- 著者
- Minoru Tabata Hiraku Kumamaru Aya Ono Hiroaki Miyata Yasunori Sato Noboru Motomura
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.84, no.9, pp.1599-1604, 2020-08-25 (Released:2020-08-25)
- 参考文献数
- 16
- 被引用文献数
- 1 2
Background:Transcatheter aortic valve replacement (TAVR) has been performed more and more frequently in elderly patients with aortic stenosis. We investigated the association of in-hospital availability of TAVR on outcomes of surgical aortic valve replacement (SAVR) in the era of TAVR.Methods and Results:We utilized data from the Japan Adult Cardiovascular Surgery Database. Between October 2013 and December 2016, 9,330 patients aged ≥80 years underwent isolated SAVR or SAVR with coronary artery bypass grafting in 557 centers in Japan. We assessed the associations of in-hospital TAVR availability with operative mortality and composite complications adjusting for each patient’s characteristics, JapanSCORE predicted the risk scores, and hospital volumes of SAVR using generalized estimation equation methods. Observed operative mortality rates were 3.4% in all centers, 2.0% in TAVR centers and 4.0% in non-TAVR centers. The multivariable analyses showed that TAVR centers had statistically significantly lower operative mortality compared with non-TAVR centers among all patients (odds ratio 0.60, 95% confidence interval 0.41–0.89, P=0.01) and among intermediate/high-risk patients (odds ratio 0.52, 95% confidence interval 0.32–0.85, P<0.01) but not among low-risk patients (odds ratio 0.82, 95% confidence interval 0.44–1.51, P=0.52).Conclusions:In-hospital TAVR availability was associated with better outcomes of SAVR among elderly patients. This association was statistically significant among intermediate/high-risk patients but not significant among low-risk patients.
- 著者
- Yuichi Tamura Hiraku Kumamaru Shiori Nishimura Yasuo Nakajima Hiromi Matsubara Yu Taniguchi Ichizo Tsujino Ayako Shigeta Koichiro Kinugawa Kazuhiro Kimura Koichiro Tatsumi
- 出版者
- International Heart Journal Association
- 雑誌
- International Heart Journal (ISSN:13492365)
- 巻号頁・発行日
- vol.64, no.4, pp.684-692, 2023-07-29 (Released:2023-07-29)
- 参考文献数
- 27
- 被引用文献数
- 3
Upfront combination therapy including intravenous prostaglandin I2 (PGI2-IV) is recognized as the most appropriate treatment for patients with severe pulmonary arterial hypertension (PAH). This retrospective study aimed to determine reasons why this therapy is not used for some patients with severe PAH and describe the hemodynamic and clinical prognoses of patients receiving initial combination treatment with (PGI2-IV+) or without (PGI2-IV−) PGI2-IV.Data for patients with severe PAH (World Health Organization Functional Class III/IV and mean pulmonary arterial pressure [mPAP] ≥ 40 mmHg) were extracted from the Japan Pulmonary Hypertension Registry. Overall, 73 patients were included (PGI2-IV + n = 17; PGI2-IV− n = 56). The PGI2-IV+ cohort was younger than the PGI2-IV− cohort (33.8 ± 10.6 versus 52.6 ± 18.2 years) and had higher mPAP (58.1 ± 12.9 versus 51.8 ± 9.0 mmHg), greater prevalence of idiopathic PAH (88% versus 32%), and less prevalence of connective tissue disease-associated PAH (0% versus 29%). Hemodynamic measures, including mPAP, showed improvement in both cohorts (post-treatment median [interquartile range] 38.5 [17.0-40.0] for the PGI2-IV + cohort and 33.0 [25.0-43.0] mmHg for the PGI2-IV − cohort). Deaths (8/56) and lung transplantation (1/56) occurred only in the PGI2-IV − cohort.These Japanese registry data indicate that older age, lower mPAP, and non-idiopathic PAH may influence clinicians against using upfront combination therapy including PGI2-IV for patients with severe PAH. Early combination therapy including PGI2-IV was associated with improved hemodynamics from baseline, but interpretation is limited by the small sample size.
- 著者
- Yudai Tamura Yuichi Tamura Yu Taniguchi Ichizo Tsujino Takumi Inami Hiromi Matsubara Ayako Shigeta Yoichi Sugiyama Shiro Adachi Kohtaro Abe Yuichi Baba Masaru Hatano Satoshi Ikeda Kenya Kusunose Koichiro Sugimura Soichiro Usui Yasuchika Takeishi Kaoru Dohi Saki Hasegawa-Tamba Koshin Horimoto Noriko Kikuchi Hiraku Kumamaru Koichiro Tatsumi on behalf of the Japan Pulmonary Hypertension Registry Network
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Reports (ISSN:24340790)
- 巻号頁・発行日
- pp.CR-22-0098, (Released:2022-10-08)
- 参考文献数
- 21
- 被引用文献数
- 3
Background: Portopulmonary hypertension (PoPH) is one of the major underlying causes of pulmonary arterial hypertension (PAH). However, PoPH, especially treatment strategies, has been poorly studied. Therefore, this study evaluated current treatments for PoPH, their efficacy, and clinical outcomes of patients with PoPH.Methods and Results: Clinical data were collected for patients with PoPH who were enrolled in the Japan Pulmonary Hypertension Registry between 2008 and 2021. Hemodynamic changes, functional class, and clinical outcomes were compared between patients with PoPH treated with monotherapy and those treated with combination therapies. Clinical data were analyzed for 62 patients with PoPH, including 25 treatment-naïve patients, from 21 centers in Japan. In more than half the patients, PAH-specific therapy improved the New York Heart Association functional class by at least one class. The 3- and 5-year survival rates of these patients were 88.5% (95% confidence interval [CI] 76.0–94.7) and 80.2% (95% CI 64.8–89.3), respectively. Forty-one (66.1%) patients received combination therapy. Compared with patients who had received monotherapy, the mean pulmonary arterial pressure, pulmonary vascular resistance, and cardiac index were significantly improved in patients who had undergone combination therapies.Conclusions: Combination therapy was commonly used in patients with PoPH with a favorable prognosis. Combination therapies resulted in significant hemodynamic improvement without an increased risk of side effects.
- 著者
- Minoru Tabata Hiraku Kumamaru Aya Ono Hiroaki Miyata Yasunori Sato Noboru Motomura
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-20-0032, (Released:2020-07-16)
- 参考文献数
- 16
- 被引用文献数
- 2
Background:Transcatheter aortic valve replacement (TAVR) has been performed more and more frequently in elderly patients with aortic stenosis. We investigated the association of in-hospital availability of TAVR on outcomes of surgical aortic valve replacement (SAVR) in the era of TAVR.Methods and Results:We utilized data from the Japan Adult Cardiovascular Surgery Database. Between October 2013 and December 2016, 9,330 patients aged ≥80 years underwent isolated SAVR or SAVR with coronary artery bypass grafting in 557 centers in Japan. We assessed the associations of in-hospital TAVR availability with operative mortality and composite complications adjusting for each patient’s characteristics, JapanSCORE predicted the risk scores, and hospital volumes of SAVR using generalized estimation equation methods. Observed operative mortality rates were 3.4% in all centers, 2.0% in TAVR centers and 4.0% in non-TAVR centers. The multivariable analyses showed that TAVR centers had statistically significantly lower operative mortality compared with non-TAVR centers among all patients (odds ratio 0.60, 95% confidence interval 0.41–0.89, P=0.01) and among intermediate/high-risk patients (odds ratio 0.52, 95% confidence interval 0.32–0.85, P<0.01) but not among low-risk patients (odds ratio 0.82, 95% confidence interval 0.44–1.51, P=0.52).Conclusions:In-hospital TAVR availability was associated with better outcomes of SAVR among elderly patients. This association was statistically significant among intermediate/high-risk patients but not significant among low-risk patients.