静岡医療センター研究業績集（27）（2019 年度）

静岡医療センター臨床研究部

発刊の辞2019 年の静岡医療センター臨床研究部業績集が完成いたしました。田邊臨床研究部長ならびに臨床研究部の職員の方々のご努力に感謝申し上げます。
本年も、英文論文の多さには驚くばかりで、臨床診療で忙しい中、数多くの英語論文を発表されている心臓血管外科の高木部長には、頭の下がる思いです。また、受託研究なども多く、静岡医療センターの実力を改めて実感しております。
国立病院機構共同臨床研究も開始され、今後、NHO 内の共同研究が盛んにおこなわれていくこととなることが期待されます。
2019 年の静岡医療センターの研究業績は、従来の心臓血管外科、循環器内科、消化器内科の業績に加え、内科系、そしてリハビリテーション科などの業績も報告され、静岡医療センターの臨床研究がさらに発展していく予感がいたします。
今後も静岡医療センター臨床研究部の活動をご支援くださるようお願い申しあげます。

2020 年 9 月
独立行政法人国立病院機構静岡医療センター
院長

中野 浩

目次
臨床研究部の活動状況---------------------------------------------------------------------------------8

発表論文
内科 -------------------------------------------------------------------------------------------------------------------16
消化器内科 --------------------------------------------------------------------------------------------------------16
循環器内科 --------------------------------------------------------------------------------------------------------16
心臓血管外科 ----------------------------------------------------------------------------------------------------17
放射線科 -----------------------------------------------------------------------------------------------------------24
薬剤部 ---------------------------------------------------------------------------------------------------------------24
リハビリテーション科-------------------------------------------------------------------------------------25

著書
内科 -------------------------------------------------------------------------------------------------------------------26
麻酔科 ---------------------------------------------------------------------------------------------------------------26

学会発表
脳神経内科 --------------------------------------------------------------------------------------------------------27
消化器内科 --------------------------------------------------------------------------------------------------------27
循環器内科 --------------------------------------------------------------------------------------------------------28
外科 -------------------------------------------------------------------------------------------------------------------29
整形外科 -----------------------------------------------------------------------------------------------------------30
心臓血管外科 ----------------------------------------------------------------------------------------------------30
歯科 -------------------------------------------------------------------------------------------------------------------31
放射線科 ------------------------------------------------------------------------------------------------------------31
麻酔科 ---------------------------------------------------------------------------------------------------------------31
研修医 ---------------------------------------------------------------------------------------------------------------31
病理 -------------------------------------------------------------------------------------------------------------------32
Ｊ Ｎ Ｐ ------------------------------------------------------------------------------------------------------------33
薬剤部 ---------------------------------------------------------------------------------------------------------------33
11

中央放射線室 ----------------------------------------------------------------------------------------------------34
リハビリテーション科 --------------------------------------------------------------------------------------35
栄養管理室 --------------------------------------------------------------------------------------------------------36
看護部 ---------------------------------------------------------------------------------------------------------------37
看護学校 -----------------------------------------------------------------------------------------------------------38
検査科 ---------------------------------------------------------------------------------------------------------------39
療育指導科 --------------------------------------------------------------------------------------------------------39

講演
内科 -------------------------------------------------------------------------------------------------------------------40
脳神経内科 --------------------------------------------------------------------------------------------------------40
消化器内科 --------------------------------------------------------------------------------------------------------40
心臓血管外科 ----------------------------------------------------------------------------------------------------40
麻酔科 ---------------------------------------------------------------------------------------------------------------40
放射線科 -----------------------------------------------------------------------------------------------------------41

発表論文集
・JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version - -----43
・The Pathologic and Genetic Characteristics of the Intestinal Subtype of Intraductal
Papillary Neoplasms of the Bile Duct. ----------------------------------------------------------------44
・CHF-B290 を用いた経口胆道鏡診断の実際と愛護的な操作方法のコツ --------45
・Exercise-based cardiac rehabilitation for patients with catheter ablation for persistentatrial fibrillation: A randomized controlled clinical trial. -------------------------------------46
・遺伝性不整脈に対するデバイス治療の適応と有効性 ------------------------------------47
・重症心不全における CRT, CRT-D-適応と課題 -----------------------------------------------48
・Meta-analysis of impact of liver disease on mortality after transcatheter aortic valve
implantation. ---------------------------------------------------------------------------------------------------49
・Impact of concurrent tricuspid regurgitation on mortality after transcatheter heart
valve aortic-valve implantation. -------------------------------------------------------------------------50
・Meta-analysis of Valve-in-Valve Transcatheter versus Redo Surgical Aortic Valve
Replacement. ---------------------------------------------------------------------------------------------------51
・Meta-analysis of transcatheter aortic valve implantation for bicuspid versus tricuspid
aortic valves. ---------------------------------------------------------------------------------------------------52
2
2

・Meta-analysis of prognostic impact of blood transfusion on survival after transcatheter
aortic valve implantation. ----------------------------------------------------------------------------------53
・A Contemporary Meta-Analysis of Antegrade versus Retrograde Cerebral Perfusion
for Thoracic Aortic Surgery. ------------------------------------------------------------------------------54
・Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic Valve
Implantation. ----------------------------------------------------------------------------------------------------55
・Meta-Analysis of Relation of Skipping Breakfast With Heart Disease. ------------------56
・A meta-analysis of impact of low-flow/low-gradient aortic stenosis on survival after
transcatheter aortic valve implantation. ---------------------------------------------------------------57
・A meta-analysis of impact of mitral stenosis on outcomes after transcatheter aortic
valve implantation. -------------------------------------------------------------------------------------------58
・Comparison of early and midterm outcomes after transsubclavian/axillary versus
transfemoral, transapical, or transaortic transcatheter aortic valve implantation. -----59
・Network meta-analysis of new-generation valves for transcatheter aortic valve
implantation. ----------------------------------------------------------------------------------------------------60
・Meta-analysis of the Relation of Television-Viewing Time and Cardiovascular
Disease. -----------------------------------------------------------------------------------------------------------61
・Meta-analysis of prognostic impact of peripheral arterial disease on mortality after
transcatheter aortic valve implantation. ---------------------------------------------------------------62
・Echocardiographic outcomes from seven randomized trials of transcatheter versus
surgical aortic valve replacement. ----------------------------------------------------------------------63
・Meta-analysis of propensity matched studies of robotic versus conventional mitralvalve surgery. ---------------------------------------------------------------------------------------------------64
・Meta-analysis of impact of troponins on mortality after transcatheter aortic valve
implantation. ----------------------------------------------------------------------------------------------------65
・A meta-analysis of ≥5-year mortality after transcatheter versus surgical aortic valve
replacement. ----------------------------------------------------------------------------------------------------66
・The association of volume of intramural thrombus with rupture of abdominal
aortic aneurysm. -----------------------------------------------------------------------------------------------67
・Matrix metalloproteinases and acute aortic dissection: Et Tu, Brute? ---------------------68
・Heart in Aorta. -------------------------------------------------------------------------------------------------69
・Baseline left ventricular diastolic dysfunction affects midterm mortality after
transcatheter aortic valve implantation. --------------------------------------------------------------70
3
3

・Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve Implantation forPure Native Aortic Regurgitation. ----------------------------------------------------------------------71
・ACS in lunar wonderland: Lunar phases and acute coronary syndrome. -----------------72
・Blood group and abdominal aortic aneurysm. ------------------------------------------------------73
・Which should we eat, fruit or vegetables? The association with abdominal aortic
aneurysm. --------------------------------------------------------------------------------------------------------74
・Colder is worse? Meteorology of acute aortic dissection. -------------------------------------75
・Wind and coronary artery disease. ----------------------------------------------------------------------76
・Marriage and mortality after acute coronary syndrome. ----------------------------------------77
・Association of aortic and intracranial aneurysm: Tweedledum and Tweedledee? -----78
・Egg Consumption and Coronary Artery Disease: A Nice Knockdown Argument. ----79
・Gait and fate: Baseline gait speed and mortality after transcatheter aortic valve
implantation. ----------------------------------------------------------------------------------------------------80
・Prognostic impact of baseline C-reactive protein levels on mortality after transcatheter
aortic valve implantation. ----------------------------------------------------------------------------------81
・Mortality after transcatheter versus surgical aortic valve replacement: an updated
meta-analysis of randomised trials. --------------------------------------------------------------------82
・Impact of postprocedural thrombocytopenia on mortality after transcatheter aortic
valve implantation. -------------------------------------------------------------------------------------------83
・Jigsaw puzzle-like multiple-barreled aorta in acute aortic dissection. ---------------------84
・Predictors of Hospital Cost After Transcatheter Aortic Valve Implantation in the
United States: From the Nationwide Inpatient Sample Database. --------------------------85
・Incidence, Trends, and Predictors of Palliative Care Consultation After Aortic Valve
Replacement in the United States. ----------------------------------------------------------------------86
・In-hospital outcomes of transcatheter versus surgical aortic valve replacement in
non-teaching hospitals. -------------------------------------------------------------------------------------87
・Comparison of Health Related Quality of Life in Transcatheter Versus Surgical Aortic
Valve Replacement: A Meta-Analysis. ----------------------------------------------------------------88
・Transradial versus transfemoral percutaneous coronary intervention of left maindisease: A systematic review and meta-analysis of observational studies. ---------------89
・In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction ComplicatedWith Cardiogenic Shock at Safety-Net Hospitals in the United States (from the
Nationwide Inpatient Sample). --------------------------------------------------------------------------90
44

・Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation
Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk
Cohort. ------------------------------------------------------------------------------------------------------------91
・Incidence and predictors of readmissions to non-index hospitals after transcatheter
aortic valve replacement and the impact on in-hospital outcomes: From thenationwide readmission database. ----------------------------------------------------------------------92
・The impact of safety-net burden on in-hospital outcomes after surgical aortic valve
replacement. ----------------------------------------------------------------------------------------------------93
・Palliative care referral in ST-segment elevation myocardial infarction complicatedwith cardiogenic shock in the United States. -------------------------------------------------------94
・Early Invasive Versus Ischemia-Guided Strategy in Non-ST-Segment Elevation AcuteCoronary Syndrome With Chronic Obstructive Pulmonary Disease: A National
Inpatient Sample Analysis. --------------------------------------------------------------------------------95
・Meta-Analysis of Hospital-Volume Relationship in Transcatheter Aortic Valve
Implantation. ---------------------------------------------------------------------------------------------------96
・Unplanned Thirty-Day Readmission After Alcohol Septal Ablation for Hypertrophic
Cardiomyopathy (From the Nationwide Readmission Database). --------------------------97
・Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective
Analysis of Nationwide Inpatient Sample Database. --------------------------------------------98
・Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Termdialysis. -----------------------------------------------------------------------------------------------------------99
・Meta-analysis of Antithrombotic Therapy in Patients With Atrial Fibrillation
Undergoing Percutaneous Coronary Intervention. ----------------------------------------------100
・Antithrombotic strategies after transcatheter aortic valve implantation: Insights from a
network meta-analysis. ------------------------------------------------------------------------------------101
・Short- and long-term outcomes in dialysis patients undergoing transcatheter aortic
valve implantation: a systematic review and meta-analysis. --------------------------------102
・Meta-Analysis Evaluating the Effects of Renin-Angiotensin-Aldosterone System
Blockade on Outcomes of Heart Failure With Preserved Ejection Fraction. ----------103
・Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary
Syndrome Undergoing Percutaneous Coronary Intervention; Insights from a
Meta-Analysis. -----------------------------------------------------------------------------------------------1045
5

・Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists
After Transcatheter Aortic Valve Implantation. --------------------------------------------------105
・Network Meta-Analysis of Surgical Aortic Valve Replacement and Different
Transcatheter Heart Valve Systems for Symptomatic Severe Aortic Stenosis. -------106
・Meta-Analysis of Antithrombotic Strategies in Patients with Heart Failure with
Reduced Ejection Fraction and Sinus Rhythm. --------------------------------------------------107
・Meta-analysis of phase-specific survival after elective endovascular versus surgicalrepair of abdominal aortic aneurysm from randomized control and propensity-scorematched studies. ---------------------------------------------------------------------------------------------108
・Risk of Amputation Associated with Sodium-Glucose Co-Transporter 2 Inhibitors:
A Meta-Analysis of Randomized Controlled Trials. -------------------------------------------109
・リスク患者での造影検査における前投薬と薬剤変更 -----------------------------------110
・外来での抗菌薬使用の手引き（小児版） 補足 --------------------------------------------111
・小児用の内服用抗菌薬の飲ませ方 ---------------------------------------------------------------112
・Postoperative atrial fibrillation is associated with delayed early rehabilitation after
heart valve surgery: a multicenter study. ------------------------------------------------------------113
・Factors related to physical functioning decline after cardiac surgery in older patients:
A multicenter retrospective study. ---------------------------------------------------------------------114
・Effect of obesity and underweight status on the hospital-acquired functional decline
in patients with cardiovascular surgery: an analysis of data from a prospective
observational multicenter cohort study. -------------------------------------------------------------115
・Exercise-based cardiac rehabilitation for patients with catheter ablation for
persistent atrial fibrillation: A randomized controlled clinical trial. ----------------------116
・薬物療法と慢性心不全 ---------------------------------------------------------------------------------117
・心臓再同期療法後の心不全患者に対する訪問リハビリテーションにより日常生活動作が改善した要介護症例 ------------------------------------------------------------118
・京都大学医学部内科学第二講座 百十五年の歴史と伝統 ---------------------------119
・全身性疾患/膠原病 ANCA 関連血管炎 ----------------------------------------------------------120
・MCI の時に受傷者が来るのは大病院だけじゃない --------------------------------------12166

臨床研究部の活動状況

臨 床 研 究 部 の 活 動 状 況
はじめに
国立病院機構の使命として質の高い臨床研究と治験の推進を掲げています。静岡医療センターもその基本指針に健康科学の推進を挙げており、当臨床研究部がその責務を担っています。
2019年度の臨床研究部活動をまとめましたのでご報告いたします。

１．臨床研究部の概要（１）設置年度
設置年度：平成３年１０月

（２）組

織

５研究室および治験管理室
氏

名

専任・併任の別備考臨床研究部長田邊潤

専任

治験管理室長併任

循環動態機能研究室長

小鹿野道雄

併任

循環器内科部長

病因病態研究室長

欠治療開発研究室長

黒田勝宏

併任

脳神経外科部長

人工臓器研究室長

高木寿人

併任

心臓血管外科部長

神経難病治療研究室長

本間

併任

脳神経内科診療部長

豊２．施設の機能付与及び特徴
臨床機能上は循環器・がん・救急・総合診療を4本柱とする急性期医療と神経、筋疾患、重症心身障害を中心に脳血管障害以外の疾患も積極的に診療をおこなっています。
独立行政法人国立病院機構の東海北陸地方における循環器病の基幹施設に指定されております。2019年3月に静岡県東部で初めて補助循環器用ポンプカテーテル、インペラの実施施設として認定されました。地域支援病院として、広域での連携強化とともに大型医療機器の共同利用についても引き続き推進していくこととしています。

３．これまでの臨床研究部の主な活動状況
臨床研究部は主として循環器病およびその関連疾患に関する病因、病態、診断、治療、予防対策、社会復帰を含む予後調査等についての系統的研究を行なってきましたが、独立行政法人化に伴う病院機能の見直しとともに、循環器に限定せず、がん・総合診療を始め看護部門等での臨床研究にも幅広く支援を行っています。

88これまでの主な研究テーマは循環器系では（１）動脈硬化性疾患の危険因子への対策に関する研究（２）虚血性心疾患、脳卒中、大動脈瘤、末梢血管疾患の病態及び先進的治療に関する研究（３）
循環器病の予後調査に関する研究です。がんでは消化器内科、外科を中心に肝胆膵での業績が多くあげられています。臨床研究部での研究は、これらの臨床活動により得られた資料を有効に活用しながら診療の水準を向上させることを目的としています。今後も社会･医療に貢献する質の高い臨床研究を目指します。

４．2019年度活動の概要
本年度は昨年度と比べて学会発表は横ばいでしたが、論文発表は増加しています。欧文での論文発表数の増加が目立っています。
平成 27 年 4 月に『人を対象とする医学系研究に関する倫理指針』が施行され、指針に則って臨
床研究審査委員会で臨床研究の倫理審査をおこなっています。静岡を拠点とするファルマバレー
センターや日本医師会、その他の紹介も利用して、より多くの試験を受託するべく、体制を整えています。本年度は PMDA より監査を受けております。

５．2019年度に獲得した研究費（1）国立病院機構共同臨床研究課題名
膵がん切除後の補助化学療法における S-1
単独療法と S-1 とメトホルミンの併用療法の非盲検ランダム化第Ⅱ相比較試験（ASMET）

中野

研究者

研究費

浩（外科）

19 万円

６．受託研究に関する実績
件 数
17件

受託金額

29,156 千円
千円

実施率
55.5％

治験審査委員会登録の有無
有千円

７．2019年度の研究発表（１）学会発表： 国内 98件、国際 2件、（２）論文発表： 邦文 10編、欧文 68編、合計 100件
合計
78編※ ただし、学会抄録、研究班報告書は含まない。
※ 欧文はLetterも含む

99論文発表数の推移

学会発表数の推移

1010

８．受託研究審査委員会
委員長 ： 田邊副委員長 ： 溝口外部委員： 杉村
青木高橋
委 員 ： 小澤委 員 ： 本間
委 員 ： 松下委 員 ： 森委 員 ： 髙木委 員 : 井上
委 員 ： 宮嶋
委 員 : 棚田

潤
功一
伸一
千賀子
和彦
章子
豊
恒久
元春
亮
淳子
由晴
良之

（臨床研究部長）（副院長）（社会福祉法人静岡恵明学園赤ちゃんセンター静岡恵明学園園長）（日本大学国際関係学部非常勤講師）（静岡県立東部特別支援学校副校長）（統括診療部長）（医局長）（副医局長）（事務部長）（薬剤部長）（看護部長）（企画課長）（業務班長）

９．2019年度新規受託研究一覧
（１）治験
研究課題

依頼者

責任医師

中等症から重症の活動期のクローン病患者を対象とする JNJ-64304500 の安全性及び有効性の評価を目的とした第 2b 相,ランダム化,二重盲検,プラセボ対照,並行群間,多施設共同試験

ヤンセンファーマ株式会社

消化器内科
部長
大西佳文

日本人の中等症又は重症の活動性潰瘍性大腸炎患者を対象として OZANIMOD を経口投与したときの有効性及び長期安全性を評価する
第 2/3 相多施設共同ランダム化二重盲検プラ
セボ対照試験

セルジーン株式会社

消化器内科
部長
大西佳文

研究課題

依頼者

責任医師

オノアクト点滴静注用 50 ㎎一般使用成績調査

小野薬品工業株式会社

循環器内科
臨床研究部長田邊 潤

IMPELLA 補助循環用ポンプカテーテルおよび IMPELLA 制御装置 使用成績調査

日本アビオメッド株式会社

心臓血管外科
波里陽介

IMPELLA 補助循環用ポンプカテーテルおよび IMPELLA 制御装置 使用成績調査

日本アビオメッド
株式会社（２）製造販売後臨床試験・使用成績調査

アデムパス錠使用成績調査（肺動脈性肺高血圧症）

バイエル薬品株式会社

ジーンプラバ®点滴静注 625mg
一般使用成績調査

MSD 株式会社

11
11

循環器内科
医長
川中秀和
循環器内科
臨床研究部長田邊 潤
循環器内科
臨床研究部長
田邊 潤

アレクシオンファーマ
合同会社

脳神経内科
診療部長
本間 豊

研究課題

依頼者

責任医師

レボフロキサシン錠 250 ㎎「杏林」の投与後に発現した「低血糖疑い」症例の詳細調査

キョーリンリメディオ
株式会社

内科
殿岡久美子

トラクリア 62.5mg 錠 副作用詳細調査

アクテリオンファーマ
シューティカルズ
ジャパン 株式会社

循環器内科
西郡 卓

プラザキサカプセル 75mg 副作用・感染症詳細報告書

日本ベーリンガー
インゲルハイム株式会社

脳神経外科
高橋照男

依頼者

責任医師

テルモ株式会社

心臓血管外科部長
高木寿人

SJM OCT イメージングカテーテルに関する使
用成績調査

アボットバスキュラー
ジャパン株式会社

循環器内科
臨床研究部長田邊 潤

体外式膜型人工肺キャピオックス FX プレコネ
クト回路使用実態調査

テルモ株式会社

心臓血管外科部長
高木寿人

JLL 食道温モニタリングシステム性能に関する
使用実態調査日本ライフライン
株式会社

循環器内科
部長
小鹿野道雄

アルチマスター及びアルチマスタータンセイ
市場実態調査テルモ株式会社

循環器内科
臨床研究部長田邊 潤

ソリリス®点滴静注 300 mg 視神経脊髄炎スペ
クトラム障害に関する特定使用成績調（３）副作用・感染症報告（４）医療機器
研究課題
経皮的補助循環システム使用実態調査

12

10.臨床研究審査委員会
委員長 ：
副委員長：
外部委員：
外部委員：
外部委員：
委 員 ：
委 員 ：
委 員 ：
委 員 ：
委 員 ：
委 員 :
委 員 ：
委 員 :

田邊
溝口
杉村
青木
高橋
小澤
本間
松下
古山
髙木
井上
宮嶋
棚田

潤
功一
伸一
千賀子
和彦
章子
豊
恒久
雅博
亮
淳子
由晴
良之

（臨床研究部長）（副院長）（社会福祉法人静岡恵明学園赤ちゃんセンター静岡恵明学園園長）（日本大学国際関係学部非常勤講師）（静岡県立東部特別支援学校副校長）（統括診療部長）（医局長）（副医局長）（事務部長）（薬剤部長）（看護部長）（企画課長）（業務班長）（１） 当院で実施の研究
研究課題

研究責任者

アロマセラピーを使用した 16 時間夜勤を行う看護師の疲労軽減について

看護師
加藤 潤
看護師
梅原朋世
看護師
飯田順子

手術室看護師の抱えるストレスについて
退院支援退院調整に対する当病棟看護師の認識
がん化学療法における HBV 再活性化対策に関する検討

薬剤部
彦坂麻美

当院におけるプレアボイド報告事例と副作用報告事例

薬剤部
田代 匠

施設間・地域連携が必要な疾患の急性期（一般）病棟における栄養管理

栄養管理室
丹羽正人

心不全患者の意思決定を支えるために～領域・分野をこえて考えよう～

看護師
市川智子

高齢心不全患者の心不全の急性増悪による再入院に関する因子の検討

リハビリテーション科

鬼頭和也

循環器病棟で勤務する看護師の職務に対するストレッサ―と職務満足度

看護師
細野奈々

頭部の除圧の必要性と頭部の圧測定～耳介の褥瘡が軽快・治癒に至った経緯から～

看護師
杉本香織

申し送りが長くなることに看護師個人の申し送りに対する考えは影響して
いるのか

看護師
河口真菜美

当院における術後訪問定着化に向けての取り組み

看護師
土屋奈津美

笑いによる仕事へのモチベーション向上の検証
当病棟看護師の退院支援・退院調整に対する認識変化の実態調査

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看護師
大庭美緒
看護師
千田舞子

急性期病院内での病棟内認知症カフェ「みかんカフェ」を開催して

看護師
塩川幸子

弾性ストッキング装着時に活動した場合の有効性－弾性ストッキングのズレと装着圧の検討－

看護師
勝又美樹

外来患者へ限られた時間での説明を視覚・色覚の視認性と合わせて考えてみた効率的な手段について

看護師
羽石麻穂
循環器内科
坪井一平
薬剤部
市川竜太郎
看護師
吉田典子

CAM-ICU 導入に向けた ICU 看護師のせん妄に対する現状の意識調査

看護師
大兼ことみ

基礎看護教育における一時吸引の教授方法の検討

看護学校
青木裕子

実習指導者と学生が看護を語りあう効果

看護学校
荻澤英幸

転倒・転落予防を目的とした対策方法選択のためのフローチャート作成の
効果

看護師
武井麻紀

静岡医療センターに移転したことで治療の幅が広がった患者に対するアプ
ローチ～副鼻腔癌、脳腫瘍に罹患した患者の看護～

看護師
望月美絵

病棟災害マニュアルに対する病棟看護師の意識調査
心房細動症例に対する右肺静脈拡大隔離における右肺静脈分岐部への右房経由心外膜伝導と心外膜脂肪織との関連についての検討
ジゴキシン血中濃度上昇に関する背景因子の検討（２）受託研究
研究課題

研究責任者

消化器内視鏡に関連した偶発症の全国調査

消化器内科
部長
大西佳文

ダプトマイシン投与による CK への影響に関する検討

薬剤部
上田真也

AI 解析に基づく十二指腸乳頭分類と ERCP におけるアウトカムとの相関性に関する検証

消化器内科
診療部長
松田浩二

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発表論文・著書・学会発表・講演

2019 年度論文発表【内科】
１）Mitsuaki Isobe, Koichi Amano, Yoshihiro Arimura, Akihiro Ishizu, Shuichi Ito,
Shinya Kaname, Shigeto Kobayashi, Yoshinori Komagata, Issei Komuro, Kimihiro
Komori, Kei Takahashi, Kazuo Tanemoto, Hitoshi Hasegawa, Masayoshi Harigai,
Shouichi Fujimoto, Tatsuhiko Miyazaki, Tetsuro Miyata, Hidehiro Yamada, Akitoshi
Yoshida, Takashi Wada, Yoshinori Inoue, Haruhito A. Uchida, Hideki Ota, Takahiro
Okazaki, Mitsuho Onimaru, Tamihiro Kawakami, Reiko Kinouchi, Atsushi Kurata,
Hisanori Kosuge, Ken-ei Sada, Kunihiro Shigematsu, Eiichi Suematsu, Eijun Sueyoshi,
Takahiko Sugihara, Hitoshi Sugiyama, Mitsuhiro Takeno, Naoto Tamura, Michi
Tsutsumino, Hiroaki Dobashi, Yoshikazu Nakaoka, Kenji Nagasaka, Yasuhiro Maejima,
Hajime Yoshifuji, Yoshiko Watanabe, Shoichi Ozaki, Takeshi Kimura, Hiroshi
Shigematsu, Keiko Yamauchi-Takihara, Toyoaki Murohara, Shin-ichi Momomura.
JCS 2017 Guideline on Management of Vasculitis Syndrome- Digest Version Circulation Journal. 2020:84: 299-359.
【消化器内科】
１）Nakanuma Y, Kakuda Y, Fukumura Y, Sugino T, Uesaka K, Serizawa M,
Terada T, Ohnishi Y.
The Pathologic and Genetic Characteristics of the Intestinal Subtype of Intraductal
Papillary Neoplasms of the Bile Duct.
American Journal of Surgical Pathology. 2019 Sep (43)9:1212-1220.
２）大西佳文CHF-B290 を用いた経口胆道鏡診断の実際と愛護的な操作方法のコツ
オリンパス株式会社冊子掲載 2020.3 号【循環器内科】
１）Kato M, Ogano M, Mori Y, Kochi K, Morimoto D, Kito K, Green FN,
Tsukamoto T, Kubo A, Takagi H, Tanabe J.
Exercise-based cardiac rehabilitation for patients with catheter ablation for persistentatrial fibrillation: A randomized controlled clinical trial.
Eur J Prev Cardiol.2019(18) 7:1931-1940.
２）小鹿野道雄
遺伝性不整脈に対するデバイス治療の適応と有効性
循環器内科 2019(5)85:703-710
３）小鹿野道雄
重症心不全における CRT, CRT-D-適応と課題
ICU と CCU 2019(12)43:683-6901616

【心臓血管外科】
１）Takagi H, Hari Y, Kawai N, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-analysis of impact of liver disease on mortality after transcatheter aortic valve
implantation.
J Cardiovasc Med (Hagerstown). 2019 Apr;20(4):237-244.
２）Takagi H, Hari Y, Kawai N, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic-valve
implantation.
Catheter Cardiovasc Interv. 2019 Apr 1;93(5):946-953.
３）Takagi H, Mitta S, Ando T.
Meta-analysis of Valve-in-Valve Transcatheter versus Redo Surgical Aortic Valve
Replacement.
Thorac Cardiovasc Surg. 2019 Jun;67(4):243-250.
４）Takagi H, Hari Y, Kawai N, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-analysis of transcatheter aortic valve implantation for bicuspid versus tricuspid
aortic valves.
J Cardiol. 2019 Jul;74(1):40-48.
５）Takagi H, Hari Y, Kawai N, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-analysis of prognostic impact of blood transfusion on survival after transcatheter
aortic valve implantation.
J Cardiovasc Surg (Torino). 2019 Aug;60(4):535-539.
６）Takagi H, Mitta S, Ando T.
A Contemporary Meta-Analysis of Antegrade versus Retrograde Cerebral Perfusion for
Thoracic Aortic Surgery.
Thorac Cardiovasc Surg. 2019 Aug;67(5):351-362.
７）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-Analysis for Impact of Statin on Mortality After Transcatheter Aortic Valve
Implantation.
Am J Cardiol. 2019 Sep 15;124(6):920-925.
８）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-Analysis of Relation of Skipping Breakfast With Heart Disease.
Am J Cardiol. 2019 Sep 15;124(6):978-986.

1717９）Takagi H, Hari Y, Kawai N, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
A meta-analysis of impact of low-flow/low-gradient aortic stenosis on survival after
transcatheter aortic valve implantation.
J Cardiovasc Med (Hagerstown). 2019 Oct;20(10):691-698.
１０）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T.
A meta-analysis of impact of mitral stenosis on outcomes after transcatheter aortic valve
implantation.
J Card Surg. 2019 Nov;34(11):1256-1263.
１１）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Comparison of early and midterm outcomes after transsubclavian/axillary versus
transfemoral, transapical, or transaortic transcatheter aortic valve implantation.
Heart Lung. 2019 Nov - Dec;48(6):519-529.
１２）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Network meta-analysis of new-generation valves for transcatheter aortic valve
implantation.
Heart Vessels. 2019 Dec;34(12):1984-1992.
１３）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-analysis of the Relation of Television-Viewing Time and Cardiovascular Disease.
Am J Cardiol. 2019 Dec 1;124(11):1674-1683.
１４）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-analysis of prognostic impact of peripheral arterial disease on mortality after
transcatheter aortic valve implantation.
J Cardiovasc Surg (Torino). 2019 Dec;60(6):723-732.
１５）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Echocardiographic outcomes from seven randomized trials of transcatheter versus
surgical aortic valve replacement.
J Cardiovasc Med (Hagerstown). 2020 Jan;21(1):58-64.
１６）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Meta-analysis of propensity matched studies of robotic versus conventional mitral valve
surgery.
J Cardiol. 2020 Feb;75(2):177-181.

1818１７）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; All-Literature Investigation of
Cardiovascular Evidence (ALICE) Group.
Meta-analysis of impact of troponins on mortality after transcatheter aortic valve
implantation.
J Cardiovasc Surg (Torino). 2020 Feb;61(1):98-106.
１８）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; All-Literature Investigation of
Cardiovascular Evidence (ALICE) Group.
A meta-analysis of ≥5-year mortality after transcatheter versus surgical aortic valve
replacement.
J Cardiovasc Surg (Torino). 2020 Feb;61(1):107-116.
１９）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T.
The association of volume of intramural thrombus with rupture of abdominal aortic
aneurysm.
J Vasc Surg. 2020 Mar;71(3):1069-1070.e3.
２０）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T.
Matrix metalloproteinases and acute aortic dissection: Et Tu, Brute?
Interact Cardiovasc Thorac Surg. 2020 Mar 1;30(3):465-476.
２１）Takagi H, Hari Y, Takinami N, Nakashima K; ALICE (All-Literature
Investigation of Cardiovascular Evidence) Group.
Heart in Aorta.
Ann Thorac Surg. 2020 Mar;109(3):e223.
２２）Takagi H, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Kuno T, Ando T ;ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
Baseline left ventricular diastolic dysfunction affects midterm mortality after
transcatheter aortic valve implantation.
J Card Surg. 2020 Mar;35(3):536-543.
２３）Takagi H, Hari Y, Kawai N, Ando T; ALICE (All-Literature Investigation of
Cardiovascular Evidence) Group.
Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve Implantation forPure Native Aortic Regurgitation.
Heart Lung Circ. 2019 May 4:S1443-9506(19)30352-X.
２４）Takagi H;
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
ACS in lunar wonderland: Lunar phases and acute coronary syndrome.
Eur J Prev Cardiol. 2019 Aug 5:2047487319868328.

1919２５）Takagi H;
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
Blood group and abdominal aortic aneurysm.
Eur J Prev Cardiol. 2019 Sep 12:2047487319876044.
２６）Takagi H;
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
Which should we eat, fruit or vegetables? The association with abdominal aortic
aneurysm.
Eur J Prev Cardiol. 2019 Oct 16:2047487319876227.
２７）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Colder is worse? Meteorology of acute aortic dissection.
Eur J Prev Cardiol. 2019 Oct 17:2047487319883726.
２８）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Wind and coronary artery disease.
Eur J Prev Cardiol. 2019 Oct 30:2047487319885195.
２９）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Marriage and mortality after acute coronary syndrome.
Eur J Prev Cardiol. 2019 Nov 6:2047487319881832.
３０）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; All-Literature Investigation of
Cardiovascular Evidence (ALICE) Group.
Association of aortic and intracranial aneurysm: Tweedledum and Tweedledee?
Eur J Prev Cardiol. 2019 Nov 7:2047487319886683.
３１）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Egg Consumption and Coronary Artery Disease: A Nice Knockdown Argument.
Angiology. 2020 Jan 31;3319719897493.
３２）Takagi H, Kato M, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Gait and fate: Baseline gait speed and mortality after transcatheter aortic valve
implantation.
J Cardiol. 2020 Feb 22:S0914-5087(20)30033-2.

2020３３）Takagi H, Kuno T, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Ando T;
ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
Prognostic impact of baseline C-reactive protein levels on mortality after transcatheter
aortic valve implantation.
J Card Surg. 2020 Mar 11:10.1111/jocs.14499.
３４）Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Mortality after transcatheter versus surgical aortic valve replacement: an updated
meta-analysis of randomised trials.
Neth Heart J. 2020 Mar 12:10.1007/s12471-020-01378-1.
３５）Takagi H, Hari Y, Nakashima K, Ueyama H, Kuno T, Ando T; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Impact of postprocedural thrombocytopenia on mortality after transcatheter aortic valve
implantation.
J Cardiovasc Med (Hagerstown). In press. doi: 10.2459/JCM.0000000000000949.
３６）Takagi H, Hari Y, Takinami N, Nakashima K; ALICE(All-Literature Investigation of Cardiovascular Evidence) Group.
Jigsaw puzzle-like multiple-barreled aorta in acute aortic dissection.
Int Angiol. In press. doi: 10.23736/S0392-9590.20.04330-8.
３７）Ando T, Adegbala O, Villablanca PA, Akintoye E, Ashraf S, Briasoulis A,
Telila T, Takagi H, Grines CL, Schreiber T, Bhatt DL, Afonso L.
Predictors of Hospital Cost After Transcatheter Aortic Valve Implantation in the UnitedStates: From the Nationwide Inpatient Sample Database.
Am J Cardiol. 2019 Apr 1;123(7):1142-1148.
３８）Ando T, Adegbala O, Uemura T, Akintoye E, Ashraf S, Briasoulis A, Takagi H,
Afonso L.
Incidence, Trends, and Predictors of Palliative Care Consultation After Aortic Valve
Replacement in the United States.
J Palliat Care. 2019 Apr;34(2):111-117.
３９）Ando T, Adegbala O, Villablanca PA, Briasoulis A, Takagi H, Grines CL,
Schreiber T, Nazif T, Kodali S, Afonso L.
In-hospital outcomes of transcatheter versus surgical aortic valve replacement in
non-teaching hospitals.
Catheter Cardiovasc Interv. 2019 Apr 1;93(5):954-962.
４０）Ando T, Takagi H, Briasoulis A, Grines CL, Afonso L.
Comparison of Health Related Quality of Life in Transcatheter Versus Surgical Aortic
Valve Replacement: A Meta-Analysis.
Heart Lung Circ. 2019 Aug;28(8):1235-1245.

21
21４１）Ando T, Aoi S, Ashraf S, Villablanca PA, Telila T, Briasoulis A, Takagi H,
Afonso L, Grines CL.
Transradial versus transfemoral percutaneous coronary intervention of left main disease:
A systematic review and meta-analysis of observational studies.
Catheter Cardiovasc Interv. 2019 Aug 1;94(2):264-273.
４２）Ando T, Akintoye E, Adegbala O, Ashraf S, Shokr M, Takagi H, Grines CL,
Afonso L, Briasoulis A.
In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction ComplicatedWith Cardiogenic Shock at Safety-Net Hospitals in the United States (from the
Nationwide Inpatient Sample).
Am J Cardiol. 2019 Aug 15;124(4):485-490.
４３）Ando T, Ashraf S, Villablanca P, Kuno T, Pahuja M, Shokr M, Afonso L,
Grines C, Briasoulis A, Takagi H.
Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation
Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk
Cohort.
Am J Cardiol. 2019 Aug 15;124(4):580-585.
４４）Ando T, Adegbala O, Villablanca P, Akintoye E, Ashraf S, Shokr M, Siddiqui F,
Takagi H, Grines CL, Afonso L, Briasoulis A.
Incidence and predictors of readmissions to non-index hospitals after transcatheter
aortic valve replacement and the impact on in-hospital outcomes: From the nationwide
readmission database.
Int J Cardiol. 2019 Oct 1;292:50-55.
４５）Ando T, Adegbala O, Akintoye E, Briasoulis A, Takagi H.
The impact of safety-net burden on in-hospital outcomes after surgical aortic valve
replacement.
J Card Surg. 2019 Nov;34(11):1178-1184.
４６）Ando T, Akintoye E, Uemura T, Adegbala O, Ashraf S, Pahuja M, Shokr M,
Takagi H, Grines CL, Afonso L, Briasoulis A.
Palliative care referral in ST-segment elevation myocardial infarction complicated withcardiogenic shock in the United States.
Heart Lung. 2020 Jan - Feb;49(1):25-29.
４７）Ando T, Adegbala O, Takagi H, Afonso L, Briasoulis A.
Early Invasive Versus Ischemia-Guided Strategy in Non-ST-Segment Elevation AcuteCoronary Syndrome With Chronic Obstructive Pulmonary Disease: A National Inpatient
Sample Analysis.
Angiology. 2019 Oct 2:3319719877096.

2222４８）Ando T, Villablanca PA, Takagi H, Briasoulis A.
Meta-Analysis of Hospital-Volume Relationship in Transcatheter Aortic Valve
Implantation.
Heart Lung Circ. 2019 Dec 9:S1443-9506(19)31519-7.
４９）Ando T, Adegbala O, Aggarwal A, Afonso L, Grines CL, Takagi H, Briasoulis A.
Unplanned Thirty-Day Readmission After Alcohol Septal Ablation for Hypertrophic
Cardiomyopathy (From the Nationwide Readmission Database).
Am J Cardiol. In press. doi: 10.1016/j.amjcard.2020.03.016.
５０）Ando T, Adegbala O, Uemura T, Ashraf S, Akintoye E, Pahuja M, Afonso L,
Briasoulis A, Takagi H.
Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective
Analysis of Nationwide Inpatient Sample Database.
Angiology. In press. doi: 10.1177/0003319720917239.
５１）Kuno T, Takagi H, Ando T, Sugiyama T, Miyashita S, Valentin N, Shimada YJ,
Kodaira M, Numasawa Y, Briasoulis A, Burger A, Bangalore S.
Oral Anticoagulation for Patients With Atrial Fibrillation on Long-Term Hemodialysis.
J Am Coll Cardiol. 2020 Jan 28;75(3):273-285.
５２）Kuno T, Ueyama H, Takagi H, Ando T, Numasawa Y, Briasoulis A, Fox J,
Bangalore S.
Meta-analysis of Antithrombotic Therapy in Patients With Atrial Fibrillation
Undergoing Percutaneous Coronary Intervention.
Am J Cardiol. 2020 Feb 15;125(4):521-527.
５３）Kuno T, Takagi H, Sugiyama T, Ando T, Miyashita S, Valentin N, Shimada YJ,
Kodaira M, Numasawa Y, Kanei Y, Hayashida K, Bangalore S.
Antithrombotic strategies after transcatheter aortic valve implantation: Insights from a
network meta-analysis.
Catheter Cardiovasc Interv. 2019 Oct 14:10.1002/ccd.28498.
５４）Kuno T, Takagi H, Ando T, Ueyama H, Fujisaki T, Kodaira M, Numasawa Y,
Briasoulis A. Hayashida K.
Short- and long-term outcomes in dialysis patients undergoing transcatheter aortic valve
implantation: a systematic review and meta-analysis.
Can J Cardiol. 2020 Jan 24:10.1016/j.cjca.2020.01.015.
５５）Kuno T, Ueyama H, Fujisaki T, Briasouli A, Takagi H, Briasoulis A.
Meta-Analysis Evaluating the Effects of Renin-Angiotensin-Aldosterone System
Blockade on Outcomes of Heart Failure With Preserved Ejection Fraction.
Am J Cardiol. 2020 Jan 30:S0002-9149(20)30050-3.

2323５６）Kuno T, Ueyama H, Ando T, Briasoulis A, Takagi H.
Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary
Syndrome Undergoing Percutaneous Coronary Intervention; Insights from a
Meta-Analysis.
Coron Artery Dis. In press.
５７）Ueyama H, Kuno T, Ando T, Briasoulis A, Fox J, Hayashida K, Takagi H.
Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists
After Transcatheter Aortic Valve Implantation.
Am J Cardiol. 2020 Jan 8:S0002-9149(20)30004-7.
５８）Ueyama H, Kuno T, Ando T, Hayashida K, Takagi H.
Network Meta-Analysis of Surgical Aortic Valve Replacement and Different
Transcatheter Heart Valve Systems for Symptomatic Severe Aortic Stenosis.
Can J Cardiol. 2020 Feb 28:10.1016/j.cjca.2020.02.088.
５９）Ueyama H, Takagi H, Briasoulis A, Harrington M, Steinberg D, Kuno T.
Meta-Analysis of Antithrombotic Strategies in Patients with Heart Failure with Reduced
Ejection Fraction and Sinus Rhythm.
Am J Cardiol. In press.
６０）Yokoyama Y, Kuno T, Takagi H.
Meta-analysis of phase-specific survival after elective endovascular versus surgicalrepair of abdominal aortic aneurysm from randomized control and propensity-scorematched studies.
J Vasc Surg. In press.
６１）Miyashita S, Kuno T, Takagi H, Sugiyama T, Ando T, Valentin N, Shimada YJ,
Kodaira M, Numasawa Y, Kanei Y, Bangalore S.
Risk of Amputation Associated with Sodium-Glucose Co-Transporter 2 Inhibitors: A
Meta-Analysis of Randomized Controlled Trials.
Diabetes Res Clin Pract. In press. doi: 10.1016/j.diabres.2020.108136.
【放射線科】
１）阿部彰子リスク患者での造影検査における前投薬と薬剤変更日獨医報 2019;64(2)23-27【薬剤部】
１）滝 久司
外来での抗菌薬使用の手引き（小児版） 補足
浜松市内科医会.AAS 通報 2020.1:第 50 回

2424２）滝 久司
小児用の内服用抗菌薬の飲ませ方
浜松市内科医会.AAS 通報 2020.3:第 54 回
【リハビリテーション科】
１）Kato M, Saitoh M, Kawamura T, Iwata K, Sakurada K, Okamura D, Tahara M,
Yuguchi S, Kamisaka K, Oura K, Mori Y, Morisawa T, Takahashi T.
Postoperative atrial fibrillation is associated with delayed early rehabilitation after heart
valve surgery: a multicenter study.
Phys Ther Res. 2019 Mar 11;22(1):1-8.
２）Itagaki A, Saitoh M, Okamura D, Kawamura T, Otsuka S, Tahara M, Mori Y,
Kamisaka K, Ochi Y, Yuguchi S, Kato M, Morisawa T, Takahashi T.
Factors related to physical functioning decline after cardiac surgery in older patients: A
multicenter retrospective study.
J Cardiol. 2019 Sep;74(3):279-283.
３）Saioth M, Kamisaka K, Kato M, Iwata K, Sakurada K, Tahara M, Oura K, Mori Y,
Otuka S, Morisawa T, Takahashi T.
Effect of obesity and underweight status on the hospital-acquired functional decline inpatients with cardiovascular surgery: an analysis of data from a prospective
observational multicenter cohort study.
Gen Thorac Cardiovasc Surg. 2019 Dec 21:10.1007/s11748-019-01279-0. [Epub aheadof print]
４）Kato M, Ogano M, Mori Y, Kochi K, Morimoto D, Kito K, Green FN,
Tsukamoto T, Kubo A, Takagi H, Tanabe J.
Exercise-based cardiac rehabilitation for patients with catheter ablation for persistentatrial fibrillation: A randomized controlled clinical trial.
Eur J Prev Cardiol. 2019 Dec;26(18):1931-1940.
５）加藤倫卓、小鹿野道雄
薬物療法と慢性心不全
理学療法ジャーナル 2020;54(2):160-166
６）石月亜由美、尾熊洋子、森 雄司、加藤倫卓
心臓再同期療法後の心不全患者に対する訪問リハビリテーションにより日常生
活動作が改善した要介護症例
理学療法ジャーナル 2020;54(3):347-352

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2019 年度著書【内科】
１）岡崎貴裕京都大学医学部内科学第二講座
京都通信社 2019.7.8:121

百十五年の歴史と伝統

２）岡﨑貴裕全身性疾患/膠原病 ANCA 関連血管炎
今日の診療のためにガイドライン外来診療 2020 2020.3.24【麻酔科】
１）内野博之、大嶽浩司、小澤章子、倉橋清泰、櫻井 淳、森崎 浩
MCI の時に受傷者が来るのは大病院だけじゃない
多数傷病者事故への院内対応手引き
公益社団法人日本麻酔科学会 オリ･パラ MCI 委員会 2019 年 12 月

26
26

2019 年度学会発表【脳神経内科】
１）田中裕三、中村聖悟、深野宗之、本間 豊、溝口功一
頚髄領域の神経症状を伴い髄膜脳炎を来した zoter sine hepete の 1 例
第 239 回内科学会東海地方会 2019.10.6（岐阜）２）中村聖悟、本間 豊、深野宗之、田中裕三、溝口功一
高熱をきたし感染症との鑑別が混んであった Bickerstaff 脳幹脳炎の 43 歳男性例
第 155 回日本神経学会東海北陸地方会 2019.10.26（金沢）３）田中裕三、堀内公成、中村聖悟、深野宗之、本間 豊、溝口功一
運動ニューロン疾患といわれていた壊死性ミオパチーの 1 例
東部脳神経疾患研究会 2019.11.13（沼津）４）本間 豊、田中裕三、深野宗之、中村聖悟、堀内公成、溝口功一
視神経脊髄炎関連疾患について複数症例を比較して
沼津医師会臨床医学集談会 2020.1.25（沼津）５）本間 豊パーキンソン病の病態とその治療
三島市薬剤師会研修会 2020.1.28（三島）【消化器内科】
１）大西佳文、吉田有徳、榎澤哲司、宮原利行、小林慎二郎、角中野 浩、関戸康友、斎藤光次、近藤福雄
肝転移巣で NEC 分化を伴った肝門部領域胆管癌の 1 例
第 59 回肝癌症例検討会 2019.5.18（東京）泰廣、２）大西佳文、石田典仁、榎澤哲司、松田浩二、宮原利行、小林慎二郎、
角 泰廣、中野 浩、関戸康友、斎藤光次、近藤福雄
肝転移巣で MiNEN 分化を伴った肝門部領域肝管癌の 1 例
第 28 回東京胆道懇話会 2019.8.2（東京）３）石田典仁、大西佳文、榎澤哲司、松田浩二、石上雄太、宮原利行、
角 泰廣、中野 浩、山野三紀
検診内視鏡で指摘された胆嚢肉芽腫性 polyp の 1 切除例
第 56 回肝胆膵治療研究会 2019.8.17（東京）2727４）大西佳文、石田典仁、榎澤哲司、松田浩二、宮原利行、角 泰廣、
中野 浩、斎藤光次
肝転移巣で NEC 分化し興味深い画像を呈した肝門部領域胆管癌の 1 例
第 71 回日本消化器画像診断研究会 2019.9.20-21（和歌山）５）石田典仁、大西佳文、榎澤哲司、松田浩二、石上雄太、宮原利行、
角 泰廣、中野 浩、山野三紀、斎藤光次
検診内視鏡で指摘された胆のう結腸瘻の 1 例
第 71 回日本消化器画像診断研究会 2019.9.20-21（和歌山）６）大西佳文
胆管 NEC の分子発症機構の検討
第 535 回 GCRC 検討会 2019.11.21（清水町）
７）大西佳文
肝門部腫瘍と造影効果のある肝腫瘍の検討
第 5 回静岡県東部肝疾患カンファレンス 2020.1.9（沼津）８）大西佳文膵・消化管神経内分泌腫瘍症例
Meet the Expert Seminar in SHIZUOKA Prefecture.

2020.2.27（三島）【循環器内科】
１）小鹿野道雄、木村 慶、坪井一平、田邊 潤、岩崎雄樹、清水CRT 植込み後の最適化
第 23 回日本心不全学会学術集会 2019.10.4（広島）渉２）Michio Ogano, Ippei Tsuboi1, Kei Kimura1, Tomoko Ichikawa,
Keiko Sugimoto, Kazuya Kitoh, Yuji Mori, Yukiko Hirobata, Jun Tanabe.
The reason of heart failure hospitalization among patients with cardiac
resynchronization therapy.
第 23 回日本心不全学会学術集会 2019.10.4（広島）３）小鹿野道雄、坪井一平、田邊 潤、岩崎雄樹、清水 渉
頸静脈的ペースメーカー電池交換治のリードレスペースメーカー植え込みを選択する際の留意点
第 12 回植込みデバイス関連冬季大会 2020.2.6-8（名古屋）４）小鹿野道雄
超高齢者のデバイス選択
第 12 回植込みデバイス関連冬季大会

2020.2.6-8（名古屋）

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28

【外科】
１）高橋 啓、角 泰廣、松下恒久、宮原利行、石上雄太、小林慎二郎、
中野 浩
肝右 3 区域切除術を施行した巨大血管腫の 2 例
第 297 回東海外科学会 2019.4.7（名古屋）２）石上雄太、高橋 啓、宮原利行、松下恒久、角 泰廣、中野 浩
upside down stomach 型食道裂孔ヘルニアに対して腹腔鏡下修復術を行った 2 例
第 73 回日本食道学会総会 2019.6.6-7（福岡）３）高橋 啓、角 泰廣、松下恒久、宮原利行、石上雄太、小林慎二郎、
中野 浩
腹腔動脈起始部症候群に対し正中弓状靭帯切離を施行し切除し得た胆管癌 1 例
第 241 回静岡県外科医会集談会 2019.8.31（静岡）４）中野浩
静岡医療センターにおけるハワイ大学医学教育プログラムの実施による効果
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
５）高橋 啓、石上雄太、宮原利行、松下恒久、角 泰廣、小林慎二郎、
古畑智久、福島久喜、中野 浩
当院における外科診療体制
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
６）石上雄太、高橋 啓、宮原利行、松下恒久、福島久喜、角中野 浩
乳房部分切除後に発生した乳腺血管肉腫の 1 例
第 81 回日本臨床外科学会総会 2019.11.14-16（高知）泰廣、７）高橋 啓、石上雄太、宮原利行、松下恒久、角 泰廣、中野
魚骨迷入による肝膿瘍に対して外側区域切除術を施行した 1 例
第 81 回日本臨床外科学会総会 2019.11.14-16（高知）浩

８）松下恒久、石上雄太、高橋 啓、宮原利行、角 泰廣、中野
十二指腸 GIST に対して LECS を行った 1 例
第 81 回日本臨床外科学会総会 2019.11.14-16（高知）浩９）高橋 啓、石上雄太、宮原利行、松下恒久、角 泰廣、中野
腹腔鏡内視鏡合同手術を施行した十二指腸 GIST の 1 例
第 32 回日本内視鏡外科学会総会 2019.12.5-7（横浜）

浩

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29

【整形外科】
１）米津大貴、太田周介、土井孝信、加藤治朗、井村直哉、安間三四郎
整形外科勤務医の『働き方改革』の取り組み～400 床規模の地方二次救急病院の 1 例～
第 92 回日本整形外科学会学術総会 2019.5.9-12（横浜）２）Naoya Imura, Naoya Takada, Yasuhiro Katsuda, Kenji Ikuta, Shunta Hanaki .
Novel Endosteal Strut Technique Using A HA/PLLA Mesh Tube In Locking Plate
Fixation Of Proximal Humeral Fractures In The Elderly.
EFORT2019 2019.6.5-7（Lisbon）【心臓血管外科】
１）中島光貴、波里陽介、高木寿人、宮地 鑑
胸部下行大動脈人工血管置換術後、人工血管感染を併発し緊急 TEVAR 及び食道抜去に至った 1 症例
第 180 回日本胸部外科学会関東甲信越地方会 2019.6.8（東京）２）高木寿人
常識を疑え!自著メタ解析論文 250 編からの心臓外科エビデンス
第 79 回可茂循環器セミナー 2019.6.27（岐阜）３）中島光貴、波里陽介、高木寿人
NO 吸入療法における ICU 環境の安全性の検討
第 23 回日本医療ガス学会・学術大会・総会 2019.10.26（東京）４）中島光貴、波里陽介、高木寿人、宮地 鑑
プロタミンショック患者に対する２Debranch TEVAR を行い治療した 1 症例
第 181 回日本胸部外科学会関東甲信越地方会 2019.11.9（東京）５）中島光貴、波里陽介、高木寿人
高度肺高血圧症を伴う僧帽弁置換術の症例
第 13 回静岡東部心臓外科・循環器科連携の会

2020.2.14（沼津）６）中島光貴、波里陽介、高木寿人、宮地 鑑
大動脈解離術中に Malperfusion となり緊急での上行大動脈直接送血（サムライカ
ニュレーション）して手術を遂行した 1 症例
第 182 回日本胸部外科学会関東甲信越地方会 2020.3.7（紙上開催）

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【歯科】
１）新井俊弘頸部ガス産生性蜂窩織炎術後に脳梗塞を発症した 1 例
第 64 回日本口腔外科学会総会・学術大会 2019.10.25-27（北海道）【放射線科】
１）中嶋貴志、阿部彰子、一瀬あずさ、杉山 彰
放射線科医のかかわる医療用二酸化炭素：使用状況と安全性
第 55 回日本医学放射線学会秋季臨床大会 2019.10.18-19（名古屋）【麻酔科】
１）小澤章子
安全委員会企画：手術室・ICU 外での安全な鎮静（の管理体制）をどう構築するか？
循環器科医が喉頭上エアウエイと静脈麻酔薬を用いて深鎮静を行っている～我々は、未来に向けて、今、何をすべきか～
日本麻酔科学会第 66 回学術集会 2019.6.1（神戸）２）今津康弘、小澤章子
側臥位麻酔導入により片側性の誤嚥性肺炎に留まった症例
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）３）小澤章子、今津康弘
声門上器具で救命できた挿管困難・換気困難事例
第 3 回気道管理学会学術集会 2020.1.18（東京）４）小澤章子救急救命士気管挿管実習-気管挿管実習から気道管理実習へ
第 3 回気道管理学会学術集会 2020.1.18（東京）５）小澤章子パネル討論会:Rapid Response System の導入と実践（普及を妨げているのは何か？）
第 6 回日本医療安全学会学術集会 2020.3.8-9（東京）【研修医】
１）黒坂洋平、安藤貴泰、岡﨑貴裕
好酸球増多症を認めた寒冷凝集素症の 1 例
日本内科学会第 238 回東海地方会 2019.5.26（愛知）3131２）上原慶大、澁谷淳介、石原 翔、木村 慶、坪井一平、田尻正治、
川中秀和、小鹿野道雄、田邊 潤
中間枝が責任病変の急性心筋梗塞に対して経皮的冠動脈形成術後に全乳頭筋断裂をきたした 1 例
日本内科学会 239 回東海地方会 2019.10.6（岐阜）３）石井宏和、宮原利行、石上雄太、高橋 啓、松下恒久、角中野 浩、波里陽介、中島光貴、高木寿人
血行再建を行った腹部アンギーナの 1 例
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）泰廣、４）神野恭輔、一瀬あずさ、小鹿野道雄、阿部彰子、中嶋貴志、杉山 彰、
田邊 潤
The usefulness of monitoring steroid response by 67Ga scintigraphy for a patient withcardiac sarcoidosis.
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
５）Yohei Kurosaka,Shoko Abe,Tomonori Maehara,Masaharu Tajiri.
Three cases of Kounis syndrome induced by contrast medium.
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
６）黒坂洋平、松下恒久、角 泰廣、宮原利行、高橋 啓、石上雄太、
鶴田統久、中野 浩
最近経験した内科疾患に合併した上部消化器癌の 2 例
第 100 回沼津医師会臨床医学集談会 2020.1.25（沼津）７）小久保亮、一瀬あずさ、中嶋貴志、清水敦夫、阿部彰子、杉山
高橋 啓、角 泰廣、山野三紀
炎症性偽腫瘍から急速に浸潤発育した肝放線菌症の 1 例
日本医学放射線学会第 167 回中部地方会 2020.2.16（名古屋）

彰、

【病理】
１）山野三紀胆管腫瘍栓を伴う転移性肝腫瘍もしくは原発性肝癌が疑われた肝腫瘍の 1 例
第 276 回静岡県病理医会（SPS）2019.8.31（静岡）
２）山野三紀、中野 浩、高橋 啓、小林愼二郎、宮原利行、角 泰廣、
鶴田統久、大西佳文、阿部彰子、松下恒久
胆管癌と術前診断された、胆嚢原発 Adenocarcinoma with enteroblastic
differentiation of Gallbladder
第 65 回日本病理学会 秋期特別総会 2019.11.7-8（つくば）3232

【JNP】
１）瀧波典子、松山伴子、新井亜弥子、井上淳子、岡崎貴裕
当院における診療看護師（JNP:Japanese Nurse Practitioner）の位置づけと活動
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）【薬剤部】
１）田代 匠、内野達宏、柴田晋弥、滝 久司、高木 亮
当院におけるプレアボイド報告事例と 副作用救済制度への薬剤師のかかわり
静岡県病院薬剤師会東部支部例会 2019.4.18（三島）２）上田真也、彦坂麻美
抗菌薬適正使用支援チーム(AST)活動におけるプロセス指標への影響
第 67 回日本化学療法学会総会 2019.5.9（東京）３）田代 匠、内野達宏、柴田晋弥、滝 久司、高木
副作用救済制度への薬剤師のかかわり
第 14 回東海北陸薬剤師会総会 2019.6.16（掛川）亮

４）上田真也
開胸術後に発症した縦隔炎･腸腰筋膿瘍に対する抗菌化学療法について考える第 32 回東海地区感染制御研究会 抗菌薬セミナーAdvanced Course
2019.6.30（浜松）５）上田真也
抗菌薬と AMR
国立病院機構東海北陸ブロックチーム医療研修会《感染》2019.10.25（名古屋）
６）田代 匠、内野達宏、柴田晋弥、滝 久司、高木
当院におけるプレアボイド報告事例と副作用報告事例
第 29 回日本医療薬学会年会 2019.11.3（福岡）亮

７）稲葉真実、彦坂麻美 、田代 匠、市川竜太郎、鬼木紘美、滝髙木 亮
がん化学療法における HBV 再活性化対策に関する検討
第 29 回日本医療薬学会年会 2019.11.3（福岡）８）薄 雅人中堅薬剤師教育～ 育てる人を育てる ～第 73 回国立病院総合医学会 2019.11.8-9（名古屋）

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33

久司、

９）上田真也、木村 慶、彦坂麻美、前田奈緒子、木山有紀、滝 久司、
高木 亮、岡崎貴裕
抗菌薬適正使用支援チーム(AST)活動におけるプロセス指標の変化
第 74 回国立病院総合医学会 2019.11.8-9（名古屋）
１０）無藤大地、内野達宏、滝 久司
トレーシングレポートを活用した医療情報共有について
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
１１）市川竜太郎、深見和宏、滝 久司、髙木 亮
ジゴキシン血中濃度上昇に関する背景因子の検討
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
１２）滝 久司
東海地区感染制御ネットワークによる抗菌薬適正使用に向けた情報の発信と多施設共同研究活動
第 3 回薬剤耐性（AMR)対策普及啓発活動表彰 2019.11.9（東京）１３）上田真也
中規模市中病院における AST 活動と評価
日本病院薬剤師会東海ブロック・日本病院薬剤師会東海支部合同学術大 2019
専門薬剤師シンポジウム（感染） 2019.11.10（名古屋）
１４）無藤大地、内野達宏、滝 久司
薬薬連携による医療情報共有について
第 31 回静岡県病院薬剤師会学術大会 2020.2.9（静岡）１５）上田真也、木村 慶、鬼木紘美、岡崎貴裕
抗菌薬適正使用支援チーム（AST）活動による院内抗菌化学療法への影響
第 35 回日本環境感染学会総会・学術集会 2020.2.14（横浜）
１６）上田真也
感染チームについて
令和元年度 NHO 東海北陸グループ主催多職種合同就職説明会
2020.3.14（名古屋）【中央放射線室】
１）安田英邦、河本沙織、荒木大輝、渡邊祥弘
Hyperecho による画像特性の検討 sar による検査時間延長を改善
令和元年度 東海北陸地区放射線技師会学術大会 2019.10.5（名古屋）3434２）岡田ちさき、瀬古由紀枝、渡邊祥弘
両股関節単純Ｘ線画像上における金属マーカのサイズ誤差の検討
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）３）安田英邦、河本沙織、荒木大輝、渡邊祥弘
Hyperecho による画像特性の検討 sar による検査時間延長を改善
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）４）千葉雄平、棚瀬真伸、松原健一、酒井一成
2 社のワークステーションによる CT サブストラックションの比較検討
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）【リハビリテーション科】
１）Michitaka Kato, Ogano Michio, Yuji Mori, Kaito Kochi, Daisuke Morimoto,Kazuya Kito, Seina Kadotani, Akira Kubo, Jun Tanabe.
Effects of cardiac rehabilitation on cardiac and physical function in patients treated withcatheter ablation for persistent atrial fibrillation.
World Confederation Physical Therapy (WCPT) Congress 2019.
2019.5.10-13（Geneve）
２）松永 香、町田ゆり子、森 雄司、竹下直紀、森 勝俊、加藤治朗、
髙瀬三貴子、太田周介
運動器不安定症の高齢者に対する外来運動療法の効果
第 56 回日本リハビリテーション医学会学術集会 2019.6.13（神戸）３）野末あずみ、加藤華奈美、高瀬三貴子、本間 豊
筋萎縮性側索硬化症（ALS）患者にスイッチと視線を併用して操作が可能な
miyasuku EyeConSW(miyasuku)の導入を試みて第 36 回東海北陸神経筋ネットワーク研究会プログラム 2019.6.14（浜松）４）Michitaka Kato, Michio Ogano, Yuji Mori, Kaito Kochi, Daisuke Morimoto,Kazuya Kito, Yayoi Fukutomi, Toshiya Tsukamoto, Yasunari Kurita, Akira Kubo,
Jun Tanabe.
Asia PRevent 2019 "Safety and efficacy of exercise training in patients treated withcatheter ablation for persistent atrial fibrillation. 2019.7.13-14（大阪）
５）鬼頭和也、光地海人、渡辺大輔、小野田博繁、藤山啓太、戸田真弘、
森 雄司、加藤倫卓
手段的日常生活動作が低下する入院心不全患者の特徴と臨床的経過
第 4 回日本心血管理学療法学会学術集会 2019.9.13（宜野湾）3535６）鬼頭和也、小鹿野道雄、森 雄司、市川智子、廣畠佑希子、加藤倫卓、
田邊 潤
入院初日より心臓リハビリテーション処方を行った心不全患者に対する効果
第 23 回日本心不全学会学術集会 2019.10.4（広島）７）森 元気パーキンソン病のリハビリテーションについて
パーキンソン友の会 市民公開講座 2019.10.6（三島）８）野末あずみ、加藤華奈美、高瀬三貴子、本間 豊
miyasuku EyeConSW(miyasuku)の導入を試みて～筋萎縮性側索硬化症(ALS)患者
2 症例の操作方法選択～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）９）森 元気、濵 貴之、加藤華奈美、高瀬三貴子、溝口功一
当院の神経難病患者に対する排痰補助機器、排痰手技の使用状況の振り返り
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）【栄養管理室】
１）丹羽正人ペプタメンスタンダードへの移行によりみえた栄養評価指標の変動
ネスレ栄養マネージメントセミナー ～栄養の価値を最大化するための手法～
2019.4.6（名古屋）２）丹羽正人ペプタメンスタンダードへの移行によりみえた栄養評価指標の変動
東海道栄養ケアセミナー第 10 回記念大会 2019.4.13（小田原）３）廣畠佑希子、小鹿野道雄、丹羽正人、市川智子、森 雄司、鬼頭和也、
田邊 潤
入院時における CONUT 法により低栄養と判定された心不全患者の特徴
第 23 回日本心不全学会学術集会 2019.10.4（広島）４）奥野愛美、田中雄太郎、小池恭子、廣畠佑希子、丹羽正人、平田病院統合における当院の変遷と見えてきた課題
第 12 回東海北陸国立病院栄養研究会 2019.10.5（名古屋）守５）廣畠佑希子、奥野愛美、小池恭子、丹羽正人、田中雄太郎、平田 守
当院における 60 歳以上の循環器疾患患者へ「ふじのくにお塩のとりかたチェック」を用いた減塩指導の取り組み
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）3636６）小池恭子、丹羽正人、 田中雄太郎、 廣畠佑希子、 奥野愛美、平田 守
化学療法・放射線療法施行患者の料理別における嗅覚障害についての調査
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）【看護部】
１）市川智子、小鹿野道雄、田邊 潤、鬼頭和也、森 雄司、廣畠佑希子、塩川幸子
認知症併発の高齢心不全患者に対するシームレスな医療チーム介入の重要性
第 23 回日本心不全学会学術集会 2019.10.4（広島）２）市川智子、高田充美、小笠原由紀、山口 学、水島 藍、宮尾真奈美、
松原弘子
心不全患者の意思決定を支えるために～領域・分野を超えて考えよう～
第 16 回日本循環器看護学会学術集会 2019.11.2（東京）３）井上淳子臨床の声：これからの看護基礎教育に望むこと
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
４）高橋登茂様々なハイリスク薬品の エラー防止に向けた当院の取り組み～薬剤師を中心としたエラー防止と検出～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
５）伊藤誉子、横地早苗
NPPV による治療継続のための看護介入を目指して～過去の診療録の状況調査～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
６）荒井依子、秋山麻有実、川野紗香、市川智子、西家あや子
心不全患者の退院支援における看護師の役割～アンケートによる実態調査～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
７）石原 匠 、加藤 潤、伊東幸子、藤田 彩、大津亜子、池田朋子、
勝又文子
3 交代勤務から 2 交代勤務へ移行後、アロマセラピーを導入した際の効果について第 73 回国立病院総合医学会 2019.11.8-9（名古屋）3737８）梅原朋世、高橋典子、秋山由佳、横山由香
手術室看護師の抱えるストレスについて
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）９）小川明子、遠藤都香
患者のストレスが軽減できる車いす移送の速度の検討
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
１０）塩川幸子、本多麻里子、内田美子、榮永奈美
急性期病院における病棟内カフェの取り組み報告
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
１１）井上淳子
勤務環境改善と医療事防止～安全と満足につながる看護体制の見直し～
2019 年度医療安全管理シンポジウム（勤務環境安全推進研修）
2020.1.23（沼津）【看護学校】
１）太田郁子
難病を看る人材の育成
第 73 回国立病院総合医学会

2019.11.8-9（名古屋）２）内田ゆかり、山口紀子、青木里香、橋爪さち代、大野澄子、濱中陽子
臨床看護総論「主要症状を示す疾患の看護（痛み）」授業案作成～単元考察から教材構造図までを検討して～第 73 回国立病院総合医学会 2019.11.8-9（名古屋）３）笠原幸代、本多利枝、海野朋美、伊藤千穂、青木裕子、篠田和佐
基礎看護教育における一時的吸引の教授方法の検討～呼吸を整える技術としての一時吸引～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）４）増田知惠、長谷部理沙、津田朋恵、伊藤みさと、谷屋千秋、村井紀子
主体的に学び看護実践につなげる看護過程の教授方法
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
５）川瀬美幸、三輪満貴代、谷優美子、宮野幸子、土屋美智子、櫻井賀奈恵
基礎看護学領域における看護過程の教育方法～問題に気付く力を育てるためには～第 73 回国立病院総合医学会 2019.11.8-9（名古屋）38６）西川貴浩、金田 瞳、松井ねむ、鈴木ひづる、内田美和子、植村奈緒子、
安井千枝
生活者の視点に着目した経過別看護の授業案考察
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
７）横山啓子、粥川由佳、吉田裕子、瀬分 亮、池田真弓、斎藤文子、
三浦美和子「医療モデル」から「生活モデル」へのてんかんを見据えた臨床看護総論における教材研究～健康モデルを連続体としてとらえるために～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
８）北道夕貴子、三田地泉美、坂本泰子、小西千恵子、荻澤英幸、
佐々木つかさ、渡會涼子
看護におけるコミュニケーション技術習得に向けて～リフレクションの活用に向けた演習計画の実践～
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）【検査科】
１）井上彩李、岩崎 顕、長倉千恵子、深谷昌利、山野三紀、木村
田邊 潤
心室中隔に発生した左室粘液腫の 1 例
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）２）岸田昌也、深谷昌利、仁科正樹、大森健彦、柘植 仁
生化学検査における「外部精度管理事前チェック表」を用いて第 73 回国立病院総合医学会 2019.11.8-9（名古屋）【療育指導科】
１）市野清美、秋山重美、中島久弥、溝口功一、桑原啓吏
前頭部扁平上皮癌を発症した脳性麻痺患者に個別療育を試みて
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）
２）土屋早紀、桑原啓吏、溝口功一
病院機能移転後の静岡医療センターの短期入所の現状
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）３）長谷川直美、土屋早紀、桑原啓吏、溝口功一
担当者会議を経て通所利用の増加につながった 1 例
第 73 回国立病院総合医学会 2019.11.8-9（名古屋）

39
39

慶、

2019 年度講演【内科】
１）岡崎貴裕リウマチ因子の読み方
平成 31 年度第 1 回三島市医師会講演会

2019.4.12（三島）２）岡崎貴裕大型血管炎の診断と治療について
LVV 学術セミナー 2019.7.10（浜松）３）岡崎貴裕全身性エリテマトーデスを理解するために
静岡市保健所難病医療講演会 2019.10.26（静岡市）【脳神経内科】
１）本間 豊神経難病と上手に付き合う
難病医療講演会 2019.12.7（御殿場）【消化器内科】
１）大西佳文細胆管細胞癌の症例における考察
第 5 回静岡県東部肝疾患カンファレンス

2020.1.9（沼津）【心臓血管外科】
１）高木寿人
常識を疑え!自著メタ解析論文 250 編からの心臓血管外科エビデンス
第 79 回可茂循環器セミナー 2019.6.27（美濃加茂）【麻酔科】
１）小澤章子リレー講演：ガイドライン 2020 を探る
手術室外での鎮静ガイドライン「日本の院内鎮静事故ゼロ」を目指そう
日本蘇生学会第 38 回大会 2019.11.15（長崎）4040

２）小澤章子
基調講演：令和時代を豊かに勝ち抜く勤務医とは
キャリア支援シンポジウム「医師として働く未来を考えよう」
浜松医科大学女性医師支援センター/静岡県医師会/ふじのくに女性医師支援センター 2019.12.14（静岡）【放射線科】
１）阿部彰子Parkinson 病と関連疾患における画像検査の有用性
Takeda Neurology Seminar 2019.5.28（沼津）２）阿部彰子放射線科医のかかわる医療用二酸化炭素：使用状況と安全性
第 23 回日本医療ガス学会学術大会・総会 2019.10.26（東京）4141発表論文集

原著ならびに症例報告の原文抄録を掲載しました。

43

Am J Surg Pathol. 2019 Sep;43(9):1212-1220. doi: 10.1097/PAS.0000000000001295.

The Pathologic and Genetic
Characteristics of the Intestinal
Subtype of Intraductal Papillary
Neoplasms of the Bile Duct
Yasuni Nakanuma 1 , Yuko Kakuda 1 , Yuki Fukumura 2 , Takashi
Sugino 1 , Katsuhiko Uesaka 3 , Masakuni Serizawa 4 , Takuro Terada 5 , Yoshifumi
Ohnishi 6
Affiliations Expand
PMID: 31166202 DOI: 10.1097/PAS.0000000000001295

Abstract

The present study aimed to identify the pathologic and genetic characteristics ofintestinal subtype of intraductal papillary neoplasm of the bile duct (iIPNB)
showing columnar cells with pseudostratified, cigar-shaped nuclei, and basophilic
or amphophilic cytoplasm with the diffuse immunohistochemical expression of
CK20 and/or CDX2. A total of 34 cases of iIPNB were pathologically examinedaccording to their anatomic location (the bile duct) and were then compared with
the intestinal subtype of intraductal papillary mucinous neoplasm (iIPMN) of thepancreas (n=22). Mutations of 26 somatic genes were examined in formalin-fixedparaffin-embedded tissue specimens from 21 cases of iIPNB using the TruSight
Tumor 26 gene panel and next-generation sequencing. iIPNB cases were divided
into intrahepatic (n=6) and extrahepatic (n=28) categories. Intrahepatic IPNBs
showed a less-complicated villous-papillary pattern, while extrahepatic IPNBs
showed a papillary pattern with tubular and/or villous components andpredominant high-grade dysplasia with complicated architectures. MUC5AC was

Eur J Prev Cardiol . 2019 Dec;26(18):1931-1940. doi: 10.1177/2047487319859974. Epub
2019 Jul 5.

44

医療従事者向け

CHF-B290 を用いた経口胆道鏡診断の実際と愛護的な操作方法のコツ

独立行政法人国立病院機構 静岡医療センター

消化器内科部長

大西 佳文 先生
新型経口胆道鏡 CHF-B290 は従来品 CHF-B260 と比較し、近点画質が強化され、血管の明瞭性が向上した。

CHF-B290 を用い胆道粘膜を直視下に評価することで、胆道内病変をより正確に診断することが可能となった。
当院では愛護的な操作方法により、新型経口胆道鏡を長期間使用することができている。そこで今回、手技のポイントと愛護的な操作方法のコツを紹介する。

愛護的な操作方法

1）前処置
主乳頭（以下、乳頭）の処置としては、内視鏡的乳頭切開術（EST:Endoscopic sphincterotomy）で中切開を行った後に結石除去用バルーンを用い、乳頭開口部を大切開と同程度に拡張する（図1a）。バルーンを拡張したまま、胆管内から外へ 2～ 3 回掻き出す操作を行い、バルーンが滞りなく可動し十二指腸へ排出することを確認する。
乳頭開口部を拡張する理由は、①胆道内でのベビースコープ（CHFB290）の可動性を良好にする ②胆道内洗浄による胆道内圧の上昇を抑える ③胆道内観察において、左右前後方向の広視野観察を可能にし、乳頭部近傍での観察を容易にするためである。乳頭とベビー
スコープに肉眼的な隙間（図1b）を生じる程度が適切で、胆管内を生理食塩水で洗浄した際に、乳頭開口部から生理食塩水が漏れ出る程度に乳頭処置を行う。流水が漏れ出ない場合には胆管内圧が上昇し胆管炎が問題となるし、過度な乳頭拡張を行った場合には出血や穿孔に繋がる（憩室内乳頭開口や傍乳頭憩室開口）ため、ともに注
図1a: 結石除去用バルーンによ 図1b: 乳頭とベビースコープの意が必要である。
る乳頭拡張
隙間2）挿入手技
基本的には、
ガイドワイヤー 0.025Inch を用いて挿入する。ベビースコープをガイドワイヤーに追従させ、
マザースコープ（TJF）の鉗子口に挿入する。その際、潤滑剤をマザースコープの鉗子口内に注入するか、ベビースコープの湾曲部に潤滑剤
260Vを十分塗布してマザースコープへ挿入する。ベビースコープをマザースコープの鉗子口内へ進める際に注意すべき点は、短いストロークで小刻みに押し進めていくことである。長いストロークで進める場合、押し込む力が効率よく伝達できず、不均衡な力の加重によりベビースコープの蛇管が座屈する可能性がある。地道ではあるが、焦らず同じ動作を小刻みに繰り返すことが、
ベビースコープの愛護的な取り扱いとして重要である。 マザースコープ内から鉗子チャンネルの外へ出す操作としては、
マザースコープの鉗子レバーを UP 方向にロックし、鉗子台にベビースコープが軽く突き当たるところで、鉗子レバーをフリーにし、ベビースコープを 2cm 程度押し出す（図2a）。マザースコープの UP アングルを使用し、乳頭開口部になるべく近接し、頭側に見上げるように、胆管内へガイドワイヤー誘導下で押し進めながら挿入する（図2b）。その際、鉗子台を使いながら、安易にベビースコープを胆道内へ推し進めるとベビースコープの故障に繋がるため、注意が必要である。つまり、鉗子台の起上は全可動の 6 分の1 までとし、マザースコープを水平にした場合 30°～ 60°までの起上に留めるべきである。ただし、鉗子起上装置を使わずに挿入が可能であれば、ベビースコープに負荷は掛けない。CHF-B290 の湾曲部は、
従来の CHF-B260 と比較して、ゴム厚を約 2 倍にする事で耐久性を向上させたが、デリケートである事に変わりはない為、以前と同様に愛護的な操作を行う事が最善である。当院では、CHF- Y0012（プロトタイプ）による 142 例の使用まで破損なく使用可能であったことか
図2a: ベビースコープを2㎝程度 図2b: 乳頭開口部に近接し見上押し出すげる。鉗子起上台ではなく、マら、CHF-B290 は愛護的な操作により長期間の使用が可能で、従来のザースコープのUPアングルのCHF-B260 と比較しても耐久性は向上したといえる。
みを使用する45

Exercise-based Cardiac Rehabilitation for
Patients With Catheter Ablation for PersistentAtrialFibrillation: A Randomized Controlled
Clinical Trial
Michitaka Kato 1 , Michio Ogano 2 , Yuji Mori 3 , Kaito Kochi 3 , Daisuke
Morimoto 3 , Kazuya Kito 3 , Fumi Nihei Green 4 , Toshiya Tsukamoto 1 , Akira
Kubo 1 , Hisato Takagi 5 , Jun Tanabe 2
PMID: 31272205 DOI: 10.1177/2047487319859974
Item in Clipboard
Abstract
Aims: The efficacy and safety of cardiac rehabilitation for patients with persistent atrial
fibrillation who restored sinus rhythm after catheter ablation remains unclear. The aim of thepresent study was to evaluate the effects of cardiac rehabilitation on exercise capacity,
inflammatory status, cardiac function, and safety in patients with persistent atrial fibrillation
who had catheter ablation.
Methods: In this randomized controlled study, 61 patients treated with catheter ablation for
persistent atrial fibrillation (male, 80%; mean age, 66 ± 9 years) were analyzed. Thirtypatients underwent cardiac rehabilitation (rehabilitation group), whereas the remaining 31
patients received usual care (usual care group). The rehabilitation group underwent
endurance and resistance training with moderate intensity, at least three times per week forsix months. Six-minute walk distance, muscle strength, serum high-sensitivity C-reactive
protein, plasma pentraxin 3, left ventricular ejection fraction and atrial fibrillation recurrence
were assessed at baseline and at six-month follow-up.
Results: In the rehabilitation group, significant increases in the six-minute walk distance,
handgrip strength, leg strength and left ventricular ejection fraction and significant decreases
in high-sensitivity C-reactive protein and plasma pentraxin 3 concentrations were observed

at six-month follow-up compared with baseline (all p < 0.05). No significant changes wereobserved in the usual care group. During the six-month follow-up period, the number ofpatients with atrial fibrillation recurrence was six (21.4%) in the rehabilitation group andeight (25.8%) in the usual care group (risk ratio, 0.83; 95% confidence interval, 0.33 to 2.10).

46

47

48

Original article

Meta-analysis of impact of liver disease on mortality after
transcatheter aortic valve implantation

Hisato Takagia,b, Yosuke Haria,b, Norikazu Kawaia, Toshiki Kunoc,
Tomo Andod, for the ALICE (All-Literature Investigation of
Cardiovascular Evidence) GroupTAVI patients, and no statistically significant difference in inhospital mortality between TAVI and SAVR in patients withcirrhosis (RR 0.60, P U 0.12).

Aims To evaluate whether liver disease is associated withincreased mortality after transcatheter aortic valve
implantation (TAVI) and whether TAVI is associated withdecreased mortality compared to surgical aortic valve
replacement (SAVR) in patients with liver disease, we
performed meta-analyses of currently available studies.

Conclusion There may be no impact of liver disease on
early mortality in TAVI patients, negative impact of liverdisease on mid-term mortality in TAVI patients, and nodifference in in-hospital mortality between TAVI and SAVR inpatients with liver cirrhosis.

Methods Studies reporting mortality in TAVI patients withliver disease versus those without liver disease andmortality after TAVI versus SAVR in patients with liverdisease were eligible to be included. A relative risk (RR) or
hazard ratio of mortality for TAVI patients with versus
without liver disease and mortality for TAVI versus SAVR inpatients with liver disease was extracted from eachindividual study. Study-specific estimates were combined in
the random-effects model.

J Cardiovasc Med 2019, 20:237–244
Keywords: cirrhosis, liver disease, meta-analysis, mortality, surgical aortic
valve replacement, transcatheter aortic valve implantationa

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka,
Department of Cardiovascular Surgery, Kitasato University School of Medicine,
Sagamihara, Japan, cDepartment of Medicine, Mount Sinai Beth Israel Medical
Center, New York, New York and dDepartment of Cardiology, Detroit Medical
Center, Detroit, Michigan, USAb

Results We identified nine studies of TAVI patients withversus without liver disease and four studies of TAVI versus
SAVR in patients with liver cirrhosis. Pooled analyses
demonstrated no association of liver disease with early (inhospital/30-day) mortality (P U 0.28), but a statisticallysignificant association of liver disease with increases midterm (1–2-year) mortality (hazard ratio 1.87, P < 0.00001) inCorrespondence to Hisato Takagi, MD, PhD, Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,Shizuoka 411-8611, Japan
E-mail: kfgth973@ybb.ne.jp
Received 2 October 2018 Revised 14 November 2018
Accepted 14 December 2018

Introduction

article, to evaluate whether liver disease is associated withincreased mortality after TAVI and whether TAVI isassociated with decreased mortality compared with SAVR
in patients with liver disease, we performed meta-analysesof currently available studies.

Liver dysfunction adversely affects outcomes of open
heart surgery such as coronary artery bypass grafting(CABG) and valvular surgery even in an elective situation.1
In patients with liver cirrhosis compared with those without cirrhosis undergoing open heart surgery, outcomessuch as mortality and readmission for reasons of hepaticor cardiac failure are poorer, and a tendency toward liverrelated mortality (predominantly due to hepatocellular
carcinoma) is still higher even after successful heart surgery.2 Also in patients undergoing surgical aortic valve
replacement (SAVR), cirrhosis brings about increased
mortality, complications, length of stay, and cost,3 whereas,in patients with mild to moderate chronic liver disease
undergoing transapical (TA) and transfemoral (TF) transcatheter aortic valve implantation (TAVI), postprocedural
complication rates are low and late complication rates are
acceptable.4 Even in candidates with cirrhosis for hepatictransplantation, TAVI may be considered a valid alternative treatment.5 However, it remains unclear how liverdisease plays a negative role in TAVI. In the present

Methods
We identified all studies evaluating the impact of liverdisease including cirrhosis on mortality after TAVI andcomparing mortality after TAVI versus SAVR in patientswith liver disease by means of the following two-levelsearch strategy. First, we searched databases (MEDLINE, EMBASE, and the Cochrane Central Registerof Controlled Trials) through July 2018 by use of Webbased search engines (PubMed and OVID). We used thefollowing search terms: percutaneous, transcatheter,transluminal, transarterial, transapical, transaortic, transcarotid, transaxillary, transsubclavian, transiliac, transfemoral, or transiliofemoral; aortic valve; liver or hepatic;
and disease, diseases, dysfunction, failure, insufficiency,
or cirrhosis. Second, to identify relevant studies, we

1558-2027  2019 Italian Federation of Cardiology - I.F.C. All rights reserved.

DOI:10.2459/JCM.0000000000000777© 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.
49

Received: 2 July 2018

Revised: 3 September 2018

Accepted: 8 October 2018

DOI: 10.1002/ccd.27948

ORIGINAL STUDIES

Impact of concurrent tricuspid regurgitation on mortality after
transcatheter aortic-valve implantation
Hisato Takagi MD, PhD1,2| Yosuke Hari MD1,2 | Norikazu Kawai MD, PhD1 |Tomo Ando MD3 | for the ALICE (All-Literature Investigation of Cardiovascular Evidence)Group
1

Department of Cardiovascular Surgery,Shizuoka Medical Center, Shizuoka, Japan

Abstract

2

Objectives: To determine whether concomitant tricuspid regurgitation (TR) is associated with

Department of Cardiovascular Surgery,
Kitasato University School of Medicine,
Sagamihara, Japan3

Department of Cardiology, Detroit Medical
Center, Detroit, Michigan
Correspondence
Hisato Takagi, MD, PhD, Department of
Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Suntogun, Shizuoka 411-8611, Japan.
Email: kfgth973@ybb.ne.jp

increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aorticvalve implantation (TAVI), we performed a meta-analysis of currently available studies.
Methods: MEDLINE and EMBASE were searched through May 2018. We included comparative
or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in-hospital or
30-day) and late (including early) all-cause mortality in patients stratified by baseline TR grade.
An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for
significant versus non-significant (typically, ≥moderate versus <moderate) TR was extracted.
Study-specific estimates were combined in the random-effects model.
Results: Our search identified 12 eligible studies enrolling a total of 41,485 TAVI patients. The
meta-analysis for early mortality combining 3 ORs demonstrated a significant 1.80-fold increasein mortality with significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary metaanalysis for midterm (6-month to 30-month) mortality combining all the 12 HRs/ORs indicated asignificant 1.96-fold increase in mortality (HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The
secondary meta-analysis for midterm mortality combining 7 homogeneous HRs (adjusted HRsfor ≥moderate versus <moderate TR) showed a significant 2.25-fold increase in mortality (HR,2.25; 95% CI, 1.20–4.24; P = 0.01).
Conclusions: Concurrent significant (typically, ≥moderate) TR is associated with an approximately
two-fold increase in both early and midterm all-cause mortality in patients with AS undergoing TAVI.
KEYWORDS

meta-analysis, mortality, transcatheter aortic valve implantation, tricuspid regurgitation

1 | I N T RO D UC TI O N

predictor of midterm (1- to 2-year) mortality in patients undergoing
TAVI, association of concurrent TR with mortality after TAVI remains

Several meta-analyses1–4 suggest that concurrent ≥moderate mitral

unclear. In the present article, to determine whether concomitant TR

regurgitation (MR) is associated with increased early and late mortality

is associated with increased mortality in patients with AS undergoingin patients with severe aortic stenosis (AS) undergoing transcatheter

TAVI, we performed a meta-analysis of currently available studies.

aortic-valve implantation (TAVI), though a trend toward decreased
MR grade is identified4 and MR severity is significantly improved inhalf of patients after TAVI2. Impact of concomitant tricuspid regurgita-

2 | M A T E R I A L S A N D M ET H O D Stion (TR) on mortality after TAVI, however, has been less investigated.
Although only a meta-analysis5 of three studies including a total of

All studies which investigated impact of concurrent TR on mortality in

1,328 patients suggests that coexisting ≥moderate TR may be apatients with AS undergoing TAVI were identified using a two-level946© 2018 Wiley Periodicals, Inc.

wileyonlinelibrary.com/journal/ccd

50

Catheter Cardiovasc Interv. 2019;93:946–953.

Original Cardiovascular

243

Meta-analysis of Valve-in-Valve Transcatheter
versus Redo Surgical Aortic Valve Replacement
Hisato Takagi1

Shohei Mitta1

Tomo Ando2

1 Department of Cardiovascular Surgery, Shizuoka Medical Center,Shizuoka, Japan
2 Department of Cardiology, Detroit Medical Center, Detroit, United States

Address for correspondence Hisato Takagi, MD, PhD, Department of
Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa,
Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan(e-mail: kfgth973@ybb.ne.jp).

Abstract

Keywords► degenerated aortic
valve bioprostheses► meta-analysis► redo surgical aortic
valve replacement► valve-in-valve
transcatheter aortic
valve implantation

Objective The objective of this study was to determine whether valve-in-valve
transcatheter aortic valve implantation (VIV-TAVI) is associated with better survival
than redo surgical aortic valve replacement (SAVR) in patients with degenerated aortic
valve bioprostheses, and we performed a meta-analysis of comparative studies.
Methods To identify all comparative studies of VIV-TAVI versus redo SAVR; MEDLINE,
Embase, and the Cochrane Central Register of Controlled Trials were searched throughOctober 2017. For each study, data regarding all-cause mortality in both the VIV-TAVI
and redo SAVR groups were used to generate odds ratios (ORs). To assess selection
bias, we generated ORs and (standardized) mean differences (MDs) for baselinecharacteristics. Study-speciﬁc estimates were combined in the random-effects model.
Results Of 446 potentially relevant articles screened initially, 6 reports of retrospective comparative studies enrolling a total of 498 patients were identiﬁed. Pooled
analyses of baseline characteristics demonstrated no statistically signiﬁcant differences in the proportion of women, patients with diabetes mellitus, patients withcoronary artery disease, and patients with baseline New York Heart Association
functional class of III; baseline ejection fraction; and predicted mortality between
the VIV-TAVI and redo SAVR groups. Patients in the VIV-TAVI group, however, weresigniﬁcantly older (MD, 4.20 years) and had undergone prior coronary artery bypass
grafting more frequently (OR, 2.19) than those in the redo SAVR group. Main pooled
analyses demonstrated no statistically signiﬁcant differences in early (30 days or inhospital) (OR, 0.91; p ¼ 0.83) and midterm (180 days–3 years) all-cause mortalities(OR, 1.42; p ¼ 0.21) between the VIV-TAVI and redo SAVR groups.
Conclusion In patients with degenerated aortic valve bioprostheses, especiallyelderly or high-risk patients, VIV-TAVI could be a safe, feasible alternative to redo
SAVR. The lack of randomized data and differences in baseline characteristics in thepresent analysis emphasize the need for prospective randomized trials.

Introduction
The use of valve-in-valve (VIV) transcatheter aortic valve
implantation (TAVI) (VIV-TAVI) for the treatment of high-riskpatients with degenerated aortic bioprostheses is associatedwith relatively low rates of mortality and major complica-

received
February 15, 2018
accepted after revision
July 2, 2018
published online
August 16, 2018

tions, improved hemodynamics and excellent improvementin functional and quality of life outcomes at 1 year,1 whereas
redo surgical aortic valve replacement (SAVR) is now performed with acceptable operative mortality of 4.6%.2
Although mortality and morbidity are high compared withprimary SAVR, the rates of stroke, vascular complications,© 2019 Georg Thieme Verlag KG
Stuttgart · New York51

DOI https://doi.org/
10.1055/s-0038-1668135.
ISSN 0171-6425.

Downloaded by: Icahn School of Medicine at Mount Sinai. Copyrighted material.

Thorac Cardiovasc Surg 2019;67:243–250.

Journal of Cardiology 74 (2019) 40–48

Contents lists available at ScienceDirect

Journal of Cardiology
journal homepage: www.elsevier.com/locate/jjcc

Original article

Meta-analysis of transcatheter aortic valve implantation for bicuspid
versus tricuspid aortic valves
Hisato Takagi (MD, PhD)a,b,*, Yosuke Hari (MD)a,b, Norikazu Kawai (MD, PhD)a,
Toshiki Kuno (MD, PhD)c, Tomo Ando (MD)d for the ALICE (All-Literature Investigationof Cardiovascular Evidence) Groupa

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japanc
Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USAd
Department of Cardiology, Detroit Medical Center, Detroit, MI, USAb

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 14 December 2018
Received in revised form 23 February 2019
Accepted 22 March 2019
Available online 21 April 2019

Background: We performed meta-analysis and meta-regression of transcatheter aortic valve implantation (TAVI) for the bicuspid aortic valve (B-AV) versus the tricuspid aortic valve (T-AV).
Methods: MEDLINE and EMBASE were searched through June 2018 using PubMed and OVID. We included
comparative studies of TAVI patients with B-AV versus T-AV reporting at least one of postproceduraltranscatheter valve regurgitation (TVR)/pacemaker implantation (PMI) incidence and early (30-day or
in-hospital)/late (including early) mortality. For each study, crude (unadjusted) data regarding TVR/PMI
incidence and early/late mortality in both the B-AV and T-AV groups were used to generate risk ratios(RRs). Study-specific estimates were combined in the random-effects model. Using meta-regression, we
assessed potential confounders identified in preliminary meta-analysis.
Results: We identified 12 eligible studies including a total of 1045 B-AV and 4069 T-AV patients. Pooled
analysis demonstrated an association of B-AV with a statistically significant increase in TVR incidence(RR, 1.42; p = 0.006) but no statistically significant difference in PMI incidence (p = 0.54) and 30-day(p = 0.11)/midterm (1-year to 2-year) mortality (p = 0.99) between patients with B-AV and those with TAV. All meta-regression coefficients of 6 identified potential confounders (age, mean aortic valve
gradient, aortic valve area, left ventricular ejection fraction, aortic calcification, and B-AV types) for theoutcomes (TVR/PMI incidence and early/late mortality) were statistically non-significant.
Conclusions: Postprocedural PMI incidence and 30-day/midterm (1-year to 2-year) mortality after TAVI
may be similar between patients with B-AV and those with T-AV despite the significant association of BAV with increased postprocedural TVR incidence.
© 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Keywords:
Bicuspid aortic valve
Meta-analysis
Meta-regression
Transcatheter aortic valve implantation
Tricuspid aortic valve

Introduction

and asymmetric calcification [1] may result in paravalvular leakage
or leaflet asymmetry, and questionable B-AV annulus strength may
potentially lead to annular rupture or aortic dissection [2]. Postprocedural moderate transcatheter valve regurgitation (TVR) andpacemaker implantation (PMI) occur respectively in approximately 12% and 18% of TAVI patients with B-AV [2], which are more
frequent than in the PARTNER [Placement of Aortic Transcatheter
Valves] II SAPIEN 3 trial [3] (3.4% and 11.2%) and the CoreValve
Evolut R study [4] (3.4% and 11.7%) and may be associated withincreased early and late mortality. Focusing postprocedural TVR/PMI incidence and early/late mortality, we performed metaanalysis and meta-regression analysis of TAVI for patients with BAV versus those with T-AV.

Transcatheter aortic valve implantation (TAVI) may bring about
less favorable results in aortic stenosis due to the bicuspid aortic
valve (B-AV) than in that due to the tricuspid aortic valve (T-AV)
because of the following theoretical concerns: geometric mismatch between the ovoid B-AV annulus and the circulartranscatheter prosthesis due to increases in annular ellipticity* Corresponding author at: 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka
411-8611, Japan. Tel.: +81 55 975 2000; fax: +81 55 975 2725.
E-mail address: kfgth973@ybb.ne.jp (H. Takagi).

https://doi.org/10.1016/j.jjcc.2019.03.018
0914-5087/© 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

52

53

Original Cardiovascular

A Contemporary Meta-Analysis of Antegrade
versus Retrograde Cerebral Perfusion for
Thoracic Aortic Surgery
Hisato Takagi1

Shohei Mitta1

Tomo Ando2

1 Department of Cardiovascular Surgery, Shizuoka Medical Center,Shizuoka, Japan
2 Department of Cardiology, Detroit Medical Center, Detroit,
Michigan, United States

Address for correspondence Hisato Takagi, MD, PhD, Department of
Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa,
Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan(e-mail: kfgth973@ybb.ne.jp).

Thorac Cardiovasc Surg 2019;67:351–362.

Abstract

Keywords► antegrade cerebral
perfusion► meta-analysis► retrograde cerebral
perfusion

Objective To determine which of antegrade and retrograde cerebral perfusion (ACPand RCP) surpasses for a reduction in postoperative incidence of neurologicaldysfunction and all-cause death in thoracic aortic surgery, we performed a metaanalysis of contemporary comparative studies.
Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials
were searched from January 2010 to June 2017. For each study, data regarding theendpoints in both the ACP and RCP groups were used to generate odds ratios (ORs) and
95% conﬁdence intervals (CIs). Study-speciﬁc estimates were combined using inverse
variance-weighted averages of logarithmic ORs in the ﬁxed-effect model.
Results We identiﬁed and included 19 eligible studies with a total of 15,365 patients
undergoing thoracic aortic surgery by means of ACP (a total of 7,675 patients) or RCP (atotal of 7,690 patients). Pooled analysis demonstrated no statistically signiﬁcantdifferences in postoperative incidence of stoke (17 studies enrolling a total of 9,421
patients; OR, 0.92; 95% CI, 0.79–1.08; p ¼ 0.32) and mortality (16 studies including a
total of 14,452 patients; OR, 1.07; 95% CI, 0.90–1.26; p ¼ 0.46) between ACP and RCP,
whereas a trend toward a signiﬁcant reduction in incidence of temporary neurologicaldysfunction (TND) for ACP (12 studies enrolling a total of 7922 patients; OR, 0.85; 95%
CI, 0.69–1.04; p ¼ 0.12) was found.
Conclusion In thoracic aortic surgery, postoperative incidence of stroke and mortality was similar between ACP and RCP, whereas a trend toward a reduction of TND
incidence existed in ACP.

Introduction
Although deep hypothermic circulatory arrest (DHCA) has
been used for thoracic aortic surgery as an effective cerebral
protective technique for more than 3 decades and proven to
be a feasible means of protection of any organ, a timedependent cascade of events resulting in brain cell injury
is initiated.1 Antegrade and retrograde cerebral perfusion

received
December 21, 2017
accepted after revision
January 17, 2018
published online
April 6, 2018

(ACP and RCP) have become well-established techniques for
cerebral protection during DHCA.2 Both ACP and RCP, however, have their own pros and cons. On the one hand,
although ACP can provide independent control of temperature and/or ﬂow to the cerebral and systemic circulation, it
has the potential for embolization; on the other hand,
although RCP can ﬂush potential embolus from the cerebral© 2019 Georg Thieme Verlag KG
Stuttgart · New York54

DOI https://doi.org/
10.1055/s-0038-1632389.
ISSN 0171-6425.

351

Meta-Analysis for Impact of Statin on Mortality After
Transcatheter Aortic Valve Implantation
Hisato Takagi, MD, PhDa,b,*, Yosuke Hari, MDa,b, Kouki Nakashima, MD, PhDa,b,
Toshiki Kuno, MD, PhDc, and Tomo Ando, MDd, for the ALICE (All-Literature Investigationof Cardiovascular Evidence) GroupTo determine whether statin (hydroxymethylglutaryl-CoA reductase inhibitor) therapy is
associated with better midterm survival after transcatheter aortic valve implantation(TAVI), the first meta-analysis of currently available studies was performed. To identify
all observational comparative studies and randomized controlled trials (RCTs) of statin
versus control (no statin) therapy or cohort studies investigating statin treatment as one ofcovariates in patients undergoing TAVI, PubMed, Web of Science, and Google Scholar
were searched through March 2019. Adjusted (if unavailable, unadjusted) hazard ratios(HRs) with their confidence interval (CIs) of midterm (≥1 year) all-cause mortality after
TAVI for statin therapy were extracted from each study. Study-specific estimates werecombined by means of inverse variance-weighted averages of logarithmic HRs in the random-effects model. Eight eligible studies with a total of 5,170 TAVI patients were identified and included in the present meta-analysis. The primary meta-analysis (including HRs
for high intensity statin from 3 studies together with other HRs) demonstrated that statin
treatment was associated with significantly lower midterm mortality (HR, 0.74; 95% CI,
0.60 to 0.91; p = 0.005). The secondary meta-analysis (including HRs for low/moderateintensity statin from 3 studies together with other HRs) also indicated an association of
statin therapy with significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93;
p = 0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64) was identified, which suggested probably no publication bias. In conclusion, statin therapy is associated with better midterm survival after TAVI. © 2019 Elsevier Inc. All rights reserved.
(Am J Cardiol 2019;124:920−925)

Methods

It has been well-known that statin (hydroxymethylglutaryl-CoA reductase inhibitor) therapy is associated with
better survival after repair of abdominal aortic aneurysm.1−5 Statin treatment also may be associated withlower early all-cause mortality6−8 and midterm mortality
from myocardial infarction (MI)9 after cardiac surgery6
and coronary artery bypass grafting.7−9 After surgicalaortic valve replacement (SAVR), however, a metaanalysis10 of only 4 studies demonstrated no significant
difference in early all-cause mortality between statin andcontrol groups. Impact of statin on mortality after transcatheter aortic valve implantation (TAVI) has been lessinvestigated. Our aim was to determine whether statin
therapy is associated with better midterm survival after
TAVI, performing the first meta-analysis of currently
available studies.

To identify all studies reporting impact of statin on midterm mortality after TAVI, PubMed (https://www.ncbi.nlm.
nih.gov/pubmed/), Web of Science (http://www.webof
knowledge.com/wos), and Google Scholar (https://scholar.
google.com) were searched through March 2019. Searchterms included transcatheter; aortic valve; implantation or
replacement; and statin, hydroxymethylglutaryl-CoA reductase inhibitor, atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, or simvastatin. Studies meeting thefollowing criteria were included in the present meta-analysis: the design was an observational comparative study anda randomized controlled trial (RCT) of statin versus control(no statin) therapy or a cohort study investigating statin
treatment as one of covariates; the study population waspatients undergoing TAVI; outcomes included midterm(≥1 year) all-cause mortality.
Adjusted (if unavailable, unadjusted) hazard ratios(HRs) with their confidence interval (CIs) of mortality forstatin therapy were extracted from each study. Study-specific estimates were combined by means of inverse variance-weighted averages of logarithmic HRs in the randomeffects model. Funnel plot asymmetry (indicating publication bias) was mathematically assessed by use of the linear
regression test. All analyses were performed using Review
Manager version 5.3 (available from http://tech.cochrane.
org/revman) and Comprehensive Meta-Analysis version 3(Biostat, Englewood, New Jersey).

aDepartment of Cardiovascular Surgery, Shizuoka Medical Center,Shizuoka, Japan; bDepartment of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan; cDepartment of Medicine,
Mount Sinai Beth Israel Medical Center, New York, New York; and dDepartment of Cardiology, Detroit Medical Center, Detroit, Michigan. Manuscript received April 28, 2019; revised manuscript received and accepted
May 31, 2019.
See page 924 for disclosure information.
*Corresponding author: Tel: (+81) 55-975-2000; fax: (+81) 55-9752725.
E-mail address: kfgth973@ybb.ne.jp (H. Takagi).

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55

Meta-Analysis of Relation of Skipping
Breakfast With Heart Disease
Hisato Takagi, MD, PhDa,b,*, Yosuke Hari, MDa,b, Kouki Nakashima, MD, PhDa,b,
Toshiki Kuno, MD, PhDc, and Tomo Ando, MDd, for the ALICE (All-Literature
Investigation of Cardiovascular Evidence) GroupTo determine whether skipping breakfast is associated with heart disease, the first metaanalysis of currently available epidemiological studies was performed. To identify casecontrol, cross-sectional, longitudinal, or cohort studies investigating the association ofskipping breakfast with prevalence, incidence, or mortality of heart disease in adults,
PubMed, and Web of Science were searched through April 2019. Adjusted (if unavailable,
unadjusted) hazard ratios (HRs) or odds ratios (ORs) with their confidence interval (CIs)of prevalence, incidence, or mortality for skipping breakfast were extracted from eachstudy. Study-specific estimates were combined using inverse variance-weighted averagesof logarithmic HRs/ORs in the random-effects model. Eight eligible studies with a total of
284,484 participants were identified and included in the present meta-analysis. The primary meta-analysis combining HRs for Q1 (first quartile, most skipping breakfast) versus
Q4 (fourth quartile, least skipping breakfast) from 3 studies together with other HRs/ORs
demonstrated that skipping breakfast was associated with the significantly increased riskof heart disease (pooled HR/OR 1.24; 95% CI 1.09 to 1.40; p = 0.001). In sensitivity analyses combining HRs for Q2 (second quartile, second most skipping breakfast) versus Q4 or
HRs for Q3 (third quartile, second least skipping breakfast) versus Q4 from 3 studies
together with other HRs/ORs, the association of skipping breakfast with the increased
risk of heart disease in the primary meta-analysis was confirmed. In conclusion, skipping
breakfast is associated with the increased risk of heart disease. © 2019 Elsevier Inc. All
rights reserved. (Am J Cardiol 2019;124:978−986)

Skipping breakfast is associated with cardiometabolicrisk including metabolic risk profiles, overweight, obesity,
hypertension, diabetes mellitus, and cardiovascular disease.1 A recent systematic review2 suggests the associationof skipping breakfast with worse lipid profiles, blood pressure levels, insulin resistance, and metabolic syndrome.
Large epidemiological studies reported that skipping breakfast was associated with the increased risk of type 2 diabetes mellitus in both females3 and males.4 Furthermore, arecent cross-sectional study5 provided the association ofskipping breakfast with the increased risk of prevalent noncoronary and generalized atherosclerosis independently of
conventional cardiovascular risk factors. However, theimpact of skipping breakfast on the risk (i.e., prevalence,incidence, or mortality) of cardiovascular disease, especially heart disease, has been less investigated. In the present article, to determine whether skipping breakfast isa
Department of Cardiovascular Surgery, Shizuoka Medical Center,Shizuoka, Japan; bDepartment of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan; cDepartment ofMedicine, Mount Sinai Beth Israel Medical Center, New York, New York;and dDepartment of Cardiology, Detroit Medical Center, Detroit, Michigan. Manuscript received May 11, 2019; revised manuscript received andaccepted June 12, 2019.
See page 986 for disclosure information.
*Corresponding author: Tel: (+81) 55-975-2000; fax: (+81) 55-9752725.
E-mail address: kfgth973@ybb.ne.jp (H. Takagi).

associated with heart disease, the first meta-analysis of currently available epidemiological studies was performed.

Methods
We conducted the present met-analysis in accordance with
the Preferred Reporting Items for Systematic Reviews andMeta-Analyses Statement (http://www.prisma-statement.org).
PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) and Web
of Science (http://www.webofknowledge.com/wos) weresearched through April 2019. Search terms included breakfast; cardiac, cardiovascular, coronary artery, coronary
heart, ischemic coronary, or ischemic heart; and disease,
event, death, or mortality. Studies meeting the following criteria were included in the present meta-analysis: the design
was a case-control, cross-sectional, longitudinal, or cohort
study; the study population was adults; the study investigated
the association of skipping breakfast with prevalence, incidence, or mortality of heart disease including coronary arterydisease (CAD).
Adjusted (if unavailable, unadjusted) hazard ratios(HRs) or odds ratios (ORs) with their confidence interval(CIs) of prevalence, incidence, or mortality for skipping
breakfast were extracted from each study. Study-specificestimates were combined using inverse variance-weighted
averages of logarithmic HRs/ORs in the random-effects
model. Funnel plot asymmetry (suggesting the presenceof publication bias) was mathematically assessed using thelinear regression test. All analyses were performed using

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56

Original article

A meta-analysis of impact of low-flow/low-gradient aortic
stenosis on survival after transcatheter aortic
valve implantation

Hisato Takagia,b, Yosuke Haria,b, Norikazu Kawaia,
Toshiki Kunoc, Tomo Andod, for the ALICE (All-Literature
Investigation of Cardiovascular Evidence) Group'RZQORDGHG IURP KWWSMRXUQDOVOZZFRPMFDUGLRYDVFXODUPHGLFLQH E\ ,%ZL2H%(G&9FW81(8P2\2Q(R;-S-G\9-I/[GUE2<Y;<GR/7E$0%IMUT]=(G5]5&[=QN+L=*=U=H/SQ)7',1-QV1)[(JAims To determine whether low-flow/low-gradient (LF/LG)
aortic stenosis affects survival after transcatheter aortic
valve implantation (TAVI), we performed a meta-analysis ofcurrently available studies.
Methods MEDLINE and EMBASE were searched throughJanuary 2019 using PubMed and OVID. Observational
studies comparing all-cause mortality after TAVI for patientswith classical LF/LG (C/LF/LG) aortic stenosis versus
normal-flow/high-gradient (NF/HG) aortic stenosis,
paradoxical LF/LG (P/LF/LG) aortic stenosis versus NF/HG
aortic stenosis, and (3) C/LF/LG aortic stenosis versus
P/LF/LG aortic stenosis were included. Study-specificestimates, risk and hazard ratios of mortality, werecombined in the random-effects model.
Results Our search identified nine eligible studies including
a total of 5512 TAVI patients. Pooled analysis demonstrated
significantly higher early mortality in C/LF/LG aortic
stenosis than NF/HG aortic stenosis (risk ratio, 1.72;
P U 0.02) and no statistically significant difference in earlymortality between P/LF/LG aortic stenosis and NF/HG
aortic stenosis (P U 0.67) and between C/LF/LG aortic
stenosis and P/LF/LG aortic stenosis (P U 0.51). Midterm
mortality in C/LF/LG (risk ratio/hazard ratio, 1.73;
P U 0.0003) and P/LF/LG aortic stenosis (risk ratio/hazard
ratio, 1.48; P < 0.0001) was significantly higher than that in
NF/HG aortic stenosis. There was no statistically significant

Introduction

difference in midterm mortality between C/LF/LG aortic
stenosis and P/LF/LG aortic stenosis (P U 0.63).
Conclusion After TAVI, C/LF/LG aortic stenosis isassociated with increased early mortality compared withNF/HG, and C/LF/LG and P/LF/LG aortic stenosis isassociated with increased midterm mortality compared withNF/HG aortic stenosis despite no difference in earlymortality between P/LF/LG aortic stenosis and NF/HG
aortic stenosis. There is no difference in early and midterm
mortality between C/LF/LG aortic stenosis and P/LF/LG
aortic stenosis.
J Cardiovasc Med 2019, 20:691–698
Keywords: low-flow/low-gradient aortic stenosis, meta-analysis, survival,transcatheter aortic valve implantationa

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka,
Department of Cardiovascular Surgery, Kitasato University School of Medicine,
Sagamihara, Japan, cDepartment of Medicine, Mount Sinai Beth Israel Medical
Center, New York, New York and dDepartment of Cardiology, Detroit Medical
Center, Detroit, Michigan, USAb

Correspondence to Hisato Takagi, MD, PhD, Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,Shizuoka 411-8611, Japan
E-mail: kfgth973@ybb.ne.jp
Received 13 November 2018 Revised 26 February 2019
Accepted 2 April 2019

RQ 

Each of low stroke volume (SV) index (SVI) (low-flow),
low aortic valve pressure gradient (low-gradient), and low
left ventricular ejection fraction (LVEF) (low-ejection
fraction) is associated with increased midterm mortality
after transcatheter aortic valve implantation (TAVI) for
patients with severe aortic stenosis, and the prognostic
impact of individual low flow, low gradient, and lowejection fraction on survival may be similar.1 Severe aortic
stenosis is defined as aortic valve maximum velocity(Vmax) at least 4 m/s or mean aortic valve pressure gradient(MPG) at least 40 mmHg and typically aortic valve area
(AVA) 1.0 cm2 or less and classified into asymptomatic(corresponding to stage C) and symptomatic severe
aortic stenosis (corresponding to stage D).2 Althoughsymptomatic severe aortic stenosis is typically high-gradient (corresponding to stage D1), it can be present inpatients with low-flow aortic stenosis leading to Vmax lessthan 4 m/s or MPG less than 40 mmHg, which is usuallycalled low-flow/low-gradient (LF/LG) aortic stenosis.3
Furthermore, symptomatic LF/LG aortic stenosis isdivided into classical LF/LG aortic stenosis and paradoxical LF/LG aortic stenosis. The definition of classical
LF/LG aortic stenosis is AVA of 1.0 cm2 or less with Vmax
less than 4 m/s or MPG less than 40 mmHg and ejection
fraction less than 50% (low-ejection fraction) (corresponding to stage D2), and that of paradoxical LF/LG
aortic stenosis is AVA of 1.0 cm2 or less with Vmax less than
4 m/s or MPG less than 40 mmHg and ejection fraction atleast 50% (normal-ejection fraction) (corresponding to1558-2027  2019 Italian Federation of Cardiology - I.F.C. All rights reserved.

DOI:10.2459/JCM.0000000000000836© 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.
57

DOI: 10.1111/jocs.14233

ORIGINAL ARTICLE

A meta‐analysis of impact of mitral stenosis on outcomes after
transcatheter aortic valve implantation
Hisato Takagi MD, PhD1,2
Toshiki Kuno MD, PhD3

| Yosuke Hari MD1,2 | Kouki Nakashima MD, PhD1,2 || Tomo Ando MD4

1

Department of Cardiovascular Surgery,Shizuoka Medical Center, Shizuoka, Japan

Abstract

2

Objectives: To determine whether concomitant mitral stenosis (MS) impairs outcomes

Department of Cardiovascular Surgery,
Kitasato University School of Medicine,
Sagamihara, Japan3

Department of Medicine, Mount Sinai BethIsrael Medical Center, New York, New York
4

Department of Cardiology, Detroit Medical
Center, Detroit, Michigan
Correspondence
Hisato Takagi MD, PhD, Department of
Cardiovascular Surgery, Shizuoka Medical
Center, 762‐1 Nagasawa, Shimizu‐cho, Sunto‐
gun, Shizuoka 411‐8611, Japan.
Email: kfgth973@ybb.ne.jp

after transcatheter aortic valve implantation (TAVI) in patients with severe aortic
stenosis (AS), we performed a meta‐analysis of currently available evidence.
Methods: To identify all observational comparative studies of outcomes after TAVI
for AS in patients with MS vs patients with no‐MS, we searched databases (MEDLINE
and EMBASE) using web‐based search engines (PubMed and OVID). Studies meetingthe following criteria were included; the design was an observational study; the study
population was patients undergoing TAVI for AS; outcomes in patients with MS werecompared with those in patients with no‐MS. Study‐specific estimates were thenpooled using inverse variance‐weighted averages of logarithmic odds and hazard
ratios in the random‐effects model.
Results: We identified six eligible studies including 111 621 patients undergoing TAVI.
In pooled analyses, postprocedural incidence of ≥ moderate paravalvular aortic
regurgitation (PAR) (P = .02), early all‐cause mortality (P = .008), early incidence of
myocardial infarction (MI) (P = .01), and midterm all‐cause mortality (P = .03) after TAVI
were significantly higher in patients with MS than in patients with no‐MS. There wereno significant differences in early incidence of stroke, major bleeding, acute kidney
injury, and new permanent pacemaker implantation after TAVI between patients with
MS and patients with no‐MS. When the study for mitral annular calcification was
excluded in the pooled analyses, no results except for MI were substantially altered but
the significance for early incidence of MI disappeared (P = .10).
Conclusion: Postprocedural incidence of ≥ moderate PAR, early all‐cause mortality,
early incidence of MI, and midterm all‐cause mortality after TAVI are higher inpatients with MS than in patients with no‐MS.
KEYWORDS

meta‐analysis, mitral stenosis, transcatheter aortic valve implantation

1 | INTRODUCTION
Concomitant mitral regurgitation (MR) affects early and midterm
mortality after transcatheter aortic valve implantation (TAVI) in
patients with severe aortic stenosis (AS). A recent meta‐analysis1

ALICE (All‐Literature Investigation of Cardiovascular Evidence) Group.

1256| © 2019 Wiley Periodicals, Inc.

wileyonlinelibrary.com/journal/jocs

58

J Card Surg. 2019;34:1256–1263.

Heart & Lung 48 (2019) 519529

Contents lists available at ScienceDirect

Heart & Lung
journal homepage: www.heartandlung.com

Comparison of early and midterm outcomes after transsubclavian/axillary
versus transfemoral, transapical, or transaortic transcatheter aortic valve
implantation
Hisato Takagi a,b,*, Yosuke Hari a,b, Kouki Nakashima a,b, Toshiki Kuno c, Tomo Ando d, ALICE (All-Literature
Investigation of Cardiovascular Evidence) Groupa

Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, United StatesdDepartment of Cardiology, Detroit Medical Center, Detroit, MI, United Statesbc

A R T I C L E

I N F O

Article history:
Received 3 January 2019
Received in revised form 30 March 2019
Accepted 5 April 2019
Available online 7 May 2019
Keywords:
Meta-analysis
Transaortic transcatheter aortic valve
implantation
Transapical transcatheter aortic valve
implantation
Transfemoral transcatheter aortic valve
implantation
Transsubclavian/transaxillary transcatheter
aortic valve implantationA B S T R A C T

Background: Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation(TAVI) have been unclear.
Objectives: To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI,or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies.
Methods: Studies considered for inclusion met the following criteria: the study population was patients
undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least
one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds
or hazard ratio of each early or late outcome with its 95% conﬁdence interval for TSc/TAx-TAVI versus theother approach was extracted from each individual study and combined in the random-effects model.
Results: Our search identiﬁed 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis ofearly all-cause mortality demonstrated a statistically signiﬁcant reduction after TSc/TAx-TAVI comparedwith TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically signiﬁcant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAoTAVI (P < 0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically signiﬁcant
increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007).
Conclusions: Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm allcause mortality was higher after TSc/TAx-TAVI than TF-TAVI.
© 2019 Elsevier Inc. All rights reserved.

Introduction
In transcatheter aortic valve implantation (TAVI), the transfemoral(TF) approach has been the most commonly used with the lowest
incidence of postprocedural complications.1 Due to concomitant
peripheral artery disease such as unpassable stenosis, severe tortuosity, or small calibers of the iliofemoral arteries, however, 10%15% of
patients are unable to undergo TF-TAVI.2 Alternative approaches
include transsubclavian (synonym for transaxillary) (TSc/TAx),Abbreviations: TAo, transaortic; TAp, transapical; TAVI, transcatheter aortic valve
implantation; TF, transfemoral; TSc/TAx, transsubclavian (synonym for transaxillary)* Corresponding author at: Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan.
E-mail address: kfgth973@ybb.ne.jp (H. Takagi).
https://doi.org/10.1016/j.hrtlng.2019.04.002
0147-9563/$ - see front matter © 2019 Elsevier Inc. All rights reserved.

59

transapical (TAp), transaortic (TAo), transcarotid, and transcaval. The
TAp access is the unique antegrade approach and may offer simple
wiring and marvelous controllability.3 The TAo approach may be
more controllable and advantageous to accurate implantation depth.4
The transcarotid (especially, left transcarotid) approach may be coaxially aligned to the ascending aorta and optimally position the transcatheter valve.5 Transcaval access is a new approach to attain fully
percutaneous TAVI in patients with the inadequate TF access.6 The
subclavian/axillary artery, the minimum luminal diameter of which iscommonly >5.0 mm even in case of the <5.0-mm iliofemoral artery,is less atherosclerotic and sinuous than the iliofemoral artery, and the
TSc/TAx approach is a fully percutaneous access as well as the transcaval approach.7 Because limited data for the comparison of TSc/TAxTAVI and other approaches have been available to date, outcomesAuthor's personal copy
Heart and Vessels (2019) 34:1984–1992
https://doi.org/10.1007/s00380-019-01442-w

ORIGINAL ARTICLE

Network meta-analysis of new-generation valves for transcatheter
aortic valve implantation
Hisato Takagi1,2 · Yosuke Hari1,2 · Kouki Nakashima1,2 · Toshiki Kuno3 · Tomo Ando4 · ALICE (All-Literature
Investigation of Cardiovascular Evidence) Group
Received: 8 March 2019 / Accepted: 24 May 2019 / Published online: 29 May 2019
© Springer Japan KK, part of Springer Nature 2019

Abstract
To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched throughSeptember 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early
generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation(PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework
for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative
ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was thebest effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%)
compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst
for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased
PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV
among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).
Keywords Network meta-analysis · New-generation transcatheter heart valve · Transcatheter aortic valve implantation

Introduction
Transcatheter aortic valve implantation (TAVI) using newgeneration valves (NGVs) (NGV-TAVI) is suggested to be
associated with lower postprocedural incidence of acutekidney injury, bleeding complications, and aortic regurgitation (AR) than TAVI using early-generation valves (EGVs)(EGV-TAVI), whereas incidence of new permanent pacemaker implantation (PMI), stroke, and all-cause death after
NGV-TAVI may be similar to that after EGV-TAVI [1]. Several NGVs are currently used in clinical practice, and a number of studies have compared NGVs each other to date. Evidence drawn from direct comparisons, however, is limited
to a few small-size studies. Because different comparators
are used in existing studies, a conventional meta-analysis
may not adequately assess comparative effectiveness of ≥ 3
different NGVs. Thus, to comprehensively compare and rank
NGVs for TAVI focusing early postprocedural outcomesof interest (all-cause death, ≥ moderate AR, and PMI), weElectronic supplementary material The online version of thisarticle (https://doi.org/10.1007/s00380-019-01442-w) contains
supplementary material, which is available to authorized users.
* Hisato Takagi
kfgth973@ybb.ne.jp
1

Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,Shizuoka 411-8611, Japan2

Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japan3

Department of Medicine, Mount Sinai Beth Israel Medical
Center, New York, NY, USA

4

Department of Cardiology, Detroit Medical Center, Detroit,
MI, USA

13

Vol:.(1234567890)

60

Meta-analysis of the Relation of Television-Viewing
Time and Cardiovascular Disease
Hisato Takagi, MD, PhDa,b,*, Yosuke Hari, MDa,b, Kouki Nakashima, MD, PhDa,b,
Toshiki Kuno, MD, PhDc, and Tomo Ando, MDd, for the ALICE(All-Literature Investigation of Cardiovascular Evidence) GroupTo determine whether television (TV) viewing is associated with cardiovascular disease(CVD) risk, we performed a meta-analysis of currently available prospective cohort studies. We systematically searched PubMed and Web of Science through April 2019. Eligible
for inclusion in the present meta-analysis was a prospective cohort study investigating theassociation of TV viewing time with CVD risk (CVD prevalence, CVD incidence, cardiovascular events, and cardiovascular mortality). From each study, adjusted hazard ratios(HRs) of CVD risk were extracted. We separately combined study-specific estimates fordichotomous, tertile, quartile, and continuous values of TV viewing time in the randomeffects model. The pooled analysis for dichotomous time demonstrated that CVD risk wassignificantly higher in the longer than shorter viewing (HR 1.28; p = 0.02). In the metaanalysis for tertile time, CVD risk was significantly higher in the longest than shortest tertile (T1) (HR 1.26; p = 0.0006), but there was no significant difference between the middle
tertile and T1 (p = 0.51). The meta-analysis for quartile time indicated that CVD risk wassignificantly higher in the longest than shortest quartile (Q1) (HR 1.32; p = 0.0007), butthere were no significant differences between the second longest quartile and Q1 (p = 0.12)
and between the second shortest quartile and Q1 (p = 0.60). In the meta-analysis for continuous time, longer viewing was significantly associated with higher CVD risk (HR per 1h/day increment; 1.06; p = 0.005). In conclusion, longer TV viewing time is significantly
associated with higher CVD risk. © 2019 Elsevier Inc. All rights reserved. (Am J Cardiol
2019;124:1674−1683)

There is the association of sedentary time with cardiometabolic health markers (such as fasting glucose, fasting insulin, triglycerides, high-density lipoprotein cholesterol, andwaist circumference),1 diabetes mellitus (DM),2 cardiovascular disease (CVD),2,3 CV mortality,2,3 and all-cause mortality.2−4 Furthermore, television (TV) viewing is also
associated with all-cause mortality. Sun et al5 performed a
meta-analysis of 10 prospective cohort studies with 647,475
individuals and showed that all-cause mortality was significantly higher in the highest category of TV viewing timethan in the lowest category. Although CVD risk (CVD prevalence, CVD incidence, CV events, and CV mortality) is considered to mainly contribute to all-cause mortality, theassociation of TV viewing with CVD risk remains unclear.
In the present article, to determine whether TV viewing is
associated with CVD risk, we performed a meta-analysis ofcurrently available prospective cohort studies.

Methods
We conducted the present meta-analysis according to thePreferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) (http://www.prisma-statement.org) andshowed the PRISMA-P [PRISMA Protocols] 2015 checklist(http://www.prisma-statement.org/Extensions/Protocols.
aspx) in Supplementary Table S1. We systematicallysearched PubMed (https://www.ncbi.nlm.nih.gov/pubmed/)and Web of Science (http://www.webofknowledge.com/wos)through April 2019 using keyword including “television”;
and “cardiovascular disease(s),” “cardiovascular event(s),”“cardiovascular death(s),” or “cardiovascular mortality.” Eligible for inclusion in the present meta-analysis was a prospective cohort study investigating the association of TV
viewing time with CVD risk (CVD prevalence, CVD incidence, CV events, and CV mortality). We evaluated the quality of the studies using the RoBANS [Risk of Bias
Assessment Tool for Nonrandomized Studies].6 From eachstudy, adjusted hazard ratios (HRs) of CVD incidence, CV
events, and CV mortality (and adjusted odds ratios of CVD
prevalence) with their confidence intervals (CIs) wereextracted. Data were extracted in duplicate by 2 investigators(HT, TK) and independently verified by a third researcheraDepartment of Cardiovascular Surgery, Shizuoka Medical Center,Shizuoka, Japan; bDepartment of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan; cDepartment of Medicine,
Mount Sinai Beth Israel Medical Center, New York, New York; and dDepartment of Cardiology, Detroit Medical Center, Detroit, Michigan. Manuscript received May 29, 2019; revised manuscript received and accepted
August 19, 2019.
Author contribution: HT contributed to conception, design, acquisition,
analysis, and interpretation, drafted manuscript, and agrees to be accountable
for all aspects of work ensuring integrity and accuracy. YH and KN contributed to acquisition and analysis. TK contributed to design, analysis, andinterpretation. TA contributed to conception, acquisition, analysis, and interpretation, and critically revised manuscript. All authors gave final approval.
See page 1683 for disclosure information.
*Corresponding author: Tel: (+81) 55-975-2000; fax: (+81) 55-9752725.
E-mail address: kfgth973@ybb.ne.jp (H. Takagi).

0002-9149/© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2019.08.032

www.ajconline.org

61

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Original article

Echocardiographic outcomes from seven randomized trialsof transcatheter versus surgical aortic valve replacement

Hisato Takagia,b, Yosuke Haria,b, Kouki Nakashimaa,b, Toshiki Kunoc,
Tomo Andod, for the ALICE (All-Literature Investigation of Cardiovascular
Evidence) Group'RZQORDGHG IURP KWWSMRXUQDOVOZZFRPMFDUGLRYDVFXODUPHGLFLQH E\ ,%ZL2H%(G&9FW81(8P2\2Q(R;-S-G\9-I/[GUE2<Y;<GR/7E$0%IMUT]E*F\;D2WKP'VG[XZPDET9Q-]W'J+/\(DSJ64

Aims We performed meta-analyses of echocardiographic
outcomes, including postprocedural aortic valve area (AVA),
aortic valve mean pressure gradient (MPG), andparavalvular aortic regurgitation (PAR), exclusively from all
currently available randomized controlled trials (RCTs) oftranscatheter aortic valve implantation (TAVI) versus
surgical aortic valve replacement (SAVR).

(P < 0.00001), incidence of at least moderate PAR was
significantly greater after TAVI than after SAVR.

Methods To identify all RCTs providing echocardiographic
outcomes (AVA, MPG, and PAR) up to 2 years after TAVI
versus SAVR, PubMed and ClinicalTrials.gov were searchedthrough June 2019. Mean differences in AVA (and MPG)
between the TAVI and SAVR groups and odds (or hazard)
ratios of at least moderate PAR for TAVI versus SAVR werepooled using the random-effects meta-analysis.

J Cardiovasc Med 2020, 21:58–64

Conclusion On the basis of the present meta-analyses of
all the seven currently available RCTs, AVA is larger, MPG islower, and incidence of at least moderate PAR is greater
30 days, 1 and 2 years after TAVI than after SAVR.

Keywords: echocardiographic outcome, meta-analysis, randomized
controlled trial, surgical aortic valve replacement, transcatheter aortic
valve implantationa

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka,
Department of Cardiovascular Surgery, Kitasato University School of Medicine,
Sagamihara, Japan, cDepartment of Medicine, Mount Sinai Beth Israel Medical
Center and dDivision of Interventional Cardiology, Department of Cardiology,
Presbyterian Hospital/Columbia University Medical Center, New York, New York,USAb

RQ 

Results We identified seven eligible RCTs. At 30 days
(P U 0.004), 1 year (P U 0.006), and 2 years (P U 0.03), AVA
was significantly larger after TAVI than after SAVR. After
TAVI than after SAVR, MPG was significantly lower at
30 days (P U 0.03) and 2 years (P U 0.01), andnonsignificantly lower at 1 year (P U 0.06). At 30 days
(P < 0.00001), 1 year (P < 0.00001), and 2 years

Received 2 August 2019 Revised 19 September 2019
Accepted 16 October 2019

Introduction

Methods

Aortic valve mean pressure gradient (MPG) is considerably
improved after both transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR)
for severe aortic stenosis.1 A number of comparative studies have demonstrated larger aortic valve area (AVA) andlower MPG after TAVI than after SAVR. Although a metaanalysis2 of these studies has supported lower postprocedural MPG favoring TAVI, findings from randomized
controlled trials (RCTs) remain limited. Recently two
RCTs, the Evolut Low Risk trial3 and the Placement of
Aortic Transcatheter Valves (PARTNER) 3 trial,4
reported better clinical outcomes after TAVI than after
SAVR. In the present article, we performed meta-analysesof echocardiographic outcomes, including postprocedural
AVA, MPG, and paravalvular aortic regurgitation (PAR),
exclusively from all currently available RCTs of TAVI
versus SAVR. Furthermore, the fragility of the statisticalsignificance for the result of the binary outcome (PAR) was
assessed using the fragility index of meta-analyses5 and theratio of the fragility index to the total number of participants included in the trials.

To identify all RCTs providing echocardiographic outcomes after TAVI versus SAVR, PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) and ClinicalTrials.gov(https://clinicaltrials.gov/ct2/home)
were
searched
through June 2019 using the following search terms:
transcatheter; aortic valve; implantation(s) or replacement(s); and randomized. The following studies were
included: the design was an RCT; the study population
comprised patients with severe aortic stenosis; patientswere randomized to TAVI versus SAVR; outcomes
included postprocedural AVA, MPG, and PAR up to 2
years. Risk of bias of RCTs is assessed using the
Cochrane Collaboration’s tool (https://training.cochrane.org/handbook). Blinding of participants and personnel(performance bias) was not used for assessment because
the treatments were interventional (TAVI) and surgical(SAVR). At baseline, 30 days, 1 year, and 2 years in each
RCT, we extracted means [with standard deviations(SDs)] of AVA (and MPG) and incidence of at least
moderate PAR in both the TAVI and SAVR groups.
The following random-effects meta-analyses were1558-2027  2020 Italian Federation of Cardiology - I.F.C. All rights reserved.

DOI:10.2459/JCM.0000000000000901

Correspondence to Hisato Takagi, MD, PhD, Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,Shizuoka 411-8611, Japan
E-mail: kfgth973@ybb.ne.jp© 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.
63

Journal of Cardiology 75 (2020) 177–181

Contents lists available at ScienceDirect

Journal of Cardiology
journal homepage: www.elsevier.com/locate/jjcc

Original article

Meta-analysis of propensity matched studies of robotic versus
conventional mitral valve surgery
Hisato Takagi (MD, PhD)a,b,*, Yosuke Hari (MD)a,b, Kouki Nakashima (MD, PhD)a,b,
Toshiki Kuno (MD, PhD)c, Tomo Ando (MD)d for the ALICE (All-Literature Investigation of
Cardiovascular Evidence) Groupa

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japanc
Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USAd
Department of Cardiology, Detroit Medical Center, Detroit, MI, USAb

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 27 February 2019
Received in revised form 27 May 2019
Accepted 20 June 2019
Available online 21 August 2019

Background: To compare early outcomes after robotic versus conventional mitral valve surgery (R-MVS
versus C-MVS), we performed a meta-analysis of currently available propensity score matched (PSM)
studies.
Methods: To identify all PSM studies of R-MVS versus C-MVS, PubMed and Web of Science were searchedthorough November 2018 using the terms of robotic or robot, mitral, and propensity. Inclusion criteria
were PSM studies of isolated R-MVS versus C-MVS. Odds ratios of dichotomous data and meandifferences for continuous data were generated for each study and combined in a meta-analysis using therandom-effects model.
Results: We identified 7 PSM studies of R-MVS versus C-MVS enrolling a total of 3764 patients. Pooled
analyses demonstrated significantly longer cardiopulmonary bypass (CPB) (p < 0.00001) and crossclamp time (p = 0.004) in R-MVS than C-MVS. However, intensive care unit (ICU) (p = 0.0005) and hospital
stay (p < 0.0001) was significantly shorter; and incidence of red blood cell (RBC) transfusion (p = 0.03),
prolonged ventilation (p = 0.048), and atrial fibrillation (AF) (p = 0.01) was significantly less frequent after
R-MVS than C-MVS. There was no significant difference in incidence of reoperation for bleeding and valve
dysfunction, moderate mitral regurgitation, renal failure, dialysis, pneumonia, stroke, cardiac arrest,
and all-cause death (p = 0.27) between R-MVS and C-MVS.
Conclusions: ICU/hospital stay was shorter and RBC transfusion/prolonged ventilation/AF was lessfrequent after R-MVS than C-MVS despite longer CPB and cross-clamp time in R-MVS than C-MVS. The
other early outcomes including all-cause mortality were similarly frequent after R-MVS and C-MVS.
© 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Keywords:
Meta-analysis
Mitral valve surgery
Robotic surgery

Introduction

time may be longer in minimally invasive than conventional MVS.
Although several comparative observational studies of robotic
versus conventional MVS have been published, no randomized
controlled trial (RCT) has been conducted to the best of ourknowledge. The gold standard to estimate causal effects oftreatments is in general considered as an RCT, notwithstanding,which is often unactable for various reasons, e.g. ethical concerns,
extreme costs, or timeliness [2]. Propensity score methods canachieve the generation of similar experimental and control units
balanced in terms of covariates [2]. In the present article, tocompare early outcomes after robotic versus conventional MVS,
we performed a meta-analysis of currently available propensity
score matched (PSM) studies.

A previous large meta-analysis [1] of 35 studies suggested that
intensive care unit (ICU) and hospital stay may be shorter and atrial
fibrillation (AF) may be less frequent after minimally invasive(mainly via thoracotomy) than conventional (via sternotomy)
mitral valve (MV) surgery (including repair and replacement)(MVS) although cardiopulmonary bypass (CPB) and cross-clamp* Corresponding author at: 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka
411-8611, Japan. Tel.:+81-55-975-2000; Fax: +81-55-975-2725.
E-mail address: kfgth973@ybb.ne.jp (H. Takagi).

https://doi.org/10.1016/j.jjcc.2019.06.014
0914-5087/© 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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ORIGINAL ARTICLE

Interactive CardioVascular and Thoracic Surgery 30 (2020) 465–476
doi:10.1093/icvts/ivz286 Advance Access publication 6 December 2019

Cite this article as: Takagi H, Hari Y, Nakashima K, Kuno T, Ando T; for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Matrix
metalloproteinases and acute aortic dissection: Et Tu, Brute? Interact CardioVasc Thorac Surg 2020;30:465–76.

Matrix metalloproteinases and acute aortic dissection: Et Tu, Brute?

aDepartment of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japanc
Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USAdDivision of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USAb* Corresponding author. Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan.
Tel: +81-55-9752000; e-mail: kfgth973@ybb.ne.jp (H. Takagi).

VASCULAR

Received 9 September 2019; received in revised form 21 October 2019; accepted 1 November 2019

Downloaded from https://academic.oup.com/icvts/article-abstract/30/3/465/5662390 by Shizuoka Medical Center user on 26 February 2020

Hisato Takagia,b,*, Yosuke Haria,b, Kouki Nakashimaa,b, Toshiki Kuno c and Tomo Andod;
for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

Abstract
OBJECTIVES: To summarize the present evidence for the association of matrix metalloproteinases (MMPs) with acute aortic dissection(AAD), we performed the first meta-analysis of all currently available case–control studies comparing circulating MMP levels between AAD
patients and control subjects.
METHODS: To identify all studies investigating the levels of circulating MMPs in AAD patients, PubMed and Web of Science were searched
up to July 2019. The levels of MMPs in AAD patients and control subjects were extracted from each study, and the standardized mean differences (SMDs) in MMP levels were generated. The study-specific estimates were combined in the random-effects model.
RESULTS: Twelve studies enrolling a total of 458 AAD patients and 711 control subjects were identified and included. Pooled analyses
demonstrated no significant differences in MMP-1 (4 studies; P = 0.21), MMP-2 (5 studies; P = 0.62) and MMP-3 levels (2 studies; P = 0.94)
between AAD patients and control subjects; and significantly higher MMP-8 (2 studies; SMD 2.11; P = 0.020), MMP-9 (9 studies; SMD 1.54;
P < 0.001) and MMP-12 levels (2 studies; SMD 1.33; P < 0.001) in AAD patients than in control subjects.

C The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
V

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Heart in Aorta
Hisato Takagi, MD, PhD, Yosuke Hari, MD, Noriko Takinami, RN, NP, andKouki Nakashima, MD, PhD, for the ALICE (All-Literature Investigation of
Cardiovascular Evidence) Group
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka; and Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan

Figure 1.

A

dissection, intimal intussusception into the left ventricle,4which leads to signiﬁcant (often severe) aortic regurgitation, has been known. “Heart in aorta” identiﬁed in thepresent case, however, has never been reported.

woman in her late 70s presented with sudden-onset
severe chest pain. Computed tomography with
contrast medium revealed a heart-shaped intimal ﬂap in
the ascending aorta (Figure 1), which was diagnosed as
type A acute aortic dissection. The patient underwent
emergency ascending aortic replacement with brachiocephalic artery reconstruction (because of the entry
located between the origins of the brachiocephalic andleft common carotid artery) and is now doing well andwaiting discharge. Heart-shaped construction abruptly
appears in ultrasonographic, computed tomography,
magnetic resonance imaging, and angiographic ﬁndings
and astonishes us, such as “heart in heart,”1 “heart inpulmonary trunk,”2 and “intracranial heart.”3 As aunique echocardiographic ﬁnding of type A acute aortic

References
1. Cramer MJ, Kasteleijn I, de Boeck B, Melman P. Heart inheart: Double oriﬁce mitral valve. Neth Heart J. 2005;13:372.
2. Funabashi N, Komuro I. Images in clinical medicine. Heartshaped tumor in pulmonary trunk. N Engl J Med. 2005;352:608.
3. Suarez Zambrano GA, Hutton GJ. Heart-shaped lesion secondary to neurosarcoidosis. Arch Neurol. 2008;65:1388-1389.
4. Kızıltan HT, Tıraş M, Idem A, Camsarı R, Toktaş S, Bozkurt A.
Intimal intussusception in aortic dissection and coexistingcoronary artery disease. Ann Thorac Surg. 2014;97:698-700.

Address correspondence to Dr Takagi, Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Suntogun, Shizuoka 411-8611, Japan; email: kfgth973@ybb.ne.jp.

 2020 by The Society of Thoracic SurgeonsPublished by Elsevier Inc.

Ann Thorac Surg 2020;109:e223  0003-4975/$36.00
https://doi.org/10.1016/j.athoracsur.2019.08.082

69

DOI: 10.1111/jocs.14409

ORIGINAL ARTICLE

Baseline left ventricular diastolic dysfunction affects midterm
mortality after transcatheter aortic valve implantation| Yosuke Hari MD1,2 | Kouki Nakashima MD, PhD1,2 |Yujiro Yokoyama MD3 | Hiroki Ueyama MD4 | Toshiki Kuno MD, PhD4 |Tomo Ando MD5 | ALICE (All‐Literature Investigation of Cardiovascular Evidence) Group
Hisato Takagi MD, PhD1,2

1

Department of Cardiovascular Surgery,Shizuoka Medical Center, Shizuoka, Japan

Abstract

2

Objectives: To determine whether preprocedural left ventricular (LV) diastolic

Department of Cardiovascular Surgery,
Kitasato University School of Medicine,
Sagamihara, Japan3

Department of Surgery, Easton Hospital,
Easton, Pennsylvania
4

Department of Medicine, Mount Sinai BethIsrael Medical Center, New York, New York
5
Division of Interventional Cardiology,
Department of Cardiology, New York
Presbyterian Hospital/Columbia University
Medical Center, New York, New York

dysfunction impairs midterm mortality after transcatheter aortic valve implantation(TAVI) for patients with severe aortic stenosis (AS), we performed a meta‐analysis ofcurrently available evidence.
Methods: We identified all studies investigating impact of preprocedural severity of
LV diastolic dysfunction on midterm (≥1‐year) all‐cause mortality after TAVI for
patients with AS through a search of databases (MEDLINE and EMBASE) until
September 2019. From each study, we extracted an adjusted (if unavailable,
unadjusted) hazard ratio (HR) of midterm mortality. We pooled study‐specificCorrespondence
Hisato Takagi MD, PhD, Department of
Cardiovascular Surgery, Shizuoka Medical
Center, 762‐1 Nagasawa, Shimizu‐cho,Sunto‐gun, Shizuoka 411‐8611, Japan.
Email: kfgth973@ybb.ne.jp

estimates in the random‐effects model.
Results: Ten eligible studies with a total of 2380 patients with AS undergoing TAVI
were identified. In accordance with pooled analyses, higher‐grade preprocedural LV
diastolic dysfunction was associated with significantly worse midterm all‐cause
mortality after TAVI compared to lower‐grade dysfunction (HR for grade II vs I, 1.15;
P = .002; HR for grade III vs I, 1.35; P = .001; HR for grade III vs II; 1.16, P = .002; HRfor grade II‐III vs I, II‐III vs 0‐I, or III vs I‐II, 1.34; P < .00001 [primary meta‐analysis];
HR per grade, 1.16; P = .003). No funnel plot asymmetry for the primary meta‐analysis(for grade II‐III vs I, II‐III vs 0‐I, or III vs I‐II) was identified, which probably indicatedno publication bias (P = .381 by the linear‐regression test).
Conclusion: Higher‐grade preprocedural LV diastolic dysfunction was associated withworse midterm all‐cause mortality after TAVI for patients with AS compared tolower‐grade dysfunction.
KEYWORDS

left ventricular diastolic dysfunction, meta‐analysis, mortality, transcatheter aortic valve
implantation

1 | I N T R O D UCTI O N(TAVI) for patients with severe aortic stenosis (AS). Meanwhile, LV
diastolic dysfunction (lower e' velocity [e'],4,5 higher E velocity to e'

It has been known that preprocedural left ventricular (LV) systolicvelocity ratio,4 and higher E velocity to A‐wave velocity ratio [E/A]6)

dysfunction, ie, low ejection fraction (EF)1-3 and low stroke volume

is associated with increased short‐term,4 short‐to‐midterm,5 and mid‐1

to‐long‐term mortality6 in septic patients4,5 and patients with chronic(SV), affects prognosis after transcatheter aortic valve implantation536| © 2019 Wiley Periodicals, Inc.

wileyonlinelibrary.com/journal/jocs

70

J Card Surg. 2020;35:536–543.

HLC 2901 No. of Pages 13

ORIGINAL ARTICLE

Heart, Lung and Circulation (2019) xx, 1–13
1443-9506/04/$36.00
https://doi.org/10.1016/j.hlc.2019.04.012

Meta-Analysis and Meta-Regression ofTranscatheter Aortic Valve Implantation
for Pure Native Aortic Regurgitation
Hisato Takagi, MD, PhD a,b*, Yosuke Hari, MD a,b,
Norikazu Kawai, MD, PhD a, Tomo Ando, MD c, for the ALICE(All-Literature Investigation of Cardiovascular Evidence) Groupa

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
Department of Cardiology, Detroit Medical Center, Detroit, MI, USAbcReceived 17 September 2018; received in revised form 19 March 2019; accepted 11 April 2019; online published-ahead-of-print xxx

Aim

To assess outcomes of transcatheter aortic valve implantation (TAVI) for pure native aortic regurgitation(AR) and to evaluate whether 30-day all-cause mortality is modulated by patient characteristics, we performed a meta-analysis and meta-regression of currently available studies.

MethodStudies enrolling 20 patients undergoing TAVI for AR were considered for inclusion. Study-specificestimates (incidence rates of outcomes) were combined using one-group meta-analysis in a randomeffects model. Subgroup meta-analysis of studies exclusively using early-generation devices (EGD) andnew-generation devices (NGD) and stepwise random-effects multivariate meta-regression were also
performed.

Results

The search identified 11 eligible studies including a total of 911 patients undergoing TAVI for AR. Pooled
analysis demonstrated an incidence of device success of 80.4% (NGD 90.2%, EGD 67.2%; p < 0.001), moderate or higher paravalvular aortic regurgitation (PAR) of 7.4% (NGD 3.4%, EGD 17.3%; p < 0.001), 30-day
all-cause mortality of 9.5% (NGD 6.1%, EGD 14.7%; p < 0.001), mid-term (4 mo - 1 yr) all-cause mortality of
18.8% (NGD 11.8%, EGD 32.2%; p < 0.001), life-threatening/major bleeding complications (BC) 5.7% (NGD
3.5%, EGD 12.4%; p = 0.015), and major vascular complications (MVC) of 3.9% (NGD 3.0%, EGD 6.2%;
p = 0.041). All coefficients in the multivariate meta-regression adjusting simultaneously for the proportionof diabetes mellitus, chronic obstructive pulmonary disease, peripheral arterial disease, concomitant moderate or higher mitral regurgitation, and mean left ventricular ejection fraction (with significant coefficientsin the univariate meta-regression) were not statistically significant.

Conclusions

Thirty (30)-day all-cause mortality after TAVI for AR was high (9.5%) with a high incidence of moderate or
higher PAR (7.4%). Compared with EGD, NGD was associated with significantly higher device success rates
and significantly lower rates of second-valve deployment, moderate or higher PAR, 30-day/mid-term allcause mortality, serious BC, and MVC.

Keywords

Aortic regurgitation  Meta-analysis  Transcatheter aortic valve implantation*Corresponding author at: Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611,
Japan., Email: kfgth973@ybb.ne.jp© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
Published by Elsevier B.V. All rights reserved.

Please cite this article in press as: Takagi H, et al. Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve
Implantation for Pure Native Aortic Regurgitation. Heart, Lung and Circulation (2019), https://doi.org/10.1016/j.
hlc.2019.04.012

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Original Article

Egg Consumption and Coronary Artery
Disease: A Nice Knockdown Argument

Angiology
1-13ª The Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0003319719897493
journals.sagepub.com/home/ang

Hisato Takagi, MD, PhD1,2 , Yosuke Hari, MD1,2,
Kouki Nakashima, MD, PhD1,2, Toshiki Kuno, MD, PhD3 ,and Tomo Ando, MD4; for The ALICE (All-Literature Investigationof Cardiovascular Evidence) Group

Abstract
To identify prospective cohort studies enrolling adults and investigating an association of egg consumption with incidence andmortality of coronary artery disease (CAD), PubMed and Web of Science were searched through June 2019. Adjusted hazard
ratios (HRs) of CAD incidence/mortality for more versus the least frequent egg consumption were extracted from each study.
Study-specific estimates were pooled in the random-effects model. Sixteen eligible studies with a total of 1 285 505 participants
were identified and included in the present meta-analysis. The primary meta-analysis pooling all HRs for the most versus least
frequent egg consumption demonstrated that egg consumption was associated with significantly low CAD incidence/mortality(pooled HR: 0.93; 95% confidence interval: 0.89-0.98; I2 ¼ 9%). In the secondary meta-analyses (separately combining HRs for thethird vs first tertile, the fourth vs first quartile, the third vs first quartile, the fifth vs first quintile, the fourth vs first quintile, and thethird vs first quintile egg consumption), the fifth (vs first) quintile egg consumption was only associated with significantly low CAD
incidence/mortality. In conclusion, egg consumption is independently associated with low incidence/mortality of CAD, which may
be derived from the comparisons of the fifth versus first quintile egg consumption.
Keywords
coronary artery disease, egg consumption, meta-analysis

Introduction

Methods

The relation of egg consumption to incidence and mortalityof coronary artery disease (CAD, synonym of coronary
heart disease and ischemic heart disease including myocardial infarction) has been insufficiently understood. 1
Previous meta-analyses suggest that egg consumption may
not be associated with low cardiovascular disease (CVD)mortality,1 all-cause mortality, 1-3 CAD incidence, 3-6 andCAD mortality.1-3 The potential association of dietary cholesterol with cardiac outcomes has been investigated forseveral decades.5 Although eggs are rich in nutrition, theircholesterol content is a concern.2 However, a recent large(>400 000 participants) prospective cohort study7 reported
a strong trend toward an association of fifth (vs first) quintile egg consumption with low CAD incidence, and anotherrecent large (>460 000 participants) prospective cohort
study 8 showed significant associations of fifth/fourth/third/second (vs first) quintile egg consumption with low
CAD incidence.
We hypothesized that egg consumption may be associatedwith low incidence and mortality of CAD. To verify our
hypothesis, we performed an updated meta-analysis of currently available prospective cohort studies.

The present meta-analysis was conducted according to thePreferred Reporting Items for Systematic Reviews and MetaAnalyses statement (http://www.prisma-statement.org).

79

Search Strategy
PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) and Web of
Science (http://www.webofknowledge.com/wos) weresearched through June 2019. Search terms consisted of egg and1

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka,Japan
2
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan3
Department of Medicine, Mount Sinai Beth Israel Medical Center, New York,NY, USA
4
Division of Interventional Cardiology, Department of Cardiology, New York
Presbyterian Hospital/Columbia University Medical Center, New York, NY,
USA
Corresponding Author:
Hisato Takagi, Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan.
Email: kfgth973@ybb.ne.jp

80

DOI: 10.1111/jocs.14499

ORIGINAL ARTICLE

Prognostic impact of baseline C‐reactive protein levels on
mortality after transcatheter aortic valve implantation
Hisato Takagi MD, PhD1,2| Toshiki Kuno MD, PhD3 | Yosuke Hari MD1,2 |Kouki Nakashima MD, PhD1,2 | Yujiro Yokoyama MD4 | Hiroki Ueyama MD3 |Tomo Ando MD5 | ALICE (All‐Literature Investigation of Cardiovascular Evidence) Group1

Department of Cardiovascular Surgery,Shizuoka Medical Center, Shizuoka, Japan2

Department of Cardiovascular Surgery,
Kitasato University School of Medicine,
Sagamihara, Japan3

Department of Medicine, Mount Sinai BethIsrael Medical Center, New York, New York
4

Department of Surgery, Easton Hospital,
Easton, Pennsylvania
5

Division of Interventional Cardiology,
Department of Cardiology, New York‐
Presbyterian Hospital, Columbia University
Medical Center, New York, New York
Correspondence
Hisato Takagi MD, PhD, Department of
Cardiovascular Surgery, Shizuoka Medical
Center, 762‐1 Nagasawa, Shimizu‐cho,Sunto‐gun, Shizuoka 411‐8611, Japan.
Email: kfgth973@ybb.ne.jp

Abstract
Objectives: To determine whether baseline C‐reactive protein (CRP) levels canpredict mortality after transcatheter aortic valve implantation (TAVI), we performed
a meta‐analysis of currently available studies.
Methods: All studies investigating the prognostic impact of baseline (preprocedural)
CRP levels on all‐cause mortality after TAVI were identified by means of searching
PubMed and Google Scholar through May 2019. For each study, (preferentially,
adjusted rather than unadjusted) odds/hazard ratios (ORs/HRs) with corresponding
95% confidence intervals of mortality per standard‐deviation (SD) (or unit) increasein CRP levels or those for high vs low CRP levels.
Results: Our search identified 14 eligible studies including a total of 3449 patients
undergoing TAVI and reporting early (in‐hospital to 3‐month) and midterm (1‐year
to 3‐year) all‐cause mortality after TAVI. Pooled analyses demonstrated associationsof high‐baseline CRP levels with a marginal, but statistically nonsignificant increasein early mortality (pooled OR/HR per SD increase in CRP levels, 2.72; P = .09 andpooled OR/HR for high vs low CRP levels, 3.32; P = .07) and a statistically significant
increase in midterm mortality after TAVI (pooled OR/HR per SD increase in CRP
levels, 1.45; P < .0001 and pooled OR/HR for high vs low CRP levels, 1.78;
P < .00001). Excluding HRs for high‐sensitivity CRP, combining ORs/HRs of 1‐year
mortality, pooling HRs of ≥2‐year mortality, and combining adjusted HRs did notalter the primary results.
Conclusion: High‐baseline CRP levels may predict increased midterm, but not early,
mortality after TAVI.
KEYWORDS

C‐reactive protein, meta‐analysis, mortality, transcatheter aortic valve implantation

1 | I NT R O D UCTI O N

coronary intervention [PCI],5‐7 coronary artery bypass grafting[CABG],8 and vascular surgery9). Several biomarkers (brain na-

C‐reactive protein (CRP) levels play an important role in predicting

triuretic peptides, troponins, galectin‐3, growth differentiation factor‐

prognoses of cardiovascular diseases (CVD) (stable coronary artery

15, and microRNAs) have been known to predict outcomes after

disease,1 acute coronary syndrome,2,3 and peripheral artery disease4)transcatheter aortic valve implantation (TAVI).10 A number of rela-and outcomes after cardiovascular (CV) interventions (percutaneoustively small‐size studies have investigated the prognostic impact of

J Card Surg. 2020;1–7.

wileyonlinelibrary.com/journal/jocs

81© 2020 Wiley Periodicals, Inc.

|

1

Original Article

Neth Heart J
https://doi.org/10.1007/s12471-020-01378-1

Mortality after transcatheter versus surgical aortic valve
replacement: an updated meta-analysis of randomised trials
H. Takagi for ALICE (All-Literature Investigation of Cardiovascular Evidence) Group · Y. Hari for ALICE (AllLiterature Investigation of Cardiovascular Evidence) Group · K. Nakashima for ALICE (All-Literature Investigationof Cardiovascular Evidence) Group · T. Kuno for ALICE (All-Literature Investigation of Cardiovascular Evidence)Group · T. Ando for ALICE (All-Literature Investigation of Cardiovascular Evidence) Group© The Author(s) 2020

Abstract
Background To determine whether transcatheter aortic valve implantation (TAVI) improves early (30-day)and midterm (1-year) mortality compared with surgical aortic valve replacement (SAVR), we performed
an updated meta-analysis of all the currently available
randomised controlled trials (RCTs).
Methods To identify all RCTs providing both 30-day
and 1-year mortality after TAVI versus SAVR, PubMed
and ClinicalTrials.gov were searched up to and including July 2019. A risk difference (RD) and its
95% confidence interval were generated using dataof prespecified outcomes in both the TAVI and SAVR
groups. Study-specific estimates were pooled using
inverse variance-weighted averages of RDs in the
random-effects model.
Results We identified seven eligible high-quality RCTs
including a total of 7631 as-treated patients. Pooled
analyses demonstrated significantly lower 30-day (RD–0.60%; p = 0.046) and 1-year all-cause mortality (RD–1.12%; p = 0.03) after TAVI than after SAVR. No funnel
plot asymmetry was detected for 30-day and 1-year
mortality. Meta-regression analyses indicated thatRDs of 30-day and 1-year mortality between TAVIand SAVR were not modulated by mean Society ofThoracic Surgeons Predicted Risk of Mortality score.
Bleeding complications at 30 days and 1 year andstage 2/3 acute kidney injury at 30 days were significantly less frequent after TAVI than after SAVR,
whereas major vascular complications and new permanent pacemaker implantation at 30 days and 1 year
were significantly more frequent after TAVI than after
SAVR.
Conclusion The best evidence from the present metaanalysis of all the currently available RCTs suggeststhat TAVI may reduce 30-day and 1-year all-cause
mortality compared with SAVR.

What’s new?
To determine whether transcatheter aortic valve
implantation (TAVI) improves early (30-day)and midterm (1-year) mortality compared withsurgical aortic valve replacement (SAVR), we
performed an updated meta-analysis of all thecurrently available randomised controlled trials(RCTs).
 We identified seven eligible high-quality RCTs including a total of 7631 as-treated patients.
 None of the included RCTs showed significantly
lower all-cause mortality after TAVI than after
SAVR.
 Pooled analyses demonstrated significantly lower
30-day [risk difference (RD) –0.60%; p = 0.046]
and 1-year all-cause mortality (RD –1.12%;
p = 0.03) after TAVI than after SAVR.
Electronic supplementary material The online version ofthis article (https://doi.org/10.1007/s12471-020-01378-1)
contains supplementary material, which is available toauthorized users.
H. Takagi () · Y. Hari · K. Nakashima
Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Department of Cardiovascular Surgery, Kitasato University
School of Medicine, Sagamihara, Japankfgth973@ybb.ne.jp
T. KunoDepartment of Medicine, Mount Sinai Beth Israel Medical
Center, New York, NY, USA
T. AndoDivision of Interventional Cardiology, Department of
Cardiology, New York Presbyterian Hospital/Columbia
University Medical Center, New York, NY, USA

Mortality after transcatheter versus surgical aortic valve replacement: an updated meta-analysis of. . .

82

83

84

Predictors of Hospital Cost After Transcatheter Aortic
Valve Implantation in the United States: From the
Nationwide Inpatient Sample Database
1XD XTomo Ando, D2X XMDa, D3X XOluwole Adegbala, D4X XMD, MPHb, D5X XPedro A. Villablanca, D6X XMD, MScc,
D7X XEmmanuel Akintoye, D8X XMD, MPHa, D9X XSaid Ashraf, D10X XMDa, D1X XAlexandros Briasoulis, D12X XMD, PhDd,
D13X XTesfaye Telila, D14X XMDe, D15X XHisato Takagi, D16X XMD, PhDf, D17X XCindy L. Grines, D18X XMDg, D19X XTheodore Schreiber, D20X XMDa,
D21X XDeepak L. Bhatt, D2X XMD, MPHh, and D23X XLuis Afonso, D24X XMDa,*
We aimed to identify risk factors of high hospitalization cost after transcatheter aortic
valve implantation (TAVI). TAVI expenditure is generally higher compared with surgicalaortic valve replacement. We queried the Nationwide Inpatient Sample database fromJanuary 2011 to September 2015 to identify those who underwent endovascular TAVI.
Estimated cost of hospitalization was calculated by merging the Nationwide Inpatient
Sample database with cost-to-charge ratios available from the Healthcare Cost and Utilization Project. Patients were divided into quartiles (lowest, medium, high, and highest)
according to the hospitalization cost, and multivariable regression analysis was performed
to identify patient characteristics and periprocedural complications associated with thehighest cost group. A total of 9,601 TAVI hospitalizations were identified. Median in-hospital costs of the highest and lowest groups were $82,068 and $33,966, respectively.
Patients in the highest cost group were older and more likely women compared with thelowest cost group. Complication rates (68.4% vs 22.5%) and length of stay (median
10 days vs 3 days) were both approximately 3 times higher and longer, respectively, in thehighest cost group. Co-morbidities such as heart failure, peripheral vascular disease,atrial fibrillation, anemia, and chronic dialysis as well as almost all complications wereassociated with the highest cost group. The complications with the highest incremental
cost were acute respiratory failure requiring intubation ($28,209), cardiogenic shock($22,401), and acute kidney injury ($16,974). Higher co-morbidity burden and major complications post-TAVI were associated with higher hospitalization costs. Prevention of thesecomplications may reduce TAVI-related costs. © 2019 Elsevier Inc. All rights reserved.
(Am J Cardiol 2019;123:1142−1148)

Transcatheter aortic valve implantation (TAVI) is an
attractive treatment method from a clinical standpoint,
however, healthcare-related cost should be examined asvalue-based therapies, and cost containment measures are
gaining increasing relevance. In 2012, the total expenditure
for TAVI from Medicare was 215,770,200 US dollars for
4,083 TAVI procedures and the hospital costs werehigher for TAVI compared with surgical aortic valve
replacement (SAVR) (median $50,200 vs $45,500).1 In
addition, TAVI had higher hospitalization costs comparedwith SAVR when factoring readmission costs.2 When

procedure-related complications occur, this additional cost
will further increase the hospital cost of TAVI and may
make it a less attractive option compared with SAVR.
Arnold et al have reported procedural costs associated withTAVI from the PARTNER trial.3 However, the data werelimited for initial TAVI experience in the United States.
This study identifies baseline characteristics and periprocedural complications associated with high cost and also to
calculate the incremental cost of major in-hospital complications after TAVI using the Nationwide Inpatient Sample(NIS) database.

aWayne State University/Detroit Medical Center, Detroit, Michigan;
Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey; cHenry Ford
Hospital, Detroit, Michigan; dUniversity of Iowa Hospitals and Clinics,
Iowa, Iowa; ePiedmont Heart Institute, Atlanta, Georgia; fShizuoka Medical Center, Shizuoka, Japan; gNorth Shore University Hospital, Hofstra
Northwell School of Medicine, Manhasset, New York; and hBrigham and
Women’s Hospital Heart & Vascular Center, Harvard Medical School,
Boston, Massachusetts. Manuscript received October 22, 2018; revised manuscript received and accepted December 19, 2018.
See page 1147 for disclosure information.
*Corresponding author: Tel: 313-745-6035.
E-mail address: LAfonso@med.wayne.edu (L. Afonso).

Methodsb

This study was conducted using the NIS database, whichis part of the Healthcare Cost and Utilization Project(HCUP).4 NIS is the largest all-payer inpatient admission
database in the United States. It represents a 20% stratified
sample of all discharges from community hospitals in the
United States. Rehabilitation and long-term acute care hospitals are not included. The NIS includes data on primaryand secondary discharge diagnoses, procedures, patient
demographics, hospital characteristics, expected payment
source, total hospitalization cost, discharge status, length of0002-9149/© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2018.12.044

www.ajconline.org

85

Research Article

Incidence, Trends, and Predictors of
Palliative Care Consultation After Aortic
Valve Replacement in the United States

Journal of Palliative Care
2019, Vol. 34(2) 111-117ª The Author(s) 2018
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0825859718819433
journals.sagepub.com/home/pal

Tomo Ando, MD1, Oluwole Adegbala, MD, MPH2, Takeshi Uemura, MD3,
Emmanuel Akintoye, MD, MPH1, Said Ashraf, MD1, Alexandros Briasoulis, MD, PhD4,
Hisato Takagi, MD, PhD5, and Luis Afonso, MD1

Abstract
Aim: Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have become a reasonably
safe procedure with acceptable morbidity and mortality rate. However, little is known regarding the incidence, trends, andpredictors of palliative care (PC) consult in aortic valve replacement (AVR) patients. The main purpose of this analysis was toassess the incidence, trends, and predictors of PC consultation in AVR recipients using the Nationwide Inpatient Sample (NIS)
database. Materials and Methods: We queried the NIS database from 2005 to September 2015 to identify those who
underwent TAVR or SAVR and had PC referral during the index hospitalization. Adjusted odds ratio (aOR) was calculated to
identify patient demographic, social and hospital characteristics, and procedural characteristics associated with PC consult using
multivariable regression analysis. We also reported the trends of PC referral in AVR recipients. Results: A total of 522 765
admissions (mean age: 75.3 + 7.8 years, 40.3% female) who had TAVR (1.7% transapical and 9.2% endovascular approach) and
SAVR (89.2%) were identified. Inpatient mortality was 3.96%, and 0.5% patients of the total admissions had PC consultation. The
PC referral for SAVR increased from 0.90 to 7.2 per 1000 SAVR from 2005 to 2015 (P ¼ .011), while it remained stable ranging
from 9.30 to 13.3 PC consults per 1000 TAVR (P ¼ .86). Age 80 to 89 (aOR: 1.93), age 90 years (aOR: 2.57), female sex (aOR:
1.36), electrolyte derangement (aOR: 1.90), weight loss (aOR: 1.88), and do not resuscitate status (aOR: 44.4) were associatedwith PC consult. West region (aOR: 1.46) and Medicaid (aOR: 3.05) were independently associated with PC consult. Endovascular(aOR: 1.88) and transapical TAVR (aOR: 2.80) had higher PC referral rates compared with SAVR. Conclusions: There was anincrease in trends for utilization of PC service in SAVR admissions while it remained unchanged in TAVR cohort, but the overall
PC referral rate was low in AVR recipients during the index hospitalization.
Keywords
surgical aortic valve replacement, transcatheter aortic valve replacement, palliative care
Research Consortium-2 document delineates several clinicallyimportant complications post-TAVR.10 However, there is
scarce discussion regarding the care required for patients who
experienced significant complications affecting their quality of

Introduction
Candidates of either transcatheter aortic valve replacement(TAVR) or surgical aortic valve replacement (SAVR) for
severe, symptomatic aortic stenosis are often old, have multiple
comorbidities related to atherosclerotic disease (ie, coronary
artery disease), and frail. Improvements in patient selection,
perioperative managements, and advancements in technologies
have led to improved outcomes in these patients. Indeed, thecontemporary short-term (in-hospital or 30-day) mortality of
TAVR and SAVR is relatively low, ranging from 2.8% to 3.9%
and 1.7% to 6.5% in intermediate to high surgical risk patients,
respectively.1-4 Although some perioperative clinical events
may not necessarily lead to mortality, it could culminate insignificant disabilities and impair quality of life.
Palliative care (PC) has been a valuable resource in patientswith terminally ill cancer as well as in noncancer medical
conditions (ie, advanced heart failure),5-8 but PC has been
underutilized in cardiovascular disease.9 The Valve Academic

1

Division of Cardiology, Detroit Medical Center, Wayne State University,
Detroit, MI, USA
2
Department of Internal Medicine, Englewood Hospital and Medical Center,
Seton Hall University–Hackensack Meridian School of Medicine, Englewood,
NJ, USA
3
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of
Medicine, New York, NY, USA
4
Divison of Cardiovascular Medicine, University of Iowa Hospitals and Clinics,
Iowa City, IA, USA
5
Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Corresponding Author:
Tomo Ando, Division of Cardiology, Detroit Medical Center, 3990, John R,
Detroit, MI 48201, USA.
Email: andotomo@hotmail.co.jp

86Received: 22 June 2018

Revised: 23 September 2018

Accepted: 16 October 2018

DOI: 10.1002/ccd.27968

ORIGINAL STUDIES

In-hospital outcomes of transcatheter versus surgical aortic
valve replacement in non-teaching hospitals
Tomo Ando MD1| Oluwole Adegbala MD, MPH2 | Pedro A. Villablanca MD, MSc3 |Alexandros Briasoulis MD, PhD4

| Hisato Takagi MD, PhD5

| Cindy L. Grines MD6 |Theodore Schreiber MD1 | Tamim Nazif MD7 | Susheel Kodali MD7 | Luis Afonso MD1
1

Department of Medicine, Division of
Cardiology, Wayne State University/Detroit
Medical Center, Detroit, Michigan

Abstract
Objectives: To assess the in-hospital outcomes of transcatheter aortic valve replacement2

Department of Medicine Department ofInternal Medicine, Englewood Hospital andMedical Center, Seton Hall UniversityHackensack Meridian School of Medicine,Englewood, New Jersey(TAVR) vs. surgical aortic valve replacement (SAVR) in non-teaching hospitals.

32015 to identify those who were 50 years or above and underwent either trans-arterial TAVR

Background: TAVR has become widely available in the United States. However, the comparative outcomes of TAVR vs. SAVR in non-teaching hospitals are largely under explored.
Methods: We queried the Nationwide Inpatient Sample database from 2011 to September

Department of Medicine, Division of
Cardiology, New York University Langone
Medical Center, New York, New Yorkor SAVR at non-teaching hospital. In-hospital clinical outcomes were compared with odds ratio(OR) in propensity-matched cohorts.

4

Department of Medicine, Division of
Cardiovascular Medicine, University of Iowa
Hospitals and Clinics, Iowa, Iowa

Results: We identified un-weighted 957 and 7,465 SAVR admissions. In propensity-matched model,
596 admissions in each arm were included for final analysis. In-patient mortality (3.9 vs. 2.5%, OR
1.54, P = 0.34), acute kidney injury requiring dialysis (2.2 vs. 2.7%, OR 0.80, P = 0.57), stroke (2.05Department of Medicine, Division of
Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japanvs. 3.2%, OR 0.61, P = 0.20), and pacemaker placement (8.9 vs. 6.4%, OR 1.47, P = 0.09) was similar
between TAVR and SAVR. Sub-group analysis showed that female and those with prior coronary

6

Department of Medicine, Division of
Cardiology, North Shore University Hospital,
Hofstra Northwell School of Medicine,
New Yorkartery bypass surgery had higher risk of in-patient morality in TAVR admission. Cost was higher(59,103 vs. 53,411 dollars, P = 0.006) but length of stay was shorter in TAVR (6.9 vs. 10.2 days,
P < 0.001).

7

Department of Medicine, Division of
Cardiology, New York-Presbyterian Hospital,
College of Physicians and Surgeons, Columbia
University Medical Center, New York,New York

Conclusions: TAVR conferred similar in-hospital mortality and major peri-procedural complications compared with SAVR in non-teaching hospitals. For those with limited access to teaching
hospitals, non-teaching hospitals appear to be a reasonable option for candidates of aortic valve
replacement for severe aortic stenosis.

Correspondence
Tomo Ando MD, Detroit Medical Center,
Division of Cardiology, 3990, John R, Detroit,
MI 48201.
Email: andotomo@hotmail.co.jp

KEYWORDS

aortic stenosis, non-teaching hospital, surgical aortic valve replacement, transcatheter aortic
valve replacement

1 | I N T RO D UC T I O N

performed was 4,627 in 2012 but almost increased by 6-folds up to
24,808 in 2015 with decline in in-hospital mortality from 5.9% in

The procedural number of transcatheter aortic valve replacement

2012 to 2.9% in 2015.3 With its expansion in utilization as a major(TAVR) has dramatically increased as large randomized control studies

treatment modality for severe, symptomatic aortic stenosis, the num-

have demonstrated its similar efficacy and safety compared with sur-ber of TAVR performed at non-teaching hospitals also increased fromgical aortic valve replacement (SAVR).

1,2

According to the 2016

only 3.6% in 2011 to 8 to 10% in 2012 to 2014.4

Annual report of the Society of Thoracic Surgeons/American College

Outcomes of invasive cardiac procedures between teaching andof Cardiology Transcatheter Valve Therapy Registry, number of TAVR

non-teaching hospitals have been reported in the past with unique954© 2018 Wiley Periodicals, Inc.

wileyonlinelibrary.com/journal/ccd

87

Catheter Cardiovasc Interv. 2019;93:954–962.

ORIGINAL ARTICLE

Heart, Lung and Circulation (2019) 28, 1235–1245
1443-9506/04/$36.00
https://doi.org/10.1016/j.hlc.2018.07.013

Comparison of Health Related Qualityof Life in Transcatheter Versus
Surgical Aortic Valve Replacement:
A Meta-Analysis
Tomo Ando, MD a*, Hisato Takagi, MD, PhD b,
Alexandros Briasoulis, MD, PhD c, Cindy L. Grines, MD d,
Luis Afonso, MD aa

Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japanc
Division of Cardiology, University of Iowa Hospitals and Clinics, IA, USAdDivision of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY, USAb

Received 12 March 2018; received in revised form 6 July 2018; accepted 25 July 2018; online published-ahead-of-print 17 August 2018

Background

Data on the effects of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve
replacement (SAVR) on health-related quality of life (HRQOL) outcomes are limited. To assess the comparative HRQOL outcomes between TAVR and SAVR, we performed a systematic review and metaanalysis.

Methods

PubMed and EMBASE databases were searched for articles that compared the HRQOL scores, Kansas City
Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study Short-Form Health Survey 12 or 36 (SF12/36), or the EuroQoL 5 Dimension score (EQ-5D) at 30 days and 1 year between TAVR and SAVR. Meandifference (MD) and 95% confidence interval (CI) was calculated with inverse variance statistical method
and random-effects model.

Results

A total of four studies with 4,125 patients (1268 transfemoral [TF]-TAVR, 1261 Non-TF TAVR [transsubclavian, transapical or transaortic], and 1,596 SAVR) were included in the studies. KCCQ overall summaryscores and its subscales, SF-12/36, and EQ-5D were significantly higher in TF-TAVR compared to SAVR but
were similar in non-TF TAVR vs. SAVR at 30 days. At 1-year follow-up, TF-TAVR and non-TF TAVR
conferred similar HRQOL scores in KCCQ overall summary and subscales scores, SF-12/36, and EQ-5D
compared to SAVR.

Conclusions

Transfermoral-TAVR achieved better HRQOL at 30 days but similar HRQOL at 1 year compared to SAVR.
Non-TF TAVR resulted in similar improvements in HRQOL at both 30 days and 1 year compared with
SAVR.

Keywords

Meta-analysis  Surgical aortic valve replacement  Transcatheter aortic valve replacement  Quality oflife

Introduction*Corresponding author at: Detroit Medical Center, Division of Cardiology, 3990, John R, Detroit, MI, 48201, USA. Tel.: +1 313 745 2620, Fax: +1 313 745 8643.,
Email: andotomo@hotmail.co.jp© 2018 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia
and New Zealand (CSANZ).

88

Received: 1 October 2018

Revised: 11 November 2018

Accepted: 25 November 2018

DOI: 10.1002/ccd.28025

ORIGINAL STUDIESTransradial versus transfemoral percutaneous coronary
intervention of left main disease: A systematic review andmeta-analysis of observational studies
Tomo Ando MD1,2| Shunsuke Aoi MD3| Said Ashraf MD1

Pedro A. Villablanca MD, MSc4 | Tesfaye Telila MD5
Alexandros Briasoulis MD, PhD6||

| Hisato Takagi MD, PhD2,7| Luis Afonso MD1 |Cindy L. Grines MD8
1

Department of Medicine Division of
Cardiology, Wayne State University/Detroit
Medical Center, Detroit, Michigan

2

ALICE (All-Literature Investigation of
Cardiovascular Evidence) Group3

Department of Medicine Division of
Cardiology, Mount Sinai Beth Israel, Icahn
School of Medicine, New York, New York

4

Department of Medicine, Division of
Cardiology, Henry Ford Hospital, Detroit,
Michigan5

Abstract
Objectives: To assess the efficacy and safety of transradial (TR) versus transfemoral(TF) percutaneous coronary intervention (PCI) in left main (LM) lesion.
Background: TR-PCI is the preferred approach compared with TF approach because of lessbleeding risk. LM-PCI is often challenging because of the anatomical complexity and uniquenessof supplying a large myocardium territory. We performed a systematic review and meta-analysis
to assess the safety and efficacy of TR-PCI compared with TF-PCI of the LM lesions.
Methods: A comprehensive literature search of PUBMED, EMBASE, and Cochrane database
was conducted to identify studies that reported the comparable outcomes between both

Piedmont Heart Institute, Atlanta, Georgia

approaches. Odds ratio (OR) and 95% confidence interval (CI) was calculated using the Mantel–

Department of Medicine, Division of
Cardiovascular Medicine, University of Iowa
Hospitals and Clinics, Iowa, Iowa

Haenszel method.

6

7

Department of Medicine, Division of
Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan

8

Department of Medicine Division of
Cardiology, North Shore University Hospital,
Hofstra Northwell School of Medicine,
New York
Correspondence
Tomo Ando, Detroit Medical Center, Divisionof Cardiology, 3990, John R, Detroit, MI
48201.
Email: andotomo@hotmail.co.jp

Results: A total of eight studies were included in the quantitative meta-analysis. TR-PCI resulted
in lower bleeding risk (OR 0.31, 95%CI 0.18–0.52, P < 0.01, I2 = 0%) while maintaining similar
procedural success rate, target lesion revascularization, myocardial infarction, stent thrombosis,
and all-cause mortality during the study follow-up period.
Conclusions: TR-PCI may achieve similar efficacy with decreased bleeding risk compared to TFPCI in LM lesions. When operator experience and anatomical complexity are favorable, TR
approach is an attractive alternative access over TF approach in LM-PCI.
KEYWORDS

left main, percutaneous coronary intervention, transfemoral, transradial

1 | I N T RO D UC T I O N

there is less consensus on whether this would hold true for left main(LM) lesions. A PCI of the LM lesion poses unique and challenging task

Transradial (TR) percutaneous coronary intervention (PCI) has been

as it jeopardizes significant myocardial territory and frequently

increasingly adopted as the preferred approach across the spectrum

includes PCI of the bifurcation, another form of a formidable lesionof coronary artery disease compared with transfemoral (TF)-PCI owing

for PCI.

mainly to low bleeding risk and in some studies even lower mortality
rate.

1–7

The data regarding the safety and efficacy of TR-PCI comparedIn the latest European revascularization guideline, radialwith TF-PCI in LM disease are limited. TF-PCI seem attractive as it

access was recommended as the standard approach for PCI, unlesswould assure more secure catheter back up support during PCI and8other considerations override (Class I, level of evidence A). However,264© 2018 Wiley Periodicals, Inc.

allows the use of larger size catheter to perform complex-PCI.

wileyonlinelibrary.com/journal/ccd

89

Catheter Cardiovasc Interv. 2019;94:264–273.

In-Hospital Outcomes of ST-Segment Elevation
Myocardial Infarction Complicated With Cardiogenic
Shock at Safety-Net Hospitals in the United States(from the Nationwide Inpatient Sample)
Tomo Ando, MDa,*, Emmanuel Akintoye, MD, MPHb, Oluwole Adegbala, MD, MPHc,
Said Ashraf, MDa, Mohamed Shokr, MDa, Hisato Takagi, MD, PhDd, Cindy L. Grines, MDe,
Luis Afonso, MDa, and Alexandros Briasoulis, MD, PhDb
Safety-net hospitals (SNHs) are hospitals that serve a higher proportion of patients
insured by Medicaid or uninsured and have been reported to have poor outcomes compared with non-SNHs. Procedural and clinical outcomes of ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) at SNHs have not been welldescribed. Nationwide Inpatient Sample from 2005 to 2011 was queried to identify
STEMI-CS and age ≥18. SNHs were defined as hospitals with the highest number of inpatient stays that were paid by Medicaid or were uninsured (the top quartile). A total of
23,229 STEMI-CS of which 3,639 (15.7%) were treated at SNHs. Admissions to SNHs
were younger (mean age 66.0 vs 67.2, p < 0.001), more likely men (64.0% vs 62.2%,
p = 0.04), more frequently ethnic minorities (Black; 11.0% vs 6.0%, Hispanic 20.4% vs
5.8%, p < 0.001), and had higher Elixhauser ≥4 (25.8% vs 21.9%, respectively, p < 0.001).
Percutaneous coronary interventions were less performed (60.4% vs 65.8%, p < 0.001)
whereas administrations of thrombolysis (2.9% vs 2.1%, p = 0.001) were more frequent at
SNHs. Coronary artery bypass and the use of mechanical circulatory support was similar.
In-hospital mortality was significantly elevated at SNHs (36.6% vs 32.7%, adjusted odds
ratio 1.24, 95% confidence interval 1.10 to 1.39) whereas new dialysis, stroke, and fatalarrhythmias were similar. The median length of stay was similar (6 vs 7 days, p = 0.58) but
the median cost was higher (40,175 vs 38,012 US dollars, p = 0.01) at SNHs. SNHs had
lower utilization of percutaneous coronary intervention and higher in-hospital mortality
compared with non-SNHs in STEMI-CS. Further cause analysis is warranted to improveoutcomes of STEMI-CS admitted at SNHs. © 2019 Elsevier Inc. All rights reserved.
(Am J Cardiol 2019;124:485−490)

Safety-net hospitals (SNHs) are defined as hospitals thatserve high proportions of patients insured by Medicaid or
uninsured.1 SNHs accounted for approximately one-third of
all hospital stays in the United States in 2014 and play vitalroles in providing healthcare to vulnerable populations.2
However, some studies have reported worse outcomes in
SNHs.3−8 When higher intensity of care is necessary, SNHs
may have disadvantages due to limitations in resources andavailable services.9 The outcomes of ST-segment elevation
myocardial infarction (STEMI) has improved dramatically
due to primary percutaneous coronary intervention (PCI) andadvancements of adjunctive pharmacological therapies.10−12

However, the mortality of STEMI complicated with cardiogenic shock (STEMI-CS) remains high, ranging from 30%
to 50%.13−17 The care of patients with STEMI-CS is complex as it requires intensive care unit stay, use of mechanicalcirculatory support (MCS), and prompt access to subspecialties. We sought to assess the patient demographics, procedural characteristics, and in-hospital outcomes of STEMI-CS
between SNHs and non-SNHs.
Methods
The Nationwide Inpatient Sample (NIS) database, anadministrative database that contains 20% sample of all thedischarges in the United States produced by the Healthcare
Cost and Utilization Project. We used the data from January2005 to December 2011 and International Classification of
Diseases, Ninth Edition Clinical Modification (ICD-9-CM)
codes to identify the primary discharge diagnosis of STEMI(ICD-9-CM; 410.0x, 410.1x, 410.2x, 410.3x, 410.4x,
410.5x, 410.6x, and 410.8x) and diagnosis of CS (ICD-9CM; 785.51) other than the primary diagnosis with age morethan 18. We excluded those with a previous heart transplant(ICD-9-CM; V42.1) and left ventricular assist device or
artificial heart (ICD-9-CM; V43.21). Additionally, electiveaDivision of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan; bUniversity of Iowa Hospitals and Clinics, Iowa,
Iowa; cDivision of Internal Medicine, Englewood Hospital and Medical
Center, Seton Hall University-Hackensack Meridian School of Medicine,Englewood, New Jersey; dDivision of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan; and eDivision of Cardiology, North
Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, New York. Manuscript received February 18, 2019; revised manuscript received and accepted May 13, 2019.
See page 489 for disclosure information.
*Corresponding author: Tel: (313) 745-2620; fax: (313) 745-8643.
E-mail address: andotomo@hotmail.co.jp (T. Ando).

0002-9149/© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2019.05.037

www.ajconline.org

90

Meta-Analysis of Effectiveness and Safetyof Transcatheter Aortic Valve Implantation
Versus Surgical Aortic Valve Replacement in
Low-to-Intermediate Surgical Risk Cohort
Tomo Ando, MDa,*, Said Ashraf, MDa, Pedro Villablanca, MD, MScb, Toshiki Kuno, MDc,
Mohit Pahuja, MDa, Mohamed Shokr, MDa, Luis Afonso, MDa, Cindy Grines, MDd,
Alexandros Briasoulis, MD, PhDe, and Hisato Takagi, MD, PhDf
Transcatheter aortic valve implantation (TAVI) has been used to treat high surgical riskcohorts but has been expanded to treat low-to-intermediate risk cohort as well. We performed a systematic review and meta-analysis to compare the outcomes between TAVI andsurgical aortic valve replacement (SAVR) in low-to-intermediate risk cohort. We queried
PUBMED, EMBASE, and ClinicalTrial.gov for relevant articles. Randomized controlled trials that compared at least one of the outcomes of interest between TAVI and SAVR were
included. Risk ratio (RR) and 95% confidence interval (CI) were pooled with a randomeffects model to compare the risk of the primary outcome between the 2 procedures. The primary outcome was a composite of all-cause mortality or disabling/major stroke at 1 year.
Seven studies with a total of 7,143 patients (3,665 TAVI) were included. All-cause mortality
or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI 0.49 to 1.03) was similar
between TAVI and SAVR but was significantly lower in TAVI at 1 year (5 studies, RR 0.81,
95% CI 0.67 to 0.98). All-cause mortality was similar at both 30 days (7 studies, RR 0.90,
95% CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04). Disabling/major
stroke was similar between the 2 procedures (6 studies, RR 0.69, 95% CI 0.42 to 1.12) at 30
days but was significantly lower in TAVI at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98).
Age, gender, diabetes, and surgical risk score did not modulate the primary outcome. TAVI
had a significantly lower composite of all-cause mortality or disabling/major stroke at 1 year
compared with SAVR in low-to-intermediate surgical risk cohort. © 2019 Elsevier Inc. All
rights reserved. (Am J Cardiol 2019;124:580−585)

Transcatheter aortic valve implantation (TAVI) is aclass IIa recommendation for intermediate surgical risk
and there is no recommendation for low surgical risk
patients. Surgical aortic valve replacement (SAVR) is aclass I for low, intermediate, and high surgical risk
patients.1 Low-to-intermediate surgical risk patients comprised >90% of candidates for aortic valve replacement.2
Therefore, it is important to compare the outcomes of
TAVI and SAVR in this cohort. Recently, 2 trials havebeen published that compared outcomes between TAVIand SAVR in low-risk patients.3,4 Our aim was to compare TAVI versus SAVR outcomes in low-to-intermediate surgical risk candidates that vast majority belong towith severe aortic stenosis requiring intervention. We

hypothesized that TAVI confers similar clinical outcomescompared with SAVR.
Methods
A comprehensive online database search (PUBMED,EMBASE, and ClinicalTrial.gov) was performed from January 1, 2002 to March 20, 2019. The search term was (TAVI
OR TAVR OR transcatheter aortic valve replacement OR
TAVI OR percutaneous aortic valve replacement OR percutaneous aortic valve intervention OR aortic valve replacement
OR aortic valve intervention) and (random OR randomized
OR randomization OR randomized OR randomization). Two
authors (TA and SA) independently searched the online database. Any disagreement was resolved through discussion.
The third author (HT) was consulted when an agreement was
not met between these 2 authors. We did not apply language
restriction. First, the title of the manuscript was screened forpotential eligibility to our study purpose and if considered relevant, an abstract was carefully read to assess for further consideration to evaluate the full manuscript. Full manuscripts
were obtained after the final list of included studies was
made. Reference list of finally included manuscripts was
manually searched for further screening of relevant articles.
No contact was made to the corresponding author when the
study did not report outcomes of interest. This systematicaWayne State University/Detroit Medical Center, Detroit, Michigan;
Henry Ford Hospital, Detroit, Michigan; cMount Sinai Beth Israel, New
York, New York; dNorth Shore University Hospital, Hofstra Northwell
School of Medicine, Manhasset, New York; eUniversity of Iowa Hospitals
and Clinics, Iowa, Iowa; and fShizuoka Medical Center, Shizuoka, Japan.
Manuscript received April 9, 2019; revised manuscript received and accepted
May 13, 2019.
There was no extramural funding for this research.
See page 584 for disclosure information.
*Corresponding author: Tel: 313-745-2620; fax: 313-745-8643.
E-mail address: andotomo@hotmail.co.jp (T. Ando).
b0002-9149/© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2019.05.017

www.ajconline.org

91International Journal of Cardiology 292 (2019) 50–55

Contents lists available at ScienceDirect

International Journal of Cardiology
journal homepage: www.elsevier.com/locate/ijcard

Incidence and predictors of readmissions to non-index hospitals after
transcatheter aortic valve replacement and the impact on in-hospitaloutcomes: From the nationwide readmission database
Tomo Ando a,⁎, Oluwole Adegbala b, Pedro Villablanca c, Emmanuel Akintoye d, Said Ashraf a, Mohamed Shokr a,
Fayez Siddiqui a, Hisato Takagi e, Cindy L. Grines f, Luis Afonso a, Alexandros Briasoulis daDivision of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States
Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, United StatescDivision of Cardiology, Henry Ford Hospital, Detroit, MI, United StatesdDivision of Cardiology, University of Iowa, Hospitals and Clinics, IA, Iowa, United Statese
Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japanf
Division of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY, United Statesba r t i c l e

i n f oArticle history:
Received 24 November 2018
Received in revised form 17 April 2019
Accepted 17 April 2019
Available online 30 April 2019
Keywords:
Continuity of care
Outcomes
Readmission
Transcatheter aortic valve replacementa b s t r a c t
Introduction: Whether readmission to non-index hospitals (where the initial procedure was not performed)
could result in adverse outcomes and increased utilization of healthcare resources compared with readmission
to index hospitals after transcatheter aortic valve replacement (TAVR) remains unclear.
Methods: From January 2012 to September 2015, a nationwide readmission database was queried to identify
those who were older than 50 years and had endovascular TAVR, using the International Classiﬁcation of Disease,
9th Revision, Clinical Modiﬁcation code 35.05. Elective readmissions were excluded. In-hospital outcomes werecompared between the index and non-index hospital readmissions. A multivariable logistic regression analysis
was performed to identify predictors of non-index hospital readmissions.
Results: A total of 6808 readmissions were identiﬁed of which 2564 (37.7%) were readmitted to non-index hospitals. Residents at smaller counties, metropolitan non-teaching hospitals, or hospitals at large metropolitan
areas were predictors of non-index readmissions. In-hospital mortality (adjusted odds ratio [aOR] 1.27, p =0.20), acute myocardial infarction (aOR 0.83, p = 0.53), pacemaker placement (aOR 0.97, p = 0.90), acute kidney
injury (aOR 0.98, p = 0.84), and stroke (aOR 1.03, p = 0.90) were similar between index and non-index
readmissions but bleeding events requiring transfusions were more frequently observed in readmissions at
non-index hospitals (aOR 1.32, p = 0.025). Hospital cost (15,410 dollars vs. 16,390 dollars, p = 0.25) and lengthof stay (5.70 days vs. 5.65 days, p = 0.85) were comparable between groups.
Conclusions: Non-index readmissions post-TAVR was relatively common but did not result in increased hospitalmortality or healthcare utilization. Our results are reassuring for TAVR recipients with limited access to index
hospitals.
© 2019 Elsevier B.V. All rights reserved.

1. Introduction
Candidates for transcatheter aortic valve replacement (TAVR) areusually older, frail, and have multiple comorbid conditions resulting in
relatively high readmission rate, ranging from 15 to 18% within 30days [1,2]. Early readmission has a negative impact on clinical and ﬁnancial outcomes and could potentially be considered as a performance
metric of TAVR [3,4].

⁎ Corresponding author at: Detroit Medical Center, Division of Cardiology, 3990, John R,
Detroit, Michigan 48201, United States.
E-mail address: tomo.ando@wayne.edu (T. Ando).

Readmission to non-index hospitals could result in fragmentation ofcare. Worse outcomes have been reported with the fragmentation ofcare or when readmissions occurred at non-index hospitals [5–7]. However, the rate and impact of readmission to non-index hospitals are
scarce post-TAVR. To avoid readmission to non-index hospitals andfragmentation of care, patients should ideally be readmitted to index
hospitals but geographical access and socioeconomic factors may limit
readmission to index hospitals given that TAVR is often performed atlarge centers. The incidence and predictors of non-index hospitalization,
as well as its impact on clinical and ﬁnancial outcomes, are limited in
TAVR population.
The aim of this study was to clarify these clinically important issues
from the Nationwide Readmission Database (NRD).

https://doi.org/10.1016/j.ijcard.2019.04.056
0167-5273/© 2019 Elsevier B.V. All rights reserved.

92

DOI: 10.1111/jocs.14187

ORIGINAL ARTICLE

The impact of safety‐net burden on in‐hospital outcomes after
surgical aortic valve replacement| Oluwole Adegbala MD, MPH2 | Emmanuel Akintoye MD, MPH3 |Alexandros Briasoulis MD, PhD3
| Hisato Takagi MD, PhD4Tomo Ando MD1

1Division of Cardiology, Department ofMedicine, Detroit Medical Center, Wayne
State University, Detroit, Michigan
2

Division of Internal Medicine, Department ofMedicine, Englewood Hospital and Medical
Center, Hackensack Meridian School of
Medicine, Seton Hall University, Englewood,
New Jersey
3
Division of Cardiology, Department ofMedicine, University of Iowa Hospitals andClinics, Iowa, Iowa
4

Division of Cardiovascular Surgery,
Department of Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Correspondence
Tomo Ando, MD, Division of Cardiology,
Department of Medicine, Detroit Medical
Center, Wayne State University, 3990 John R,
Detroit, MI 48201.
Email: andotomo@hotmail.co.jp

Abstract
Background and Aim: Surgical aortic valve replacement (SAVR) is the most common
valvular surgery and thus needs to be widely available including minorities andsocially disadvantaged patients. SAVR outcomes at safety‐net hospitals, which serve ahigh percentage of these patients, are limited. We aimed to compare the outcomes of
SAVR at different safety‐net burden hospitals.
Methods: Nationwide Inpatient Sample from 2005 to 2011 was queried to identify
SAVR performed for over the age of 50. The safety‐net burden of hospitals wascalculated as the number of admission to a hospital in a year who were uninsured orinsured by Medicaid divided by the total number of admissions for the respective
year. Hospitals were categorized into quintiles of safety‐net rate and then into three
categories based on the safety‐net burden (low burden hospitals [LBHs], lowest
quintile, medium burden hospitals [MBHs], 2nd‐4th quintiles; and high burden
hospitals [HBHs], highest quintile).
Results: A total of 85 441 SAVR were included. In unadjusted models, in‐hospitalmortality was higher in HBHs compared with LBHs but became nonsignificant after
adjustments for patient and hospital‐level characteristics. Major perioperativecomplications and hospital costs were similar, but hospital stay was longer at HBHs
compared with LBHs. At MBHs, acute kidney injury requiring dialysis and bleeding
requiring transfusion was lower compared with LBHs. Length of stay and cost wereshorter and lower at MBHs compared with LBHs. Nonroutine discharge was similar
for HBHs and MBHs compared with LBHs.
Conclusion: SAVR outcomes are reassuring at MBHs and HBHs.
KEYWORDS

safety‐net hospital, surgical aortic valve replacement

1 | I N T R O D UCTI O N

and pose a substantial financial burden on the healthcare system.2 Itis estimated that approximately 1.9 million patients are eligible for

Surgical aortic valve replacement (SAVR) is the most common cardiac

SAVR in 37 advanced economies.3 SAVR continues to be ansurgery performed for valvular heart disease in the United States andimportant surgical procedure among other surgeries, and thus needs

more than 40 000 cases have been performed in 2015.1 Severe aortic

to be widely available, including to minorities and vulnerable

stenosis is the most common indication for SAVR. Those who arepatients. Safety‐net hospitals serve those who are socially disadvan-

medically treated do poorly, with a mean survival of only 1.8 years,

taged, insured by Medicaid or uninsured. Safety‐net hospitals,1178| © 2019 Wiley Periodicals, Inc.

wileyonlinelibrary.com/journal/jocs

93

J Card Surg. 2019;34:1178-1184.

Heart & Lung 49 (2020) 2529

Contents lists available at ScienceDirect

Heart & Lung
journal homepage: www.heartandlung.com

Paliative Care

Palliative care referral in ST-segment elevation myocardial infarction
complicated with cardiogenic shock in the United States
Tomo Andoa,*, Emmanuel Akintoyeb, Takeshi Uemurac, Oluwole Adegbalad, Said Ashrafa,
Mohit Pahujaa, Mohamed Shokra, Hisato Takagie, Cindy L. Grinesf, Luis Afonsoa,
Alexandros BriasoulisbaDivision of Cardiology, Wayne State University, Detroit Medical Center, 3990, John R, Detroit 48201, MI, United States
University of Iowa Hospitals and Clinics, Iowa, Iowa, United StatescUniversity Health Partners of Hawaii, John A Burns School of Medicine University of Hawaii, Honolulu, Hawaii, United StatesdEnglewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, United Statese
Shizuoka Medical Center, Shizuoka, Japanf
North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY, United Statesb

A R T I C L E

I N F O

Article History:
Received 15 May 2019
Revised 13 October 2019
Accepted 16 October 2019
Available online 6 November 2019
Keywords:
Cardiogenic shock
Palliative care
ST-segment elevation myocardial infarctionA B S T R A C T

Background: ST-segment elevation myocardial infarction complicated with cardiogenic shock (STEMI-CS) is
associated with high mortality but the trends of utilization and predictors of palliative care (PC) referral inthis population have not been well described.
Objectives: To investigate the utilization trends and predictors of PC referral in STEMI-CS.
Methods: Nationwide inpatient sample from 20052014 was queried to identify patients with STEMI-CS ofage 18. PC referral was identiﬁed International Classiﬁcation of Diseases, Ninth Edition Clinical Modiﬁcation, V66.7.
Results: A total of 33,294 admissions were identiﬁed and 1,878 (5.6%) had PC encounter. PC referral groupwere older and had higher comorbidities. PC consultation increased approximately 10 times over the study
period in those who died (from 2.3% to 27.4%) and in those who survived (from 0.21% to 2.83%). In multivariable analysis, age, higher Exlixhauser score, no revascularization, teaching hospital, large bed hospital,
mechanical circulatory support use, and lower income status were associated with increased PC referral
whereas coronary artery bypass graft was associated with lower PC referral rates. Patients under PC groupwere more often discharged to an extended care facility and less likely discharged home.
Conclusion: PC utilization increased substantially during the 10-years study period in the United States in
STEMI-CS. Several baseline, procedural, hospital, and socioeconomic factors were associated with PC referralin the setting STEMI-CS.
© 2019 Elsevier Inc. All rights reserved.

Introduction
Cardiogenic shock continues to have unacceptably high in-hospital mortality of over 50% and ST-segment elevation myocardial
infarction (STEMI) is the leading cause of cardiogenic shock among
other causes such as myocarditis, non-ST-elevation myocardial
infarction, acute exacerbation of chronic heart failure, and pulmonary
embolism.1 STEMI resulting in left ventricular failure accounts for
7080% of STEMI complicated with cardiogenic shock (STEMI-CS)
and the prevalence of STEMI-CS was 6.5 to 10.1% in the United States
between 20032010.14 Despite a declining trend in mortality of
STEMI-CS because of early revascularization5,6 and increased use of*Corresponding author.
E-mail address: tomo.ando@wayne.edu (T. Ando).
https://doi.org/10.1016/j.hrtlng.2019.10.005
0147-9563/© 2019 Elsevier Inc. All rights reserved.

94

mechanical circulatory support (MCS) devices,7 STEMI-CS remains asigniﬁcant cause of morbidity and mortality.1,2,6,8
Management of STEMI-CS is complex, and disease course varies
from rapid demise of the patient to prolonged hospital course in theintensive care unit. In addition, various treatment options including
revascularization and MCS are time sensitive and decisions need tobe made in a timely manner among physicians, patients and caregivers. This can be challenging given the acuity of the disease and theburden of stress on caregivers and patients.
Palliative care (PC) has been shown to enhance patient satisfaction, improve care providers’ communication, and reduce total healthcare cost.9,10 PC consultation can be a potentially useful intervention
in STEMI-CS given its high mortality but the use of PC has not been
well studied in this population. Indeed, STEMI-CS is not discussed
in the policy statement from the American Heart Association on PC inCoronary Artery Disease

Early Invasive Versus Ischemia-Guided
Strategy in Non-ST-Segment Elevation
Acute Coronary Syndrome With Chronic
Obstructive Pulmonary Disease: A National
Inpatient Sample Analysis

Angiology
2020, Vol. 71(4) 372-379ª The Author(s) 2019
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0003319719877096
journals.sagepub.com/home/ang

Tomo Ando, MD1 , Oluwole Adegbala, MD, MPH2,
Hisato Takagi, MD, PhD3 , Luis Afonso, MD1,
and Alexandros Briasoulis, MD, PhD4

Abstract
Chronic obstructive pulmonary disease (COPD) is a risk factor for non-ST-segment elevation–acute coronary syndromes (NSTEACS). Whether early invasive strategy (EIS) or ischemia-guided strategy (IGS) confers better outcomes in NSTE-ACS with COPD
is largely unknown. Nationwide Inpatient Sample database of the United States was queried from 2010 to 2015 to identify NSTEACS with and without COPD. Early invasive strategy was defined as coronary angiogram with or without revascularization on
admission day 0 or 1, whereas IGS included patients who did not receive EIS. Standardized morbidity ratio weight was used to
calculate the adjusted odds ratio. A total of 228 175 NSTE-ACS admissions with COPD were identified of which 34.0% received
EIS. In-hospital mortality was lower with EIS in patients with COPD (3.1% vs 5.5%, adjusted odds ratio 0.57, 95% confidence
interval 0.50-0.63) compared to IGS, but the magnitude of mortality reduction observed in EIS in patients with COPD was lesscompared to non-COPD patients (Pinteraction ¼ .02). Length of stay was shorter (4.2 vs 4.7 days, P < .0001) but the cost was higher(US$23 804 vs US$18 533, P < .0001) in EIS in COPD. Early invasive strategy resulted in lower in-hospital mortality and marginallyshorter length of stay but higher hospitalization cost in NSTE-ACS with COPD.
Keywords
chronic obstructive pulmonary disease, early invasive, non-ST-segment elevation acute coronary syndromes, ischemia-guided
strategy

Introduction
Chronic obstructive pulmonary disease (COPD) is a major
health issue affecting an estimated 7.6% of the populationworldwide.1 Chronic obstructive pulmonary disease and nonST-elevation–acute coronary syndromes (NSTE-ACS) share
several common risk factors, the most important being smoking, and therefore, the 2 conditions commonly coexist.
Ischemic heart disease affects 10% to 16% of patients with
COPD,2,3 and COPD increases the risk of developing cardiovascular disease by 5-fold.4
Chronic obstructive pulmonary disease is a predictor ofworse in-hospital survival in those presenting with ACS.5-8 The
COPD cohorts were found to have more severe coronary arterydisease on coronary angiography9-11 and lower utilization of
b-blockers, statins, and coronary interventions.6-8 The guidelines for NSTE-ACS recommend early invasive strategy (EIS),
invasive strategy, or ischemia-guided strategy (IGS) based onclinical presentation and high-risk comorbidities (ie, prior95

coronary artery bypass).12,13 Despite the reported negative
impact of COPD on NSTE-ACS and association with more
severe coronary artery disease, it remains unknown whether
EIS should be the preferred approach in these patients. We
hypothesized that EIS and IGS may have different effects on
the early outcomes of patients with NSTE-ACS and COPD. For

1

Division of Cardiology, Detroit Medical Center, Wayne State University,
Detroit, MI, USA
2
Division of Internal Medicine, Englewood Hospital and Medical Center, Seton
Hall University-Hackensack Meridian School of Medicine, Englewood, NJ,
USA
3Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
4
Division of Cardiology, University of Iowa Hospitals and Clinics, IA, USA
Corresponding Author:
Tomo Ando, Division of Cardiology, Detroit Medical Center, Wayne State
University, 3990, John R, Detroit, MI 48201, USA.
Email: andotomo@hotmail.co.jp

HLC3034_proof ■ 21 January 2020 ■ 1/10

ORIGINAL ARTICLE

Heart, Lung and Circulation (2019) -, -–1443-9506/19/$36.00
https://doi.org/10.1016/j.hlc.2019.10.016

Meta-Analysis of Hospital-Volume
Relationship in Transcatheter Aortic
Valve Implantation
Tomo Ando, MD a,*, Pedro A. Villablanca, MD, MSc b,
Hisato Takagi, MD, PhD c, Alexandros Briasoulis, MD, PhD daDepartment of Medicine, Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA
Department of Medicine, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USAc
Department of Surgery, Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japand
Department of Medicine, Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAb

Received 8 March 2019; received in revised form 12 June 2019; accepted 20 October 2019; online published-ahead-of-print xxx

Background

Whether a volume-outcome relationship, that is, higher volume centres have better outcomes comparedwith lower volume hospitals, exists in transcatheter aortic valve implantation (TAVI) has not yet beensystematically explored.

Methods

We performed a systematic review and meta-analysis to evaluate whether highest or intermediate annual
TAVI volume hospitals has better short-term (in-hospital or 30-days) mortality compared with the lowest
volume hospitals. Odds ratio (OR) and 95% conﬁdence interval (CI) was calculated with the MantelHaenszel method.

Results

We identiﬁed 10 publications from nine different countries including TAVI performed between 2005–2017.
Included patients were mainly high-risk cohorts. We included ﬁve and six studies to assess volumeoutcome relationship in the highest and intermediate volume hospitals compared with the lowest
volume hospitals, respectively. Our results showed that in both the highest (OR 0.66, 95%CI 0.53–0.83,
p=0.0003, I2=78%) and intermediate (OR 0.85, 95%CI 0.79–0.92, p,0.0001, I2=0%) volume hospitals, there
was a statistically signiﬁcant volume-outcome relationship for short-term mortality compared with thelowest volume hospitals.

Conclusions

Our review suggests a signiﬁcant volume-outcome relationship post-TAVI in both the highest and intermediate volume hospitals compared with the lowest volume hospitals mainly in high surgical risk patients.
The high heterogeneity in this relationship between the highest and the lowest volume hospitals warrant
cautious interpretation. Whether this relationship remains signiﬁcant in low-risk cohort requires further
study.

Keywords

Aortic stenosis  Transcatheter aortic valve implantation  Volume  Mortality

Introduction

TAVI results compared with surgical aortic valve replacement (SAVR) and evolving transcatheter heart valves technologies [1,2]. In this regard, a multi-society consensus
document has recently been updated for recommendations
on institutional annual TAVI volume to initiate or maintain

The numbers of transcatheter aortic valve implantations(TAVI) are exponentially increasing worldwide supported
by large randomised clinical trials showing non-inferior*Corresponding author at: Detroit Medical Center, Division of Cardiology, 3990, John R, Detroit, Michigan, 48201, United States. Tel.: 313-745-2620; fax: 313-745-8643.,
Email: andotomo@hotmail.co.jp
 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
Published by Elsevier B.V. All rights reserved.

Please cite this article in press as: Ando T, et al. Meta-Analysis of Hospital-Volume Relationship in Transcatheter Aortic
Valve Implantation. Heart, Lung and Circulation (2019), https://doi.org/10.1016/j.hlc.2019.10.016

96

97

98

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 75, NO. 3, 2020

ª 2020 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATIONPUBLISHED BY ELSEVIER

Oral Anticoagulation for
Patients With Atrial Fibrillation on
Long-Term Dialysis
Toshiki Kuno, MD, PHD,a Hisato Takagi, MD, PHD,b Tomo Ando, MD,c Takehiro Sugiyama, MD, MSHS, PHD,d,e,f
Satoshi Miyashita, MD,a Nelson Valentin, MD, MSC,a Yuichi J. Shimada, MD, MPH,g Masaki Kodaira, MD, PHD,hYohei Numasawa, MD, PHD,h Alexandros Briasoulis, MD, PHD,i Alfred Burger, MD,a Sripal Bangalore, MD, MHAj

ABSTRACTBACKGROUND Patients on long-term dialysis are at increased risk of bleeding. Although oral anticoagulants (OACs)
are recommended for atrial ﬁbrillation (AF) to reduce the risk of stroke, randomized trials have excluded these
populations. As such, the net clinical beneﬁt of OACs among patients on dialysis is unknown.
OBJECTIVES This study aimed to investigate the efﬁcacy and safety of OACs in patients with AF on long-term dialysis.
METHODS MEDLINE and EMBASE were searched through June 10, 2019, for studies that investigated the efﬁcacy andsafety of different OAC strategies in patients with AF on long-term dialysis. The efﬁcacy outcomes were ischemic stroke
and/or systemic thromboembolism, all-cause mortality, and the safety outcome was major bleeding.
RESULTS This study identiﬁed 16 eligible observational studies (N ¼ 71,877) regarding patients on long-term dialysis
who had AF. Only 2 of 16 studies investigated direct OACs. Outcomes for dabigatran and rivaroxaban were limited tomajor bleeding events. Compared with no anticoagulants, apixaban and warfarin were not associated with a signiﬁcantdecrease in stroke and/or systemic thromboembolism (apixaban 5 mg, hazard ratio [HR]: 0.59; 95% conﬁdence interval[CI]: 0.30 to 1.17; apixaban 2.5 mg, HR: 1.00; 95% CI: 0.52 to 1.93; warfarin, HR: 0.91; 95% CI: 0.72 to 1.16). Apixaban
5 mg was associated with a signiﬁcantly lower risk of mortality (vs. warfarin, HR: 0.65; 95% CI: 0.45 to 0.93; vs. apixaban
2.5 mg, HR: 0.62; 95% CI: 0.42 to 0.90; vs. no anticoagulant, HR: 0.61; 95% CI: 0.41 to 0.90). Warfarin was associatedwith a signiﬁcantly higher risk of major bleeding than apixaban 5 min/2.5 mg and no anticoagulant (vs. apixaban 5 mg,
HR: 1.41; 95% CI: 1.07 to 1.88; vs. apixaban 2.5 mg, HR: 1.40; 95% CI: 1.07 to 1.82; vs. no anticoagulant, HR: 1.31; 95% CI:
1.15 to 1.50). Dabigatran and rivaroxaban were also associated with signiﬁcantly higher risk of major bleeding than
apixaban and no anticoagulant.
CONCLUSIONS This meta-analysis showed that OACs were not associated with a reduced risk of thromboembolism inpatients with AF on long-term dialysis. Warfarin, dabigatran, and rivaroxaban were associated with signiﬁcantly higher
bleeding risk compared with apixaban and no anticoagulant. The beneﬁt-to-risk ratio of OACs in patients with AF on
long-term dialysis warrants validation in randomized clinical trials. (J Am Coll Cardiol 2020;75:273–85)© 2020 by the American College of Cardiology Foundation.

From the aDepartment of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York;b

Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; cDepartment of Cardiology, Detroit Medical

Center, Detroit, Michigan; dDiabetes and Metabolism Information Center, Research Institute, Center for Global Health andMedicine, Tokyo, Japan; eDepartment of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan;fListen to this manuscript’s

Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; gDivision of

Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York; hDepartment of Cardiology,

audio summary by

Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan; iDivision of Cardiovascular Medicine, Section of Heart Failure andEditor-in-Chief

Transplantation, University of Iowa, Iowa City, Iowa; and the jDivision of Cardiovascular Medicine, New York University School of

Dr. Valentin Fuster on

Medicine, New York, New York. Dr. Shimada is supported in part by unrestricted grants from the American Heart Association

JACC.org.

National Clinical and Population Research Award and Career Development Award, Honjo International Scholarship Foundation,
and Korea Institute of Oriental Medicine. Dr. Bangalore is supported by grants from Abbott Vascular and the National Heart, Lung,
and Blood Institute; and is a member of the Advisory Board of Abbott Vascular, Biotronik, Amgen, Pﬁzer, and Reata. Dr. Burger
holds stock in Potola Pharmaceutical. All other authors have reported that they have no relationships relevant to the contents ofthis paper to disclose. Louise Pilote, MD, MPH, PhD, served as Guest Associate Editor for this paper.
Manuscript received July 30, 2019; revised manuscript received October 28, 2019, accepted October 29, 2019.

ISSN 0735-1097/$36.00

https://doi.org/10.1016/j.jacc.2019.10.059

99Meta-analysis of Antithrombotic Therapy in Patients
With Atrial Fibrillation Undergoing PercutaneousCoronary Intervention
Toshiki Kuno, MD, PhDa,*, Hiroki Ueyama, MDa, Hisato Takagi, MD, PhDb, Tomo Ando, MDc,
Yohei Numasawa, MD, PhDd, Alexandros Briasoulis, MD, PhDe, John Fox, MDf, andSripal Bangalore, MD, MHAg
For patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention(PCI), antithrombotic therapy including oral anticoagulants and antiplatelets are indicated. The optimal combination is not known. We investigated the efficacy and safety ofdifferent antithrombotic strategies in patients with AF undergoing PCI. PUBMED and
EMBASE were searched through September 2019 for randomized trials investigating theefficacy and safety of different antithrombotic strategies in patients with AF who underwent PCI and/or acute coronary syndrome. Nine antithrombotic strategies were compared
including combinations of vitamin K antagonist (VKA) with dual antiplatelet therapy(DAPT) or P2Y12 inhibitor, combinations of direct oral anticoagulants (DOAC) (apixaban,
dabigatran, rivaroxaban, and edoxaban) with DAPT or P2Y12 inhibitor (clopidogrel, prasugrel, and ticagrelor). The primary safety outcome was trial defined primary bleeding
outcome. The primary efficacy outcome was trial defined major adverse cardiovascular
events. Our search identified 5 eligible trials that enrolled a total of 11,532 patients andcompared 9 treatment strategies. VKA + DAPT significantly increased bleeding whencompared with most combinations (for example, vs VKA + P2Y12 inhibitor: odds ratio
2.11; 95% confidence interval [1.76 to 2.52], p <0.001). Of all the combinations, apixaban + P2Y12 inhibitor showed the lowest bleeding risk (for example, vs VKA + P2Y12 inhibitor: odds ratio 0.63; 95% confidence interval [0.51 to 0.78], p <0.001) and was ranked
the best treatment. There were no significant differences in ischemic outcome ofmajor adverse cardiovascular events between various antithrombotic regimens. In conclusion, in patients with AF undergoing PCI, apixaban + P2Y12 inhibitors were associatedwith lowest bleeding compared with other regimens including other DOACs + P2Y12
inhibitors with no increase in ischemic outcomes. © 2019 Elsevier Inc. All rights
reserved. (Am J Cardiol 2020;125:521−527)

Antithrombotic agents are necessary for thromboembolicrisk protection in patients with atrial fibrillation (AF) undergoing percutaneous coronary interventions (PCI) and/or for

those presenting with acute coronary syndrome (ACS).
Although triple antithrombotic therapy can increase bleedingrisk, stroke, and stent thrombosis prevention are crucial forthese patients.1,2 Recent randomized controlled trials havedemonstrated favorable outcomes of patients with AF withdual antithrombotic strategies including P2Y12 inhibitorsand direct oral anticoagulants (DOACs).3−5 Based on theseresults, the most recent guidelines recommend oral anticoagulant (OAC) + P2Y12 inhibitors in patients with AF who underwent PCI with stenting for ACS.6,7 Although, regimens
without aspirin are shown to have lower bleeding, it remains
unknown whether any particular strategy (VKA vs DOAC
with dual antiplatelet therapy [DAPT] or P2Y12 inhibitors) ispreferable. We investigated the safety and efficacy of various
antithrombotic combination therapies in AF patients who
underwent PCI.

a
Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York; bDepartment of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; cCenter for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia
University Medical Center, New York; dDepartment of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan; eDivision of Cardiovascular Medicine, Section of Heart Failure and Transplantation,
University of Iowa, Iowa; fDepartment of Cardiology, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York; and gDivision of Cardiovascular Medicine, New York University School of Medicine, New York. Manuscript received October 22, 2019; revised manuscript
received and accepted November 11, 2019.
Funding Sources: Dr. Bangalore is supported from Abbott Vascular,
National Heart Lung and Blood Institute by research grant. Remaining
authors have nothing to disclose. The funding organizations did not have anyrole in the study design, collection, analysis, or interpretation of data, in writing of the manuscript, or in the decision to submit the article for publication.
The researchers were independent from the funding organizations.
See page 526 for disclosure information.
*Corresponding author: Tel: (212) 420-2000.
E-mail address: Toshiki.Kuno@mountsinai.org (T. Kuno).

Methods
All studies investigating the impact of antithrombotic
strategy in patients with AF who underwent PCI weresearched using a 2-level search strategy. First, PUBMEDand EMBASE were searched through September 13, 2019using web-based search engines. Second, relevant studies

0002-9149/© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2019.11.022

www.ajconline.org

100Received: 2 April 2019

Revised: 13 July 2019

Accepted: 5 September 2019

DOI: 10.1002/ccd.28498

ORIGINAL STUDIES

Antithrombotic strategies after transcatheter aortic valve
implantation: Insights from a network meta-analysis
Toshiki Kuno MD, PhD1

| Hisato Takagi MD, PhD2

Takehiro Sugiyama MD, MSc, PhD

3,4,5

|
6

| Tomo Ando MD| Satoshi Miyashita MD1 |Nelson Valentin MD, MSc1 | Yuichi J. Shimada MD, MPH7 |Masaki Kodaira MD, PhD8 | Yohei Numasawa MD, PhD8
Kentaro Hayashida MD, PhD, FESC, FACC, FJCS10| Yumiko Kanei MD9 || Sripal Bangalore MD, MHA11

1

Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai BethIsrael, New York, New York2

Department of Cardiovascular Surgery,Shizuoka Medical Center, Shizuoka, Japan

3

Diabetes and Metabolism Information Center,Research Institute, Center for Global Healthand Medicine, Tokyo, Japan

4

Department of Health Services Research,
Faculty of Medicine, University of Tsukuba,
Tsukuba, Japan

5

Department of Public Health/Health Policy,
Graduate School of Medicine, The Universityof Tokyo, Tokyo, Japan

6

Objectives: We aimed to investigate the efficacy and safety of different antithrombotic strategies in patients undergoing transcatheter aortic valve implantation(TAVI) using network meta-analyses.
Background: Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual
antiplatelet therapy (DAPT), ± oral anticoagulant (OAC) was conducted to determine
the appropriate post TAVI antithrombotic regimen. However, there was limited directcomparisons across the different therapeutic strategies.
Methods: MEDLINE and EMBASE were searched through December 2018 to investigate the efficacy and safety of different antithrombotic strategies (SAPT, DAPT,OAC, OAC + SAPT, and OAC + DAPT) in patients undergoing TAVI. The main out-

Department of Cardiology, Detroit Medical
Center, Detroit, Michigan

come were all-cause mortality, major or life-threatening bleeding events, and stroke.

7

Results: Our search identified 3 randomized controlled trials and 10 nonrandomized

Division of Cardiology, Department ofMedicine, Columbia University Medical
Center, New York, New York

8

Department of Cardiology, Japanese Red
Cross Ashikaga Hospital, Ashikaga, Japan

9

Department of Cardiology, Icahn School of
Medicine at Mount Sinai, Mount Sinai BethIsrael, New York, New York10

Department of Cardiology, Keio University
School of Medicine, Tokyo, Japan11

New York University School of Medicine,
New York, New York

studies, a total of 20,548 patients who underwent TAVI. All OACs were vitamin K
antagonists. There was no significant difference on mortality except that OAC+ DAPT had significantly higher rates of mortality compared with others (p < .05, I2 =0%). SAPT had significantly lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard ratio [HR]: 0.59 [0.46-0.77], p < .001, HR: 0.58
[0.34-0.99], p = .045, HR: 0.41 [0.18-0.93], p = .033, respectively, I2 = 0%). There wasno significant difference on stroke among all antithrombotic strategies.
Conclusion: Patients who underwent TAVI had similar all-cause mortality rates
among different antithrombotic strategies except OAC+DAPT. Patients on SAPT had

Correspondence
Toshiki Kuno, MD, PhD, Department ofMedicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth, Israel, First Avenue,
16th street, New York, NY 10003.
Email: toshiki.kuno@mountsinai.org

significantly lower bleeding risk than those on DAPT, OAC + SAPT, and OAC+ DAPT. Our results suggest SAPT is the preferred regimen when there is no indication for DAPT or OAC. When DAPT or OAC is indicated, DAPT + OAC should be
avoided.

Abbreviations: CI, confidential interval; DAPT, dual antiplatelet therapy; HR, hazard ratio;
NOAC, novel oral anticoagulant; OAC, oral anticoagulant; SAPT, single antiplatelet therapy;
TAVI, transcatheter aortic valve implantation; VKA, vitamin K antagonist.

Catheter Cardiovasc Interv. 2019;1–10.

wileyonlinelibrary.com/journal/ccd

101© 2019 Wiley Periodicals, Inc.

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Short- and long-term outcomes in dialysis patients undergoingtranscatheter aortic valve implantation: a systematic review andmeta-analysis)*

Toshiki Kuno, MD, PhD, FESC, FSCAI ' ( • Hisato Takagi, MD, PhD • Tomo Ando, MD • ...
Yohei Numasawa, MD, PhD • Alexandros Briasoulis, MD PhD FACC •Kentaro Hayashida, MD, PhD, FESC, FACC, FJCS • Show all authors
Published: January 24, 2020 • DOI: https://doi.org/10.1016/j.cjca.2020.01.015

Abstract
Keywords
References.
Article Info
Related Articles

Abstract
Background
Transcatheter aortic valve implantation (TAVI) has become themain treatment for symptomatic severe aortic stenosis but
patients on dialysis have been excluded from major randomized
controlled trials. Our aim was to compare mortality andprocedure-related complications after TAVI in patients with endstage renal disease (ESRD) on dialysis versus those without.
Methods
EMBASE and MEDLINE were searched through November

2019 to investigate the comparative outcomes between ESRD
patients on dialysis and those without who underwent TAVI. The
main outcomes were short-term (30-day/in-hospital) mortality

and procedural complications, and long-term (> 6 months) allcause mortality.
Results
Our search identiÞed 10 observational studies enrolling 128,094(5,399 on dialysis) patients who underwent TAVI. Dialysis
patients had a signiÞcantly higher rate of short-term and longterm mortality than non-dialysis patients (odds ratio [95%conÞdential interval]: 2.18 [1.64-2.89], P < 0.001, I 2=60%; 1.91
[1.46-2.50], P < 0.001, I 2=80%, respectively). In addition,
dialysis patients had signiÞcantly higher rates of short-term life
threatening and/or major bleeding, permanent pacemaker
implantation, and device failure compared to non-dialysis
patients (OR [95% CI]: 1.90 [1.24-2.90], P < 0.001, I 2=67%;
1.33 [1.15-1.53], P < 0.001, I 2=0%; 2.08 [1.05-4.10], P = 0.03,
respectively), but did not have signiÞcantly higher rates ofvascular complications and stroke.
Conclusion
Dialysis patients had signiÞcantly higher rates of short- andlong-term mortality, short-term life threatening and/or major
bleeding, permanent pacemaker implantation, and device failurecompared to non-dialysis patients. Careful patient selection who
would beneÞt from TAVI in patients with ESRD requiring dialysis,
is necessary to prevent high-rates of post-procedural
complications.

102

PlumX Metrics

ARTICLE IN PRESS
Meta-Analysis Evaluating the Effects of ReninAngiotensin-Aldosterone System Blockade on Outcomesof Heart Failure With Preserved Ejection Fraction
Toshiki Kuno, MD, PhDb, Hiroki Ueyama, MDb, Tomohiro Fujisaki, MDc,
Artemis Briasouli, MD, MPHd, Hisato Takagi, MD, PhDe, and Alexandros Briasoulis, MD, PhDa,*
Clinical trials of renin-angiotensin-aldosterone system (RAAS) antagonists in heart failure
with preserved ejection fraction (HFpEF) have suggested neutral results and treatment isfocused on associated symptoms and comorbidities. MEDLINE and EMBASE weresearched through October 2019 for randomized controlled studies investigating the effects
of different RAAS antagonists in patients with HFpEF. The main outcomes were all-cause
mortality, trial defined cardiovascular mortality, and heart failure (HF) hospitalizations.
To compare different RAAS antagonists, a random-effects restricted-maximum-likelihood
network meta-analysis based on a frequentist framework for indirect and mixed comparisons was used. We used p scores to rank best treatments per outcome. Our search identified 5 eligible clinical trials (PEP-CHF, perindopril; CHARM-preserved, candesartan;
I-PRESERVE, irbesartan; TOPCAT, spironolactone; PARAGON-HF, sacubitril-valsartan and valsartan) enrolling a total 10,523 on RAAS antagonists and 6,259 controls. We
did not identify any statistical difference in all-cause and cardiovascular mortality among
RAAS antagonists and placebo. The combination of sacubitril-valsartan was associatedwith significantly decreased HF hospitalization risk compared with controls (odds ratio
0.73, 95% confidence interval 0.61 to 0.87) and angiotensin II receptor blockers (odds ratio
0.80, 95% confidence interval 0.71 to 0.91), without heterogeneity among studies (I2 = 0).
Angiotensin receptor neprilysin inhibitor (ARNI) ranked better than other RAAS antagonists for HF hospitalizations (p value 0.9). In conclusion, RAAS antagonists do not affectmortality but the combination of sacubitril-valsartan is associated with lower HF hospitalizations in HFpEF patients. © 2020 Elsevier Inc. All rights reserved. (Am J Cardiol
2020;00:1−7)

Heart Failure with preserved ejection fraction (HFpEF)
is the most common type of heart failure (HF) in the elderly
and affects more than 2 million Americans.1 Despite its
importance, there are large gaps in our understanding oftreatment of HFpEF. The role of renin-angiotensin-aldosterone system (RAAS) inhibitors in HFpEF remains controversial, with multiple clinical studies showing conflicting
results.2−6 The PARAGON-HF trial of angiotensin receptor-neprilysin inhibitor (ARNI) in patients with HFpEF did
not show a statistically significant lower rate of hospitalization for HF and death from cardiovascular causes but suggested possible benefit among patients with an LVEF ≤57% (the median) and among women.7 The TOPCAT trialof spironolactone in patients with HFpEF showed overalllower hospitalization for HF in the treatment arm.8 In thiscontext, we performed a net-work meta-analysis of themain randomized controlled trials (RCTs) in the field2−4,7,8
to compare the effects of different RAAS antagonists
with each other and with placebo, with regards to HFpEF
outcomes.
Methods
We conducted a network meta-analysis in accordancewith the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines.9 A comprehensive literaturesearch was conducted through September, 2019 in the
MEDLINE and EMBASE database to include all relevant
studies investigating the impact of immunosuppression
strategy after heart transplantation. The search term
included ‘‘heart failure with preserved ejection fraction,’’‘‘angiotensin-converting enzyme inhibitors,’’ ‘‘Angiotensin
Receptor Antagonists,’’ “mineralocorticoid receptor antagonists,” “aldosterone antagonists,” “angiotensin receptor
neprilysin inhibitor,” and the names of individual angiotensin-converting enzyme inhibitors (ACE-I), Angiotensin
Receptor Antagonists (ARB), mineralocorticoid receptor
antagonists (MRA), ARNI agents. There was no language
restriction.
We included RCTs that met the following criteria: thestudy was published in peer-reviewed journals; designed tocompare the effects of ACE-I, ARB, MRA, ARNI in theaDivision of Cardiovascular Diseases, Section of Heart Failure andTransplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa;b
Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York; cDepartment of Medicine, Icahn
School of Medicine at Mount Sinai, Mount Sinai St. Luke’s and West,
New York; dJohns Hopkins Medicine, Department of Medicine, Baltimore,
Maryland; and eDepartment of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan. Manuscript received December 12, 2019; revisedmanuscript received and accepted January 17, 2020.
See page 6 for disclosure information.
*Corresponding author: Tel: (319) 678-8418; fax: (319) 353-6343.
E-mail address: Alexandros-briasoulis@uiowa.edu (A. Briasoulis).

0002-9149/© 2020 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2020.01.009

www.ajconline.org

103

Antithrombotic Therapy in Patients with Atrial Fibrillation
and Acute Coronary Syndrome Undergoing PercutaneousCoronary Intervention; Insights from a Meta-Analysis.

Toshiki Kunoa, Hiroki Ueyamaa, Tomo Andob, Alexandros Briasoulisc andHisato Takagid
Background Acute coronary syndrome (ACS) patients are at increased risk for futureadverse cardiac events. The optimal antithrombotic regimen for patients undergoing
percutaneous coronary intervention (PCI) in ACS with concomitant atrial fibrillation(AF) is largely under investigated.
Method PUBMED and EMBASE were searched through October 2019 for randomized
trials (RCTs) or subgroup analyses of RCTs investigating the efficacy and safety ofdifferent antithrombotic strategies in patients with AF and ACS undergoing PCI. We
compared dual antithrombotic therapy (DAT) vs. triple antithrombotic therapy (TAT).
DAT was defined as vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC)
plus P2Y12 inhibitor. TAT was defined as VKA or DOAC plus dual antiplatelet therapy(aspirin plus P2Y12 inhibitor). The primary safety outcome was trial defined primary
bleeding outcome. The primary efficacy outcome was trial defined major adverse
cardiovascular events (MACE).
Results Our search identified 5 eligible sub-group analyses of RCTs that enrolled a totalof 4,733 patients and compared the two treatment strategies. DAT significantly decreased
the bleeding risk when compared with TDAT (hazard ratio (HR): 0.61; 95% confidential
interval (CI) [0.51-0.71], P < 0.001, I2=31%). However, there were no significant
differences in MACE between DAT vs. TAT (HR: 1.081; 95%CI: 0.893-1.3123, P =0.4493, I2=0%).
Conclusion Among In patients with AF and ACS undergoing PCI, DAT was associatedwith lower bleeding risk compared with TAT while conferring similar MACE risk. Our
results should be interpreted cautiously since we did not analyze the risk of stent
thrombosis. Therefore, DAT might be the preferred antithrombotic regimen in ACS
patients undergoing PCI with concomitant AF.
Keywords: acute coronary syndrome, atrial fibrillation, antiplatelet therapy, oral
anticoagulant, percutaneous coronary interventionaDepartment of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel,
NY, USA, bCenter for Interventional Vascular Therapy, Division of Cardiology, New YorkPresbyterian Hospital/Columbia University Medical Center, cDivision of cardiovascular
medicine, section of heart failure and transplantation, University of Iowa, IA, USA dDepartmentof Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
Correspondence to Toshiki Kuno, MD, PhD, FESC, FSCAI, Department of Medicine, Icahn
School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th street, New
York, NY, 10003, USA
Tel: +1 212 420 2000; e-mail: Toshiki.Kuno@mountsinai.org

104

Meta-analysis Comparing Direct Oral Anticoagulants
Versus Vitamin K Antagonists After Transcatheter
Aortic Valve Implantation
Hiroki Ueyama, MDa, Toshiki Kuno, MD, PhDa,*, Tomo Ando, MDb,
Alexandros Briasoulis, MD, PhDc, John Fox, MDd, Kentaro Hayashida, MD, PhDe, andHisato Takagi, MD, PhDf
Atrial fibrillation (AF) is a common co-morbidity in patients undergoing transcatheter aortic
valve implantation (TAVI), but whether direct oral anticoagulants (DOACs) confer similarsafety and efficacy compared with vitamin K antagonist (VKA) remains unclear in this population. The aim of our study was to investigate the safety and efficacy of DOACs comparedwith VKA in patients undergoing TAVI with concomitant indication of oral anticoagulation.
PUBMED and EMBASE were searched through October 2019 for studies comparing
DOACs versus VKA in patients undergoing TAVI with indication of oral anticoagulation.
The main efficacy outcomes were all-cause mortality and stroke whereas the main safety outcome was major and/or life-threatening bleeding. Our search identified 5 eligible studies
including 2,569 patients. Majority of patients had atrial fibrillation as indication of anticoagulation. There were no significant differences in all-cause mortality, major and/or lifethreatening bleeding, and stroke in patients treated with DOACs versus VKA (odds ratio[OR] 1.07, 95% confidence interval [CI] [0.73 to 1.57], p = 0.72, OR = 0.85, 95% CI [0.64 to
1.12], p = 0.24, OR 1.52, 95% CI [0.93 to 2.48], p = 0.09, respectively). In conclusion, inpatients undergoing TAVI with concomitant indication for oral anticoagulation, all-cause
mortality, major and/or life-threatening bleeding, and stroke were similar between DOACs
and VKA. Further large scale randomized controlled trials are needed to search the optimaloral anticoagulation regimen in this population. © 2020 Elsevier Inc. All rights reserved.
(Am J Cardiol 2020;125:1102−1107)

Indication of transcatheter aortic valve implantation(TAVI) has rapidly expanded to now include patients in all
categories of surgical risk with severe aortic stenosis, supported by randomized control trials showing superiority or
noninferiority of TAVI compared with surgical aortic valve
replacement.1−5 Preexisting atrial fibrillation (AF) and new
onset AF is a common co-morbidity in patients undergoing
TAVI with rates ranging from 32.9% to 46.8% and 7.2 to
8.4%, respectively.1,6−8 These together put this population
at a higher risk for both thromboembolic and bleeding
events.6,9 Previous randomized control trials comparing
direct oral anticoagulants (DOACs) versus vitamin K antagonist (VKA) in nonvalvular AF have demonstrated noninferiority or superiority of DOACs compared with VKA inboth safety and efficacy outcomes.10,11 However, a recent

study demonstrated that the use of rivaroxaban in patientswith TAVI without AF was associated with increased riskof thromboembolic events, bleeding events, and all-cause
death.12,13 Optimal anticoagulation strategy, whether
including DOACs or VKA, remains unclear and is actively
debated in this population. Therefore, we conducted ameta-analysis of studies comparing DOACs versus VKA inpatients undergoing TAVI with a concomitant indicationfor oral anticoagulation to explore the safety and efficacy of
DOACs compared with VKA in this population.
Methods
A comprehensive literature search was conducted to include all relevant articles from inception to October 13, 2019
in the PUBMED and EMBASE database. There was norestriction on publication language. The search term included
transcatheter aortic valve implantation or transcatheter aortic valve replacement, or TAVI or TAVR; atrial fibrillation;
venous thromboembolism or VTE; anticoagulation or anticoagulant or antithrombotic or vitamin K antagonist or VKA or
Coumadin or Warfarin or novel oral anticoagulant or NOAC
or direct oral anticoagulant or DOAC or Dabigatran or
Apixaban or Rivaroxaban or Edoxaban.
Studies were included in our meta-analysis when the following criteria were met: (1) the study was published inpeer-reviewed journals, (2) and compared the use of
DOACs versus VKA in patients undergoing TAVI with aconcomitant indication of anticoagulation, (3) and reportedaDepartment of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, New York; bDivision of Cardiology,
Center for Interventional Vascular Therapy, New York-Presbyterian
Hospital/Columbia University Medical Center, New York, New York;c
Division of Cardiology, Heart failure, and Transplantation, University of
Iowa, Iowa city, Iowa; dDivision of Cardiology, Icahn School of Medicine
at Mount Sinai, Mount Sinai Beth Israel, New York, New York; eDivisionof Cardiology, Keio University School of Medicine, Tokyo, Japan; andf
Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka,
Japan. Manuscript received October 28, 2019; revised manuscript received
and accepted December 30, 2019.
See page 1105 for disclosure information.
*Corresponding author: Tel: (212) 420-2000.
E-mail address: Toshiki.Kuno@mountsinai.org (T. Kuno).

0002-9149/© 2020 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.amjcard.2019.12.039

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Network Meta-Analysis of Surgical Aortic Valve Replacement andDifferent Transcatheter Heart Valve Systems for Symptomatic Severe
Aortic Stenosis)*

Hiroki Ueyama, MD • Toshiki Kuno, MD, PhD, FESC ' ( • Tomo Ando, MD •Kentaro Hayashida, MD, PhD, FESC, FACC, FJCS • Hisato Takagi, MD, PhD

Published: February 28, 2020 • DOI: https://doi.org/10.1016/j.cjca.2020.02.088

Abstract
References
Article Info
Related Articles

Abstract
Background
Although different transcatheter heart valve (THV) systems havebeen introduced to overcome transcatheter aortic valve
replacement (TAVR) speciÞc complications, head-to-headcomparisons of these THV systems are scarce. The aim of thisstudy was to compare different THV systems and surgical aortic
valve replacement (SAVR) by conducting a network metaanalysis.
Methods
PUBMED and EMBASE were searched through November
2019 for studies comparing safety and efÞcacy of balloonexpandable valve (BEV), self-expanding valve (SEV),

mechanically-expandable valve (MEV) and SAVR for
symptomatic severe aortic stenosis. Endpoints of short-term at
30 days or at discharge and long-term up to 2 years wereassessed.
Results
We identiÞed 11 randomized controlled trials with a total of
10,300 patients eligible for inclusion in our study. There were no
signiÞcant differences in all-cause death among different THV
systems and SAVR both in short- and long-term. Disabling
stroke was signiÞcantly lower with MEV compared to BEV and
SAVR (HR 0.31, 95% CI 0.12-0.77; HR 0.33, 95% CI 0.14-0.76,
respectively) in the long-term. MEV was associated with anincreased risk of new permanent pacemaker implantationcompared to BEV, SEV, and SAVR (HR 3.82, 95% CI 1.83-7.97;
HR 1.85, 95% CI 1.02-3.36; HR 5.23, 95% CI 2.61-10.47,
respectively) in the long-term.
Conclusions

In patients with symptomatic severe aortic stenosis undergoingintervention, there were no signiÞcant differences in all-cause
death among different THV systems and SAVR. MEV had low
frequency of disabling stroke compared to BEV and SAVR, but
had an increased frequency of permanent pacemaker
implantation compared to other interventions.

106

PlumX Metrics

Meta-Analysis of Antithrombotic Strategies in Patients with
Heart Failure with Reduced Ejection Fraction and Sinus
RhythmHiroki Ueyama, MDa, Hisato Takagi, MD, PhDb,
Alexandros Briasoulis MD PhDc, Matthew Harrington MDa,
Daniel Steinberg MDa, and Toshiki Kuno, MD, PhDa,*
Heart failure with reduced ejection fraction (HFrEF) is associated with an increased
risk of thrombotic events. We compared the safety and efficacy of different
antithrombotic strategies for HFrEF and sinus rhythm. PUBMED and EMBASE
were searched through January 2020 for studies comparing oral anticoagulants
versus antiplatelet agents or placebo in HFrEF and sinus rhythm to include in thisnetwork meta-analysis. We identified 5 randomized controlled trials with a total of
9,390 patients randomized to low dose rivaroxaban, vitamin K antagonist (VKA),
antiplatelets, or placebo. Low dose rivaroxaban and VKA did not show a significant
decrease in stroke compared to placebo but were associated with an increased riskof major bleeding (risk ratio [RR] 6.86, 95% confidence interval [CI] 1.16-40.7; RR
8.62, 95% CI 1.52-48.9, respectively). When compared to antiplatelets, low dose
rivaroxaban and VKA were associated with a significantly decreased risk of stroke(RR 0.67, 95%CI 0.47-0.96; RR 0.50, 95% CI 0.33-0.76, respectively), but with asignificantly increased risk of major bleeding (RR 1.65, 95% CI 1.16-2.33; RR 2.07,
95% CI 1.51-2.84, respectively). There was no significant difference in theseoutcomes between low dose rivaroxaban versus VKA and antiplatelets versus
placebo. There were no significant differences in all-cause mortality, myocardial
infarction or rehospitalization for heart failure among each treatment. In conclusion,in patient with HFrEF and sinus rhythm, use of oral anticoagulation with or without
antiplatelet agents increases the risk of bleeding without substantial effects on therisk of ischemic stroke.
Heart failure with reduced ejection fraction (HFrEF) is associated with an increased
risk of thrombogenesis, which may lead to cerebral embolism.1-3 Although
anticoagulation with either a vitamin K antagonist (VKA) or a direct oral anticoagulant(DOAC) is recommended in patients with heart failure with concomitant atrial
fibrillation,4 the role of oral anticoagulation therapy in HFrEF and sinus rhythm remains
unclear. Randomized controlled trials (RCTs) assessing the effect of VKA, antiplatelets
or placebo in patients with HFrEF and sinus rhythm have yielded conflicting results.5-8
The COMMANDER HF trial of rivaroxaban versus placebo in patients with HFrEF withsinus rhythm showed no significant reduction in a composite outcome of all-cause
mortality, myocardial infarction or stroke.9 A meta-analysis of RCTs comparing oral
anticoagulation (VKA or rivaroxaban) to antiplatelets or placebo found anticoagulation
to be associated with a decreased risk of stroke but an increased risk of major bleeding.10
Rivaroxaban and VKA have not yet been compared in patients with HFrEF and sinus
rhythm. The aim of our study was to perform a network meta-analysis to investigate thesafety and efficacy profile of each type of antithrombotic strategy in patients with HFrEF
and sinus rhythm.

107

Meta-analysis of phase-specific survival after elective
endovascular versus surgical repair of abdominal aortic
aneurysm from randomized control and propensity-scorematched studies
Yujiro Yokoyama, MD,a Toshiki Kuno, MD, PhD,b and Hisato Takagi, MD,
PhD,c Easton, Pa; New York, NY; and Shizuoka, Japan
ABSTRACT

Objective: Although endovascular repair (EVAR) for abdominal aortic aneurysm(AAA) significantly decreases perioperative mortality compared to open surgical repair(OSR), we have not concluded superiority between EVAR and OSR beyond theperioperative period. Our aim of this study was to compare phase-specific survival after
EVAR versus OSR.
Methods: The review was conducted according to PRISMA guideline. EMBASE andMEDLINE were searched up to November 2019 to identify randomized control trials(RCTs) and propensity-score matched (PSM) studies that investigated ≥2-year all-cause
mortality (primary outcome) after EVAR versus OSR for intact infrarenal AAA. For
each study, the hazard ratio (HR) with 95% confidence interval (CI) of mortality for
EVAR versus OSR was calculated using survival curves for the following specificphases: the early-term (0-2 years after repair), mid-term (2-6 years after repair),long-term (6-10 years after repair), and very long-term (≥10 years after repair) periods.
The risk ratio (RR) in the perioperative (in-hospital or 30-day) period was also extracted.
Phase-specific HRs or RRs were separately pooled using the random-effects model.
Sensitivity analyses were performed by removing one study at a time to confirm that
our findings were not derived from any single study. Funnel-plot asymmetry was also
examined using the linear-regression test.
Results: Our search identified 4 RCTs and 7 PSM studies enrolling a total of 106,243
AAA patients assigned to EVAR (n = 53,123) or OSR (n = 53,120). The mortality after
EVAR compared with OSR was significantly lower in the perioperative period (RR,
0.39; 95% CI, 0.29-0.51; P < .00001), and similar in the early-term period (HR, 0.93;
95% CI, 0.84-1.03; P = .16). Notably, significant higher mortality was observed in the
EVAR group compared with the OSR group in the mid-term period (HR, 1.15; 95% CI,
1.03-1.29; P = .01). However, similar mortality was observed between the EVAR groupand the OSR group in the long-term (HR, 1.06; 95% CI, 0.96-1.17; P = .27) and very
long-term (HR, 1.17; 95% CI, 0.93-1.47; P = .19) periods. In sensitivity analyses, thesignificant benefit of EVAR in the perioperative period and that of OSR in the mid-term
period were not changed. No funnel plot asymmetry was identified in all analyses.
Conclusions: Compared to OSR, EVAR associated with lower perioperative mortality
and higher mortality in the mid-term period for intact infrarenal AAA. The superiorityof EVAR was absent in the early-term period, and the inferiority of EVAR in the
mid-term period disappeared in the long-term and very long-term periods.
Keywords: Abdominal aortic aneurysm, Endovascular aneurysm repair, Open surgicalrepair, Phase specific mortality, Meta-analysis

108

109

110

静岡薬剤耐性菌制御チーム通報 50
外来での抗菌薬使用の手引き（小児版） 補足㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 静岡医療センター㻌 薬剤部㻌 滝㻌 久司
㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 本康医院㻌 本康宗信
2019 年 9 月静岡県 HP で外来での抗菌薬使用手引き（小児版）が公開されました。
https://www.pref.shizuoka.jp/kousei/ko-420a/amr.html
https://www.pref.shizuoka.jp/kousei/ko-420a/documents/2019tebikisouni.pdf
公開に至っては、静岡県感染症発生動向調査委員会薬剤耐性(AMR)対策部会での討論、修正を重ねて公開の運びとなりました。外来でよく経験する疾患で、市中感染症を考えての抗菌薬の選択と使用量を示しています。普段、小児をご専門に診療されている先生方には、受け入れられやすいと思いますが、外科、眼科、耳鼻咽喉科、泌尿器科、皮膚科など成人も小児も混在して診療をされる外来診療科では、必ずしも使い慣れた薬剤ではないかもしれません。そこで㻌 手引きに示された抗菌薬について、使用法について少しだけ補足をさせていただきます。力価で分かりにくい場合があるので、製剤量で処方量を下表に示しました。商品名は後発を中心に代表的なものを記載していますが、これらを推奨しているわけではありません。㻌

アモキシシリン(AMPC)
溶連菌
ワイドシリン細粒10%
ワイドシリン細粒20%
肺炎球菌
ワイドシリン細粒10%
ワイドシリン細粒20%
アモキシシリン/クラブラン酸(AMPC/CVA)
クラバモックスDS
セファレキシン(CEX)
通常
ケフレックス細粒10%
ケフレックス細粒20%
重症ケフレックス細粒10%
ケフレックス細粒20%
クラリスロマイシン(CAM)
クラリスロマイシンDS10%
アジスロマイシン(AZM)
アジスロマイシン細粒10%
スルファメトキサール・
トリメトプリル（ST合剤）
ダイフェン配合顆粒

製剤量 (g/kg/日)

力価 (mg/kg/日)

用法

0.4
0.2

40
40

分3 (分1も可)分3 (分1も可)

0.9
0.45

90
90

分3
分3

0.15

96.4

分2 食直前

0.5
0.25

50
50

分3
分3

1
0.5

100
100

分3
分3

0.1～0.15

10～15

分2

0.1

10

分1, 3日間

0.12

10

分2

ST合剤全体で(トリメトプリムとして）111

静岡薬剤耐性菌制御チーム 通報 54
小児用の内服用抗菌薬の飲ませ方
静岡医療センター薬剤部 滝 久司
令和元年 11 月 9 日（土）、野村コンファレンスプラザ日本橋において、第 3 回薬剤耐性（AMR）
対策普及啓発活動表彰式＆「薬剤耐性へらそう！」応援大使によるトークイベントに参加してきた。
その中で応援大使から“抗菌薬は医師の指示通りちゃんと飲みきる～”と会場に向かってオリジナ
ルソングが披露された。大人はそれでよいが、ところで小児は？との思いを巡らせながら、通報 50に続き、小児用の内服用抗菌薬の飲ませ方にフォーカスをあててみた。
溶出・放出制御技術の開発と応用
小児用に開発された内服用抗菌薬の多くは服薬コンプライアンスを向上させるためストロベリー
味やオレンジ味など溶出・放出制御技術が開発、応用されている。しかし、抗菌薬を溶くときに強く混ぜすぎ、飲ませ方によっては苦みを生じてしまうなど適切な方法で抗菌薬の服用を行わないとその恩恵をあずかることができなくなってしまうばかりでなく、小児に「くすり＝まずい」という認識をもたせてしまい、その抗菌薬の服薬コンプライアンスの低下が感染症に対する治療の失敗やAMR につながってしまう恐れがある。
内服用抗菌薬の飲ませ方の工夫
小児に散剤を飲ます際に、散剤を溶く飲料水は必ず水で溶いている介護者（保護者）が 64%、
水やジュースで溶いている介護者（保護者）が 36%であったとのアンケート報告がある。さらに、その報告の中では「薬なので水にしか溶いてはいけないと思っていた」「ジュースに溶いたけど良かったですか？」との質問もあったという。また、小児の年齢と服薬に抵抗を示した子の調査をした
報告では、全体の 73%の子が服薬を嫌がったことがあるとの回答だったとある。その服薬拒否・困難を示した比率は 1 歳から 5 歳は年齢とともに増加傾向を示し、一度服薬に失敗するとその体験を覚えており、その後の服薬に苦労するとのアンケート結果がそれを裏付けており、最初に服薬させるときにいかに薬嫌いにさせないことが最大のポイントであると述べられている。
また、一般的に散薬の飲ませ方としてインターネットなどの情報源に総論として各種ジュース類
やスポーツ飲料などがあげられているが、製剤毎にそれぞれの特徴として色、味、においがある
ように混ぜると飲みやすくなるもの、混ぜると相性の悪いものがある。そこで、各インタビューフォーム及び各メーカーからの聞き取り調査をもとに“小児用内服用抗菌薬に混ぜると飲みやすくなる
もの・悪いもの”を一覧表にまとめてみた（表 1）。ただし、メーカーからの聞き取り調査では、もともと何かと混合すること自体を推奨しておらず、混合した製剤の有効性・安全性・品質は保証できな
いということが前提であり、インタビューフォーム掲載事項を除いては配合における相性についての正式見解はないとの回答があったことを補足しておきたい。

112

113

2019 Sep;74(3):279-283. doi: 10.1016/j.jjcc.2019.02.020. Epub 2019 Jun 20.

Factors Related to Physical Functioning
Decline After Cardiac Surgery in Older
Patients: A Multicenter Retrospective Study
Atsunori Itagaki 1 , Masakazu Saitoh 2 , Daisuke Okamura 3 , Tomonori Kawamura 4 , Shota
Otsuka5, Masayuki Tahara

6

Yuguchi10, Michitaka Kato

, Tomoyuki Morisawa

11, Yuji Mori

7

, Kenta Kamisaka
128, Yusuke Ochi

, Tetsuya Takahashi

9, Satoshi

13

Abstract

Background: As few studies have examined physical functioning changes after
cardiac surgery, the factors related to the decline in physical functioning remain
unclear. This study aimed to investigate the factors related to physicalfunctioning decline after cardiac surgery in older patients.
Methods: The final study sample consisted of 523 older (≥65 years) patients(age 74.2±6.1 years, 66% male) who underwent cardiac surgery at 8 Japaneseinstitutions. We excluded patients who were unable to walk independently or
had a slow gait speed (<0.8m/s) before surgery, and those who were unable toregain independent walking after surgery. We divided the patients into twogroups, a decline-in-gait-speed group and a non-decline-in-gait-speed group,
according to whether their gait speed was less than 0.8m/s at discharge. We
analyzed patients' clinical characteristics to identify the factors that predicted
the postoperative decline in gait speed.
Results: Eighty-nine patients (17.0%) showed a postoperative decline in gait
speed. Multivariate logistic regression analysis showed that the following factors
predicted a postoperative decline in gait speed: age [odds ratio (OR) 1.06, 95%
confidence interval (CI) 1.02-1.11]; estimated glomerular filtration rate (OR 0.98,
CI 0.96-0.99); preoperative gait speed (OR 0.01, CI 0.00-0.08); and the
postoperative day on which the patient could walk independently (OR 1.08, CI
1.02-1.14).

114

Gen Thorac Cardiovasc Surg 2019 Dec 21. doi: 10.1007/s11748-019-01279-0. Online ahead of print.

Effect of Obesity and Underweight Status on
the Hospital-Acquired Functional Decline inPatients With Cardiovascular Surgery:
An Analysis of Data From a Prospective
Observational Multicenter Cohort Study
Masakazu Saioth 1 , Kenta Kamisaka 2 , Michitaka Kato 3 , Kentaro Iwata 4 , Koji Sakurada 5 , Masayuki
Tahara 6 , Keisuke Oura 7 , Yuji Mori 8 , Shota Otuka 9 , Tomoyuki Morisawa 10 , Tetsuya Takahashi 10
Affiliations Expand

Affiliations PMID: 31865600

DOI: 10.1007/s11748-019-01279-0

Abstract

Objects: The aim of this study was to determine the association between
underweight or obese status and hospital- acquired functional decline (HAFD)
following cardiovascular surgery.

Methods: We performed a retrospective, observational, multicenter cohort
study of cardiovascular surgery patients between April, 2010, and June, 2017.
Body mass index (BMI) was categorized into four classes: underweight group (<18.5 kg/m2), normal weight group (18.5 to < 25 kg/m2), overweight group (25 to< 30 kg/m2), and obese group (≥ 30 kg/m2). HAFD was defined as a decrease ofat least one point on the short physical performance battery score at discharge,
compared with the preoperative score.
Results: A total of 3,850 adult patients were included in the analysis data set(median age 72 years, 35% female). A total of 811 (21.0%) patientsdemonstrated HAFD: 27.2% in the underweight group, 21.3% in the normal
weight group, 18.8% in the overweight group, and 19.3% in the obese group.

The relative risk for HAFD was 1.381 (95% CI 1.052-1.814) for the underweightgroup versus the normal weight group, although that is comparable to theobese group after adjustment by confounding factors.

115

Eur J Prev Cardiol 2019 Dec;26(18):1931-1940. doi: 10.1177/2047487319859974. Epub 2019 Jul 5.

Exercise-based Cardiac Rehabilitation for
Patients With Catheter Ablation for
Persistent Atrial Fibrillation: A Randomized
Controlled Clinical Trial
Michitaka Kato 1 , Michio Ogano 2 , Yuji Mori 3 , Kaito Kochi 3 , Daisuke Morimoto 3 , Kazuya Kito 3 , Fumi
Nihei Green 4 , Toshiya Tsukamoto 1 , Akira Kubo 1 , Hisato Takagi 5 , Jun Tanabe

2Affiliations Expand PMID: 31272205 DOI: 10.1177/2047487319859974
Abstract
Aims: The efficacy and safety of cardiac rehabilitation for patients with persistent atrial fibrillation
who restored sinus rhythm after catheter ablation remains unclear. The aim of the present study
was to evaluate the effects of cardiac rehabilitation on exercise capacity, inflammatory status,
cardiac function, and safety in patients with persistent atrial fibrillation who had catheter ablation.
Methods: In this randomized controlled study, 61 patients treated with catheter ablation for
persistent atrial fibrillation (male, 80%; mean age, 66 ± 9 years) were analyzed. Thirty patients
underwent cardiac rehabilitation (rehabilitation group), whereas the remaining 31 patients
received usual care (usual care group). The rehabilitation group underwent endurance andresistance training with moderate intensity, at least three times per week for six months. Sixminute walk distance, muscle strength, serum high-sensitivity C-reactive protein, plasma
pentraxin 3, left ventricular ejection fraction and atrial fibrillation recurrence were assessed atbaseline and at six-month follow-up.
Results: In the rehabilitation group, significant increases in the six-minute walk distance,
handgrip strength, leg strength and left ventricular ejection fraction and significant decreases inhigh-sensitivity C-reactive protein and plasma pentraxin 3 concentrations were observed at sixmonth follow-up compared with baseline (all p < 0.05). No significant changes were observed in
the usual care group. During the six-month follow-up period, the number of patients with atrial
fibrillation recurrence was six (21.4%) in the rehabilitation group and eight (25.8%) in the usual
care group (risk ratio, 0.83; 95% confidence interval, 0.33 to 2.10).

116

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119

120

MCI って知ってる？

～東京オリンピック・パラリンピックに向け～
MCI 多数傷病者災害：麻酔科医も勤務施設の備えに参画を！

災害発生場所は大会会場のみではない！
（地下鉄サリン事件・JR 福知山線脱線事故・相模原障害者施設事件・他）

MCI 関連知識のポイント
1 思考回路を『最大多数の最大幸福』に転換！
2「治療対象と医療資源のバランス」が崩れる！
3 災害発生付近の施設に『直ぐに』『大量に』来る
4 緊急手術が必要な四肢・脳・腹部外傷が多数
5『輸血』が必要例多数（駆血帯解除は OR が原則！）
6 災害の種類は多岐（外傷・熱傷・中毒・爆傷・銃創）

各施設で確保すべき４S例）マドリード多発列車爆破

1 物的資源（Stuﬀ）
2 人的資源（Staﬀ）
3 スペース（Space）
4 システム（System）

３駅４列車（通勤時間帯 10 回爆発）
死者 191 名、負傷者 2,062 名
近隣２病院に患者集中！
【Gegorio Maranon 大学病院】
最初の患者来院：爆発から 19 分！
ICU28 床の空床確保
OR 予定手術中止緊急手術 37 件 /24h

源
資
療 ！
医 足
不

治
療
多 対
数 象
！

全国の麻酔科医は MCI に備え1 良好な院内コミュニケーションを！
2 優先順を含む手術対応と院内連携を！
3 手術室外での診療にも参画を！
4 事前に院内シミュレーション実施を！
JSA オリパラ MCI 委員会

内野博之・大嶽浩司・小澤章子
倉橋清泰・櫻井淳・森崎浩

121本手引きの目的と使用法
我が国においても、自然災害はもとより、地下鉄サリン事件、JR 福知山線脱線事故あるいは相模原障害者施設事件など、多数傷病者事故（Mass Casualty Injury: MCI）が数多く発生している。2005 年に発足した災害派遣医療チーム（DMAT）体制は一定の成果を上げつつあるものの、テロや爆発事故など多数傷病者発生に対応する社会的基盤や医療機関の体制は欧米諸国に比べ十分整備されているとは言い難い。2020 年夏の東京オリン
ピック・パラリンピック開催を控え、関連する学術団体が「救急災害医療体制に係る学術連合体 (http://2020ac.com/)」を 2016 年 5 月に結成、公益社団法人日本麻酔科学会も 2018年 10 月より 23 番目の学術団体として参画した。MCI は必ずしも競技会場で発生するとは限らず、対応可能な医療機関の体制や諸準備を整える重要な機会と捉え、安全かつ効率的な手術室運営に主眼を置いた院内対応について、全国の麻酔科医が適切に対応するための手引きを作成した。
なお本手引きは、大規模自然災害によりライフラインが途絶あるいは医療機関が被災す
る広域災害を想定したものではない。これまでに公表されている海外文献や学術団体指針
等を参考に箇条書きにまとめているが、我が国における医療環境や社会基盤など異なる点も多く、文献を基にした「推奨」に加え当委員会「提案」も数多く含まれている。また勤務施設の規模や地域、診療体制等に院内 MCI 対応は左右されるため、「MCI 発生時の対応のポイント（推奨と提案）」「MCI 対応準備のためのチェックリスト」として集約した。
また当該施設に該当する職位がない場合にはそれに相当する職位に置き換えて対応頂くことを想定している。
日本麻酔科学会会員が勤務する医療機関あるいは地域において、麻酔科医師の社会的責務を果たして頂く一助となれば幸いである。

公益社団法人日本麻酔科学会 オリ・パラ MCI 委員会
内野博之、大嶽浩司、小澤章子、倉橋清泰、櫻井淳、森崎浩

122

編集後記

2019 年度の業績集が完成いたしました。日常診療が忙しいなか、臨床研究および治験に多大な努力をされている先生方、誠にありがとうございます。そして治験管理室看護師の井上さん、薬剤師の薄先生、いままで本当にありがとうご
ざいました。それぞれ新天地での活躍をお祈りしています。また治験管理室看
護師の勝又さん、今年もありがとうございました。そして受託研究審査委員会のメンバーのみなさん、特に外部委員の先生方にはお忙しいところ貴重なお時間をいただき、改めて感謝申し上げます。それから事務の渡邉光子さん。今年もまた締切間際まで仕事が終わらない私のためにご迷惑をおかけしました。渡
邉さんの多大なる努力なしでこの業績集は完成できませんでした。ここに改めて心より感謝の意を表したいと思います。本当にありがとうございました。

2020 年 9 月

静岡医療センター

臨床研究部長田邊潤

静岡医療センター研究業績集
令和2年9月発行
発 行 静岡医療センター〒411-8611 静岡県駿東郡清水町長沢762-1
電話 ０５５－９７５－２０００
ＦＡＸ ０５５－９７５－２７２５
発行者 静岡医療センター院長 中野 浩
編集者 臨 床 研 究 部 長
田邊 潤
印 刷 松本印刷株式会社