutive MV repair.

Thoracic and thoracoabdominal aortic repair under regional spinal cord hypothermia.

Objectives: Spinal cord deficits are devastating complications after surgery for thoracic and thoracoabdominal aortic aneurysms. We developed a regional spinal cord cooling system using an epidural catheter containing cold saline within an isolated counter-current lumen to prevent such complications and reviewed the clinical results.

Methods: We enrolled 37 patients with thoracic (n = 13) and thoracoabdominal (n = 24) aortic aneurysms that were repaired using the regional spinal cord cooling system under mild hypothermia with a partial femoro-femoral bypass.

Induction of human cardiomyocyte-like cells from fibroblasts by defined factors.

Heart disease remains a leading cause of death worldwide. Owing to the limited regenerative capacity of heart tissue, cardiac regenerative therapy has emerged as an attractive approach. Direct reprogramming of human cardiac fibroblasts (HCFs) into cardiomyocytes may hold great potential for this purpose.

Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan.

Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices.

Surgery for primary intrapericardial tumors in adults.

Primary intrapericardial tumors in adults, whether benign or malignant are rare. Surgical treatment for these tumors are reviewed together with their incidence, classification, clinical features, and diagnosis.

Successful surgical treatment for a thrombus straddling a patent foramen ovale: a case report.

Paradoxical embolism (PDE) occurs after embolic material passes from the venous to the arterial circulation through a right-to-left shunt, which is frequently a patent foramen ovale (PFO). We describe the case of a patient with deep venous thrombosis and an intracardiac thrombus straddling a PFO and who was successfully treated with an emergency surgery.

Thoracic endovascular aortic repair in patients with prior open aortic surgery.

Objective: To review our experience of thoracic endovascular aortic repair (TEVAR) in patients with prior open aortic repair (OAR).

Materials And Methods: Stent-grafts were deployed in the arch, descending thoracic and thoracoabdominal aortae of 39, 13 and 5 patients, respectively, and in a deteriorated extra-anatomical prosthesis in one. The access route was the femoral artery in 10 of 23 patients with, and in 30 of 35 patients without a prior abdominal prosthesis.

Using a double-plicated posterior leaflet as an anchor for mitral valve replacement: a case of mitral annular calcification.

We present a 62-year-old man with mitral regurgitation whose posterior annulus had severe calcification. Mitral valve replacement was performed by anchoring the cuff on a double-plicated posterior leaflet, and reinforcing with an equine pericardium. The patient is doing well 13 years after surgery with echocardiography showing no problems.

Hybrid repair of subclavian-axillary artery aneurysms and aortic arch aneurysm in a patient with Marfan syndrome.

A patient with Marfan syndrome who had previously undergone a Cabrol procedure and thoracoabdominal aortic replacement had enlarging, symptomatic aneurysms in the subclavian-axillary artery and aortic arch. Both vessels were replaced with prosthetic grafts. A thoracic endoprosthesis was inserted bridging the aortic arch graft and the previously implanted descending aorta graft.

Cerebral blood flow after hybrid distal hemiarch repair.

Objectives: Aortic arch disease can be treated with hybrid repair (extra-anatomic bypass plus placement of aortic endoprostheses), but there is controversy about whether a bypass from one relatively small vessel will provide adequate blood flow to the entire brachiocephalic system. We, therefore, compared flow volumes before and after hybrid repair.

Methods: We reviewed the records of 16 patients who underwent a hybrid distal hemiarch repair between October 2010 and May 2012.

Numerical analysis of blood flow distribution in 4- and 3-branch vascular grafts.

Trifurcated arch grafts (3-branch grafts) are now being used to repair the thoracic aorta in addition to conventional arch grafts (4-branch grafts). The anatomical shape of the 3-branch graft is different from the original vessel, so it is necessary for clinical application to evaluate blood flow distribution in the graft to assess whether there is adequate blood flow to the target organs. To achieve this, we developed a computational fluid dynamics (CFD) method to evaluate blood flow distribution in the grafts.