川崎大動脈センターで治療を行なっている主な大動脈疾患 •大動脈解離 •弓部大動脈瘤 •基部大動脈瘤 •胸腹部大動脈瘤 •下行大動脈瘤 •大動脈弁輪拡張症 •上行大動脈瘤 •腹部大動脈瘤 *動脈径が50mmを超えていると言われた方は早めに受診して下さい。 川崎大動脈センター 044-544-4611(代表)

Thank you for your comment. I am still far from reaching the level of the great surgeons who came before me. Teaching surgery is truly challenging. Even in standardized procedures, each case has its own unique characteristics, along with potential pitfalls. A small misstep can lead to serious consequences, yet such nuances are rarely found in textbooks. To train the next generation of surgeons, it is essential to transform implicit knowledge into explicit knowledge and provide them with firsthand experience of these challenges. When I think about how our predecessors learned surgery with far less information than we have today, I realize that their efforts must have been extraordinary. They likely put in multiple times the effort that today’s surgeons do. No one becomes a skilled surgeon on their own. If we, as ordinary individuals, aim to surpass the legendary surgeons of the past, we must work many times more efficiently than they did just to catch up. And if a surgeon lacks the motivation to improve, they have no right to operate. This is because patients suffer when they are treated by surgeons who lack both skill and dedication. For cardiovascular surgeons, an unwavering commitment to always providing the best possible surgery for their patients is absolutely essential.

今月はKACにて開胸胸部大動脈手術52件開腹腹部大動脈手術9件行いました。急性大動脈解離スタンフォードA型25件、胸腹部大動脈瘤は4件たでした。その中でもステントグラフト抜去が必要になったケースが4件あったり、re-doケースが8件ありました。また下肢虚血を伴う急性A型解離に関しては弓部置換、Ax-bil.FAまで行いましたが、真腔が腹部で血栓閉塞し、AAARまで必要になるなど珍しいケースが多い傾向にありました。大動脈手術に関しては今までいろんな経験をしましたが、まだまだ自分の進歩も必要ですし、後輩の育成もしていかないといけないと感じる1ヶ月でした。 This month at KAC, we performed 52 open thoracic aortic surgeries and 9 open abdominal aortic surgeries. Among them, we treated 25 cases of acute Stanford type A aortic dissection and 4 cases of thoracoabdominal aortic aneurysm. Notably, we encountered 4 cases requiring stent graft removal and 8 re-do surgeries. Additionally, we had several rare and complex cases, such as acute type A dissection with lower limb ischemia, where we performed total arch replacement with Ax-bilateral femoral artery bypass. However, in one case, the true lumen became thrombosed at the abdominal level, requiring abdominal aortic aneurysm repair (AAAR) as well. Although I have gained extensive experience in aortic surgery over the years, this month reminded me that there is always room for my own improvement. At the same time, I feel a strong responsibility to train and support the next generation of surgeons.

@ykuroda12 ありがとうございます。インフルエンザ厄介ですね。今回は山本先生と高梨先生の話が僕の発表に厚みを加えてくれました。

上行55ミリで経過観察されていた患者。A型解離、下肢虚血ありで搬送されてきました。解離すると、下行以下の正常な血管も障害を受ける他、手術リスクも10倍になります。虚血臓器がある場合はさらに死亡率が高くなります。また抗凝固剤を服用している場合には出血コントロールが難しくなることがあり、さらに手術リスクは上がります。上行大動脈置換の場合、予定手術であればリスクは1%程度で手術治療出来ます。抗凝固薬も中止してから手術することが出来るので、飲まれている方でも問題ありません。上行大動脈が50ミリ以上ある方は是非一度ご相談ください。

当センターでは、大動脈瘤のある方はいつでも紹介状なしで受診していただけます。患者がどの医療機関を選ぶかは大切な権利です。セカンドオピニオンや他の治療法を探している方、ぜひご相談ください。 #医療 #健康 #セカンドオピニオン #大動脈瘤

Happy New Year! As the new year begins, I am ready to continue performing aortic surgeries with a fresh mindset. New Year’s Eve and January 1st are always extremely busy, and this year is no exception. We are now preparing for our third case of acute type A aortic dissection. Including the stent graft procedure performed late last night for a patient with type B aortic dissection, we have already treated four aortic cases since the start of the year. Sudden drops in temperature seem to increase the incidence of dissections, so we must remain vigilant.

This year, we performed 621 cases of open thoracic aortic surgery, marking an increase from the previous year. With the implementation of national workstyle reform policies limiting working hours, we have faced the need to improve efficiency in every aspect of our practice. This includes optimizing surgical workflows, standardizing postoperative management, enhancing the functionality of our electronic medical records, and expanding the availability of hospital beds. These efforts have required a more streamlined and focused approach than ever before. As we anticipate another busy year ahead, our goal is to further eliminate inefficiencies, refine our systems, and continue to improve patient outcomes through a more efficient and organized structure. Additionally, the number of aortic diseases continues to rise, with an increasing prevalence of complex cases, such as post-stent graft expansions, aortoesophageal fistulas, and infections following frozen elephant trunk procedures. Our aim is to establish our facility as one capable of providing standardized, high-quality treatments for these challenging and intricate aortic conditions that are beyond the scope of conventional hospitals. None of this would have been possible without the collaboration and dedication of various co-medical staff, whose tireless support has been invaluable. We are deeply grateful for their contributions and remain committed to approaching aortic surgery with humility and a continual drive for excellence. Together, we strive to provide the best possible care for our patients.

I am scheduled to speak at the 55th Annual Meeting of the Japanese Society for Cardiovascular Surgery about thoracoabdominal aortic aneurysm repair in reoperations. According to the analysis of 712 repairs for thoracoabdominal aortic aneurysms Extent I, II, III performed at Kawasaki Aortic Center from January 2012 to September 2024, out of these 712 cases, there were 545 elective surgeries. Among these elective cases, there were 113 re-do cases and 432 initial surgeries via left thoracotomy. For elective surgeries following descending thoracic aortic graft replacement, the 30-day mortality rate for thoracoabdominal aortic graft replacement is zero, and so is the incidence of paraplegia. However, the incidence of paraparesis is about 5% regardless of whether it is a reoperation or an initial left thoracotomy. Postoperative bleeding was indeed a risk factor for spinal cord injury, but in cases of thoracoabdominal graft replacement following descending thoracic aortic graft replacement, it was thought that spinal cord infarction could be prevented.

I had the opportunity to participate in the aortic academic conference held in Nanjing, where I presented the outcomes of our thoracoabdominal aortic surgeries. I would like to express my gratitude to Dr. Wei. During the Q&A session after my presentation, I was surprised to learn that Dr. Coselli has started using renal perfusion instead of renal cooling for renal protection during surgery.

昨日は定時手術2件に加えて緊急手術でA型解離3件の手術。11日で24件の胸部大動脈手術をKACで行いました。中にはB型解離破裂に対する緊急手術もあります。先日KASカンファレンスで広上先生がプレゼンテーションしましたが、KACではこの5年間で63件のB型破裂に対する手術を行い、手術成績は良好でした。 Yesterday, in addition to two scheduled surgeries, we performed three emergency surgeries for Type A dissections. Over the course of 11 days, we conducted 24 thoracic aortic surgeries at KAC, including emergency surgeries for ruptured Type B dissections. Recently, at the KAS Conference, Dr. Hirokami presented that over the past five years, KAC has performed 63 surgeries for Type B ruptures with excellent surgical outcomes. #ThoracicAorticSurgery

12月は緊急が多い月です。そのため胸部大動脈の定時手術を原則一日1件にしておりますが、それでもすでに今月は10日で20件の手術を行いました。私たちの状況を見て、台湾の友達が川崎の冬景色だねとエールをくれました。 December is packed with emergencies, so we’ve been scheduling only one planned thoracic aortic surgery per day. Yet, by the 10th, we’ve already performed 20 surgeries. A friend from Taiwan offered words of support, describing it as “Kawasaki’s winter scenery.

@PShivanesandr @PrajnaKota @World_fvs @Vascular_India Very nice 👍

@PShivanesandr I haven't written a paper on this topic yet. Although I have had a lot of aortic surgery, I have hardly written a paper yet, so I will do my best to write from now on.

今週は2件弓部置換➕オープンステント後の感染症例の手術。オープンステントは手術を簡単にするかもしれませんが、物事には面裏が必ずあります。感染はオープンステントを伝って下行大動脈にまで拡大し、その後の治療をとても複雑にします。 当センターではオープンステントを使用する事は今のところ殆どありません。これは私の師匠からの教えですが、必要は発明の母なりで、どうしても必要な場合に新しい技術を用いるのはいいけれども、新しいデバイスがあるから何かに使ってみようという考えは必ず失敗するからやめておけと言われました。元々は西洋の諺ですが、私も大動脈治療においてしばしばそのように思うことがあります。従来通りの手術でこれまで自分で1800例以上治療しましたが、新しい技術に頼らないといけない事は数回でした。

術前カンファレンス。ステントグラフト後の大動脈瘤再拡大が7件中3件。ステントグラフトを施行されたのは、皆60代の時点。日本人の寿命とステントグラフトの寿命を考えるとやはり60代でステントグラフトを入れるのは根治的とは言えないと思います。ステントグラフト後の手術は切開も拡大しなければならず、より侵襲的になります。そのため、適応やその後の再手術に関して患者とよく話し合う必要があります。またステントグラフトの種類によっては再治療がより難しくなるものもあるため、入れる医師は将来抜くことも考慮すべきだと思います。

Today, I successfully completed my presentation at the 30th PATACSI conference. I presented on the surgical treatment of thoracoabdominal aortic aneurysms, while Dr. Ozaki presented on the Open surgery after TEVAR failure. The presentation from Kawasaki Aortic Center was graciously given nearly an hour to present, allowing us to respond to numerous questions. The moderator extended the session until all questions from the audience were addressed, which led to a lively discussion. I was also entrusted with greetings from everyone to Dr. Poch from the Philippines, who is currently learning aortic surgery with us. I am committed to fully supporting him as he establishes the Philippine Aortic Center. Furthermore, I had the invaluable opportunity to meet many pioneering doctors of aortic surgery in the Philippines. Numerous doctors shared their experiences of working with Dr. Yamamoto at the Texas Heart Institute, which made me proud once again to be his disciple. I am determined to maintain and expand these connections to improve the outcomes of aortic surgeries across Asia, which I believe is one of my key missions. #PATACSI #aortaEd

I will give a presentation about thoracoabdominal aortic repair based on our experience with 648 cases of open surgery over the past ten years at 30th annual convention of PATACSI. My focus will be on extent I, II, and III repairs, excluding extent IV and V repairs. This is because extent IV repairs include juxtarenal AAAs from a lateral approach, and extent V repairs involve only descending aortic repair. In the Philippines, thoracic surgeons face challenges in improving their outcomes. I will do my best to share our knowledge and experience, and I hope this will be helpful for them. #PATACSI