Publications by authors named "Tatsuhiko Komiya"
Background: There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension.
Methods And Results: Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.
Article Synopsis
- * TAVI centers preferred aortic valve replacement (AVR) treatments, with a higher percentage opting for transcatheter aortic valve implantation (TAVI) compared to non-TAVI centers (71% vs. 23%).
- * Despite the differences in treatment frequency, both types of centers showed similar rates of all-cause death or heart failure hospitalizations over three years, indicating no significant outcome difference.
Background: Data on the impact of valve position on clinical outcomes in patients with atrial fibrillation (AF) and bioprosthetic valves (BPVs) are limited.
Methods And Results: The BPV-AF Registry was a multicenter, prospective, observational study involving 894 patients with BPVs and AF. In this post-hoc substudy, patients were classified according to BPV position: aortic (n=588; 65.
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.
Transcatheter aortic valve replacement failure: surgical valve explantation after more than a decade.
Interdiscip Cardiovasc Thorac Surg
November 2024
Article Synopsis
Background: Bilateral internal thoracic artery (ITA) grafting is associated with improved long-term outcomes; however, the appropriate graft configuration remains controversial. We compared the long-term outcomes of different graft configurations.
Methods: Between 2009 and 2015, 1171 patients underwent isolated bilateral ITA grafting for left-sided complete revascularization at 4 Japanese cardiac surgery centers: underwent in situ left ITA to the left anterior descending artery plus in situ right ITA to the left circumflex artery (LR group, n = 278), in situ right ITA to the left anterior descending artery plus in situ left ITA to the left circumflex artery (RL group, n = 665), and in situ left ITA to the left anterior descending artery plus free right ITA to the left circumflex artery (free group, n = 228).
Article Synopsis
- The study investigates the R-CHADS-VASc score's ability to predict cardiovascular events in atrial fibrillation (AF) patients post bioprosthetic valve replacement, using data from the BPV-AF registry with 766 participants.
- Patients were classified into low, moderate, and high risk based on their R-CHADS-VASc scores, with results indicating that those with higher scores experienced significantly more cardiovascular events during the follow-up period.
- The findings suggest that the R-CHADS-VASc score is an effective tool for assessing cardiovascular risk in AF patients who have undergone BPV replacement, with higher scores correlating to worse outcomes.
There are numerous approaches for transcatheter aortic valve replacement (TAVR); however, access-related complications remain a point of concern. We analyzed consecutive patients who underwent TAVR for severe aortic stenosis via the brachiocephalic artery (BCA) without sternotomy (TBc group, n = 10) and via the trans-ascending aortic (TAo group, n = 8). The median BCA diameter and distance between the access point and suprasternal notch or superior margin of the clavicle were 11.
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- Current guidelines suggest using either DOACs or warfarin for patients with atrial fibrillation who have a bioprosthetic valve, but research on elderly patients (≥80 years) in this context is limited.
- A study analyzed data from 752 patients, revealing that those aged ≥80 had a significantly higher risk of adverse outcomes than younger patients, with a hazard ratio of 2.04.
- The findings indicate that both DOACs and warfarin have comparable efficacy and safety in managing elderly patients with bioprosthetic valves and atrial fibrillation.
Article Synopsis
- 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.
Article Synopsis
- The study analyzed the presence of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) and how it relates to different treatment methods: TAVI, SAVR, and conservative management.
- Among the 3,365 patients examined, 384 (11.4%) had moderate/severe MR, and this group showed a significantly higher 3-year incidence of death or heart failure (HF) hospitalization compared to those with no/mild MR.
- The risk of death or HF hospitalization was notably higher in patients treated with SAVR and conservative strategies, while this risk was less clear in those who underwent TAVI.
Objectives: Valve-sparing aortic root replacement requires expertise to predict repair results and prevent secondary aortic clamping for valve repair or replacement secondary to aortic valve insufficiency. Thus, intraoperative evaluation of the aortic valve using diastolic pressure at the aortic root may be helpful. The goal of this retrospective study was to compare the early and mid-term results of aortic valve repair with those of valve-sparing aortic root replacement using intraoperative endoscopic evaluation.
View Article and Find Full Text PDFIntroduction: Post-myocardial infarction ventricular septal defect (PIVSD) is a life-threatening mechanical complication of acute myocardial infarction (AMI). Delayed elective surgical repair can be considered in patients who respond well to aggressive heart failure therapy. Impella has been reported as a bridge to allow the deferment of surgery for PIVSD.
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- A study analyzed long-term mortality in patients with severe coronary artery disease who underwent either PCI or CABG, focusing on those with peripheral artery disease (PAD).
- Out of 14,867 patients, 3,380 were assessed, revealing a higher cumulative 5-year mortality rate of 31.2% for patients with PAD compared to 16.2% for those without.
- The findings indicated that while both procedures carried a higher risk of all-cause death for PCI versus CABG, there was no significant difference in cardiovascular deaths based on PAD status.
Diameter changes of the thoracic aorta caused by acute type B aortic dissection.
Asian Cardiovasc Thorac Ann
March 2024
Article Synopsis
- This study investigates how type B acute aortic dissection (TBAAD) affects the diameter of the thoracic aorta by comparing CT scans from before and after dissection in 50 non-Marfan patients with normal aortic valves.
- The results show that while the ascending aorta and proximal arch had minimal changes, the diameters of the proximal, mid, and distal aorta significantly increased, reaching values between 105.7% to 109.3% compared to pre-dissection measurements.
- A notable finding is that age (specifically being 80 years or older) correlates with the degree of diameter change in the proximal descending aorta, highlighting the complexity of predicting factors related to aortic diameter
Objective: The association between a combined anaemia and renal failure index and 1-year prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) is unexplored. We aimed to investigate a simple risk score in patients undergoing TAVI.
Methods: A total of 469 consecutive patients undergoing TAVI between 2015 and 2021 were enrolled.
Clinical impact of turn-up anastomosis in the treatment of type A acute aortic dissection.
Asian Cardiovasc Thorac Ann
November 2023
Background: The management of anastomosis and hemostasis of the dissected aorta remains challenging. This study aims to establish an optimal surgical strategy for type A acute aortic dissection by reviewing single-center data using the turn-up anastomosis technique.
Methods: Between 2003 and 2015, 264 consecutive patients with type A acute aortic dissection who underwent emergency surgery within 14 days of symptom onset were enrolled.
There were no data comparing the in-hospital outcomes after transcatheter aortic valve implantation (TAVI) with those after surgical aortic valve replacement (SAVR) in Japan. Among consecutive patients with severe AS between April 2018 and December 2020 in the CURRENT AS Registry-2, we identified 1714 patients who underwent aortic valve replacement (TAVI group: 1134 patients, and SAVR group: 580 patients). Patients in the TAVI group were much older (84.
View Article and Find Full Text PDFThe left atrial volume index (LAVI) is important for predicting thromboembolism in patients with non-valvular atrial fibrillation (AF), but the utility of LAVI for predicting thromboembolism in patients with both bioprosthetic valve replacement and AF remains unclear. Of 894 patients from a previous multicenter prospective observational registry (BPV-AF Registry), 533 whose LAVI data had been obtained by transthoracic echocardiography were included in this subanalysis. Patients were divided into tertiles (T1-T3) according to LAVI as follows: T1 (n=177), LAVI=21.
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- The study examined the effects of different surgical ablation procedures for atrial fibrillation during aortic valve replacement surgery involving 171 patients across 16 hospitals in Japan from 2010 to 2015.
- Patients were divided into three groups: those who underwent a full maze operation, those who had pulmonary vein isolation (PVI), and those who had no surgical ablation.
- While the maze group experienced longer myocardial ischemia time, there were no significant differences in mortality rates at 30 days or 2 years, and both maze and PVI were found to effectively restore sinus rhythm over that period.