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Mid-term Outcome of HeartWare HVAD in Small Patients in Japan
Get PDFObjectives: We investigated the impact of cuff position on the inflow cannula direction and wedge thrombus formation during mid-term HeartWare ventricular assist device (HVAD) support in relatively small patients.
Patients and Methods: Thirty-one patients, including five pediatric patients, underwent HVAD implantation between August 2011 to August 2020 in our institute. Two patients were implanted the HVAD in the true apex and other 29 patients were implanted in the posterior apex. Postoperatively, the direction of the inflow cannula was evaluated by three-dimensional computed tomography, and wedge thrombus was investigated at the time of heart transplantation.
Results: The patients' average body surface area (BSA) was 1.58 ± 0.33 m2. Twenty-three had dilated cardiomyopathy and five had ischemic cardiomyopathy. Two patients required the right ventricular assist device (RVAD), and one was weaned from temporary RVAD on postoperative day 20, but another required permanent RVAD implantation using HVAD. The mean support duration was 578 ± 498 days. Fifteen patients successfully bridged to heart transplantation. The survival rate with HVAD support at 3 years was 90.2%. The angle between the inflow cannula and the posterior wall was 34.3 ± 21.6° in patients with posterior apex implantation of HVAD and 5.9 ± 10.2° in those with true apex implantation. Wedge thrombus around the inflow cannula was seen all patients with true apex implantation and one with the posterior apex (8%).
Conclusion: HVAD could be safely used in small patients for mid-term support, and implantation at the posterior apex could be an important option for small patients to prevent wedge thrombus formation during LVAD support.journal articl
Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and fib-4 index
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Guide wire selection (straight vs. angled) in endoscopic retrograde cholangiopancreatography using a normal contrast catheter performed by a trainee: a single-center prospective randomized controlled cross-over study
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Effects of Moderate Spine Exercise or Diet on Hemodynamics in Patients with Hypertrophic Obstructive Cardiomyopathy and Aortic Stenosis
Get PDFLeft ventricular outflow tract stenosis is present in patients with hypertrophic cardiomyopathy; however, this is a dynamic change, and the pressure gradient changes easily. We aimed to compare the hemodynamic effects of moderate exercise or diet in hypertrophic obstructive cardiomyopathy with dynamically changing obstruction and aortic stenosis with fixed stenosis. We included 14 hypertrophic obstructive cardiomyopathy patients with a left ventricular outflow tract continuous-wave Doppler pressure gradient of ≥ 30 mmHg on fasting or postprandial condition and eight aortic stenosis with pressure gradient of ≥ 20 mmHg. Echocardiographic examinations were performed during fasting, passive leg raising, 5 min of exercise, early and late recovery periods, and 30 min after meals. The pressure gradient in patients with aortic stenosis increased during passive lower extremity elevation, causing increased preload pressure, but that at the left ventricular outflow tract stenosis in hypertrophic obstructive cardiomyopathy decreased. The pressure gradient in hypertrophic obstructive cardiomyopathy did not change during supine exercise but increased rapidly after exercise and slowly recovered thereafter. A diet with decreased afterload slightly increased the pressure gradient in patients with aortic stenosis and significantly increased left ventricular outflow tract stenosis in patients with hypertrophic obstructive cardiomyopathy. Left ventricular outflow tract-pressure gradient in hypertrophic obstructive cardiomyopathy fluctuates dynamically with daily exercise and diet. The left ventricular outflow tract-pressure gradient increases immediately after exercise; therefore, it is important to encourage drinking before exercise and instruct patients to cool down at the end of exercise. Exercise after eating should be avoided in patients with hypertrophic obstructive cardiomyopathy.journal articl
Short-Term Outcomes of Robot-assisted Colectomy for Right-Sided Colon Cancer
Get PDFAim: To clarify the short-term outcomes of robot-assisted colectomy for right-sided colon cancer.
Materials and Method: Fourteen patients with colon cancer who underwent robot-assisted right-sided colon surgery between July 2022 and April 2023 were included in this study. The short-term outcomes of robot-assisted surgery were evaluated.
Results: The mean age of the patients (8 men and 6 women) was 76.5 ± 9.8 years. ASA scores were class II in 12 cases and class III in 2 cases. The sites of involvement were the cecum in 7 cases, the ascending colon in 5 cases, and the transverse colon in 2 cases. The surgical procedures were ileocecal resection in 7 cases (50%), partial colectomy (5 cases [36%] in the ascending colon; 1 case [7%] in the transverse colon), and the right hemicolectomy in 1 case (7%). The median operative time was 223.0 minutes (range: 160-521), and the blood loss was 20 ml (range: 1-580). The console operating time was 102.5 minutes (range: 42-188). There were no cases of conversion to laparoscopy. The pathological stages were as follows: stage 0 in 1 case, stage I in 2 cases, stage II in 7 cases, stage III in 4 cases, and stage IV in 0 cases. The number of lymph nodes retrieved was 14 (range: 9-24). No postoperative complications were observed.
Conclusion: Robot-assisted colectomy for right-sided colon cancer was found to be effective in terms of safety and short-term outcomes without causing any postoperative complications or surgical mortality.journal articl