Cardiovascular Surgery

Overview of the department

Chairman Prof. Takaaki Koshiji

Chairman
Prof. Takaaki Koshiji

We are responsible for surgery for various diseases of the heart and great/peripheral blood vessels. The results of /cardio-thoracic surgery for all fields of adult diseases are favorable: surgery for ischemic heart disease (coronary artery bypass), surgery for valvular disease (artificial valve replacement, valvuloplasty), and thoracic aortic surgery (surgery for true/dissecting aortic aneurysms). Furthermore, surgery for peripheral artery disease (bypass) and surgery for varices are performed.

Consultation system/therapeutic strategies

Treatment methods are selected, and whether or not surgery is indicated is determined based on discussions with cardiologists and the physicians who referred patients to our department according to the guidelines. The contents are explained to patients and their families. Considering that it is important for all members to care all patients, we are making efforts to promote close communication. If necessary, we obtain specialized advice/cooperation from various departments, characteristic of university hospitals, to further improve the results of treatment. For this reason, we are also positively providing surgery for high-risk patients, such as those with marked heart dysfunction and elderly patients with many complications, after obtaining informed consent.

Field of expertise

Coronary artery bypass

Bypass for angina pectoris/myocardial infarction is characterized by circulatory reconstruction of several blood vessels, achieved during the initial surgery, with long-term stability. Therefore, either off-pump coronary artery bypass (OPCAB) or coronary aortic bypass graft (CABG) is selected in accordance with patients’ conditions. As the materials of bypass blood vessels, arterial grafts, involving the internal thoracic artery, of which the quality is optimal, are routinely used.

Left ventriculoplasty/surgery for ventricular septal perforation

In patients with ventricular aneurysms after myocardial infarction or those with ischemic/dilated cardiomyopathy, the heart function is improved by incising/suturing the left ventricle. In patients with severe heart failure due to ventricular septal perforation, modified Komeda-David procedure with double patch technique is used , leading to a high cure rate.

Valvuloplasty

Valvuloplasty for mitral valve insufficiency has become a standard technique. Functional valvuloplasty involving leaflet plication and reconstruction of artificial chordae tendineae is performed. In the aortic valve, valve-sparing aortic root replacement is also conducted. Such a valve-sparing technique makes anticoagulant therapy with Warfarin unnecessary, improving the postoperative quality of life (QOL).

Maze operation (surgery for arrhythmia)

Atrial fibrillation, which frequently occurs in the presence of valvular heart disease, reduces the heart function, and it is important as an etiological factor for cardiogenic cerebral embolism. In patients with paroxysmal atrial tachycardia or chronic atrial fibrillation, it is possible to simultaneously perform treatment safely using a high-frequency ablation device during another procedure of heart surgery.

Surgery for acute aortic dissection

Among aortic diseases, acute aortic dissection (type A) is associated with a poor prognosis. As medical treatment alone leads to a fatal outcome in most cases, emergency surgery is performed. However, the mean surgery-related mortality rate in Japan is still 10% or more. In our department, a high cure rate has been achieved using unigue telescopic shape anastomosis, which we developed, under the established brain protection method.

Symptoms/diseases treated in our department

Coronary artery bypass for angina pectoris/myocardial infarction, artificial valve replacement for valvular heart disease, valvuloplasty, valve-sparing aortic root replacement, maze operation for atrial fibrillation-related arrhythmia, thoracic aortic stent graft(TEVAR) for thoracic aortic aneurysms, graft replacement for dissecting aortic aneurysms, surgery for abdominal aortic aneurysms, abdominal aortic stent graft(EVAR), bypass for peripheral artery disease, stripping for lower-limb varices, and sclerotherapy.