Remote Cardiac Rehabilitation With Wearable Devices

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

Predictor of Activities of Daily Living (ADL) Disability in Patients Undergoing Cardiovascular Surgery / 日本心臓血管外科学会雑誌

Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery. Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.

A Case of Perigraft Seroma after Ascending Aorta Replacement That Was Cured by an Omental Pedicle Graft / 日本心臓血管外科学会雑誌

A 40-year-old man with a family history of Marfan syndrome was admitted to our hospital because of acute Stanford type A aortic dissection. He underwent a Bentall operation with an artificial vascular graft. Postoperative computed tomography revealed a low-density area around the graft in the ascending aorta and at the left subclavian artery cannulation site. He showed no symptoms and was discharged uneventfully. Five months after the operation, a pulsatile subdermal tumor appeared in the center of the median sternotomy. Computed tomography showed low- and high density fluid accumulation surrounding the ascending aortic graft, and this was connected with a subdermal tumor. We suspected collapse of the anastomotic site and performed an emergency operation. The fluid around the aortic graft was clear and diagnosed as perigraft seroma. To prevent recurrence, we filled the space around the aortic graft with an omental pedicle graft. After the operation, perigraft seroma did not recurr. In addition, with the disappearance of the seroma in the mediastinum, fluid accumulation at the left subclavian artery cannulation site also disappeared.

Aortic Valve Reconstruction (AVrC) Using Autologous Pericardium for a Patient with Severe Aortic Stenosis and Chronic Renal Failure Prior to Kidney Transplant Surgery / 日本心臓血管外科学会雑誌

We performed aortic valve reconstruction (AVrC) using autologous pericardium for a patient with severe aortic stenosis and chronic renal failure, prior to kidney transplantation. The patient received kidney transplantation in the early phase after cardiac surgery. The case was a 61-year-old man with severe aortic valve stenosis who received dialysis due to chronic renal failure. We performed AVrC using autologous pericardium for the following reasons. Anticoagulant therapy is not desirable because of the need to perform kidney transplantation in the early phase after cardiac surgery. Implantation of prosthesis was not desirable because the patient requires oral immunosuppression therapy after kidney transplantation. There was no significant postoperative pressure gradient of the aortic valve orifice or aortic valve regurgitation (AR). The patient received kidney transplantation 113 days after surgery. AVrC using autologous pericardium was feasible for aortic stenosis patients in a patient waiting to receive kidney transplantation because anticoagulation therapy is not necessary after AVrC.

Midterm Results of Radial Artery Graft in Coronary Artery Bypass Surgery: AC Bypass Technique versus Y-Graft Technique / 日本心臓血管外科学会雑誌

We treated 162 patients by isolated CABG with a left internal thoracic artery (LITA) anastomosed to the left anterior descending artery and a radial artery anastomosed to the circumflex artery between August 1996 and December 2002. Late angiograms were performed 6 to 65 months (21.7±15.8) after the operation. The purpose of this study was to compare midterm results of radial arteries anastomosed to the side wall of LITA (group Y) with those anastomosed to the aorta (group AC). There were no operative deaths in either group and no difference in the postoperative complication rate including cerebral infarction. The early patency of group Y was lower than that of group AC (group AC: 97.8%, group Y: 87.1%, <i>p</i>=0.017), and also the late patency of group Y was significantly lower than that of group AC (group AC: 90.9%, group Y: 36.4%, <i>p</i>=0.0008). All of the early patent radial artery grafts in group AC were patent on late angiograms, but 3 of the 25 anastomoses in group Y which were clearly patent on early angiograms later showed a string sign later. When using a radial artery graft in circumflex artery territory, we recommend an aorto-coronary bypass graft rather than Y-graft.

A Successful Operative Case of Delayed Repair for Acute Traumatic Aortic Rupture / 日本心臓血管外科学会雑誌

Although recent progress in surgery for acute traumatic rupture of the thoracic aorta is encouraging, hospital mortality remains high due to associated fatal lesions. Delayed repair of acute aortic rupture, after management of critical lesions, has been reported in the literature with increasing frequency. We present here a successful operative case of a 54-year-old-woman with acute traumatic aortic rupture. She was admitted to the intensive care unit with loss of consciousness, rib fracture and lung contusion in order to investigate additional critical lesions under strict control of systolic blood pressure under 120mmHg. After completion of all diagnostic procedures, aortic repair was performed 2 days after the accident. The intima of the aorta was found to be disrupted for two thirds of the circumference and pseudoaneurysm was diagnosed. A gelatin-coated vascular prosthesis with one branch was interposed under cardiopulmonary bypass during which general heparinization, systemic hypothermia (20°C) and retrograde brain perfusion method were used. She recovered uneventfully and was discharged 2 weeks after the operation.