To consult

  We welcome Consultation or Second opinion about heart surgery

For more details, please check each page of “Brief lecture of cardiovascular surgery” in this home page.

1. To those who are told to undergo surgery for valvular heart disease： 

   In ”Mitral Regurgitation” (or Mitral Insufficiency), the mitral valve can be repaired in most cases (either posterior or anterior leaflet). However, if the valve leaflet is too rigid or thickened, repair surgery is not necessarily the best choice for the patient.  For those who are beyond 60-65 y.o., or young female patients who wish to have a baby in the future or young patients who wish to do very hard sport (e.g. rugby or ice hockey etc.), we consider/ discuss not only valve repair but also replacement using tissue valve (bovine or porcine valve) if repair seems not best suitable for the patient. For old patients with Aortic root enlargement, stentless valve may become an excellent choice. The most important strategy is, we believe, to understand benefits and limitations of each method of surgery, and is to offer the most suitable method for the patient.

2.　For those who have both valvular heart disease and atrial fibrillation (i.e., irregularly irregular rhythm)： 

“Cox-Maze procedure” has been done so far for atrial fibrillation. However, Cox-Maze procedure is not effective for patients with too much enlarged atrium or for patients who has atrial fibrillation over 10 years. Thus, we developed atrial volume reduction Maze, so that the “tough” atrial fibrillation can be cured. With the method, most of the “tough” patients recover normal rhythm.  Please note that atrial fibrillation is often fatal disease in the long-term by means of thrombi formation or stroke/embolism.

3. For those who have cardiomyopathy, cardiac dilatation or heart failure： 

We do left ventricular restoration surgery (e.g., modified Batista procedure, Dor surgery, SAVE surgery, or Overlap surgery etc.) when it improves the patient’s prognosis more than medication does.  For young patients especially 30s or 40s, we recommend heart transplantation.  For older patients or for those who have a very good chance of recovery, we recommend LV restoration surgery.  In patient with severe cardiomyopathy or heart failure, the risk of the surgery is higher than other heart patients, and we believe it very important to evaluate risk and benefit of the surgery specifically for the patient.

4. For those who have thoracic Aortic aneurysm or thoracoabdominal Aortic aneurysm： 

We replace whole aortic arch (total arch replacement) safely. If the aortic disease is extended or multiple, we use/add catheter-based stentgraft by cooperation with cardiologists.  For patients with connective tissue disease (e.g., Marfan’s syndrome), it is very important to take long-term durability of the tissue so that the beneficial results of the surgery last long.  For instance, we are not too much aggressive for aortic root repair by David or Yacoub method for this population because tissue valve may last longer. Depending the age of the patients, Bentall procedure by employing mechanical valve may be more beneficial. In summary, we believe it important to consider what surgery is most suitable for the very patient.

5. For those who have angina or history of myocardial infarction： 

Here, we do collaborative approach, choosing coronary bypass surgery or catheter intervention or both (hydrid procedure) depending on the patient’s disease and background.

When necessary, we consider tissue engineering treatment as well. For those who suffered big myocardial infarction, when indicated, we consider LV restoration surgery, especially when ischemic mitral regurgitation or ischemic cardiomyopathy is present.  Depending the patient’s anatomy, etiology and dysfunction of LV, we choose new reparative method of mitral valve, or replacement with total preservation of papillary muscles, or LV restoration as required, so that we can maximize the LV function after the surgery.

For inquiry, send e-mail to komeda@heart-center.or.jp

  We welcome Consultation or Second opinion about heart surgery

For more details, please check each page of “Brief lecture of cardiovascular surgery” in this home page.

1. To those who are told to undergo surgery for valvular heart disease： 

   In ”Mitral Regurgitation” (or Mitral Insufficiency), the mitral valve can be repaired in most cases (either posterior or anterior leaflet). However, if the valve leaflet is too rigid or thickened, repair surgery is not necessarily the best choice for the patient.  For those who are beyond 60-65 y.o., or young female patients who wish to have a baby in the future or young patients who wish to do very hard sport (e.g. rugby or ice hockey etc.), we consider/ discuss not only valve repair but also replacement using tissue valve (bovine or porcine valve) if repair seems not best suitable for the patient. For old patients with Aortic root enlargement, stentless valve may become an excellent choice. The most important strategy is, we believe, to understand benefits and limitations of each method of surgery, and is to offer the most suitable method for the patient.

2.　For those who have both valvular heart disease and atrial fibrillation (i.e., irregularly irregular rhythm)： 

“Cox-Maze procedure” has been done so far for atrial fibrillation. However, Cox-Maze procedure is not effective for patients with too much enlarged atrium or for patients who has atrial fibrillation over 10 years. Thus, we developed atrial volume reduction Maze, so that the “tough” atrial fibrillation can be cured. With the method, most of the “tough” patients recover normal rhythm.  Please note that atrial fibrillation is often fatal disease in the long-term by means of thrombi formation or stroke/embolism.

3. For those who have cardiomyopathy, cardiac dilatation or heart failure： 

We do left ventricular restoration surgery (e.g., modified Batista procedure, Dor surgery, SAVE surgery, or Overlap surgery etc.) when it improves the patient’s prognosis more than medication does.  For young patients especially 30s or 40s, we recommend heart transplantation.  For older patients or for those who have a very good chance of recovery, we recommend LV restoration surgery.  In patient with severe cardiomyopathy or heart failure, the risk of the surgery is higher than other heart patients, and we believe it very important to evaluate risk and benefit of the surgery specifically for the patient.

4. For those who have thoracic Aortic aneurysm or thoracoabdominal Aortic aneurysm： 

We replace whole aortic arch (total arch replacement) safely. If the aortic disease is extended or multiple, we use/add catheter-based stentgraft by cooperation with cardiologists.  For patients with connective tissue disease (e.g., Marfan’s syndrome), it is very important to take long-term durability of the tissue so that the beneficial results of the surgery last long.  For instance, we are not too much aggressive for aortic root repair by David or Yacoub method for this population because tissue valve may last longer. Depending the age of the patients, Bentall procedure by employing mechanical valve may be more beneficial. In summary, we believe it important to consider what surgery is most suitable for the very patient.

5. For those who have angina or history of myocardial infarction： 

Here, we do collaborative approach, choosing coronary bypass surgery or catheter intervention or both (hydrid procedure) depending on the patient’s disease and background.

When necessary, we consider tissue engineering treatment as well. For those who suffered big myocardial infarction, when indicated, we consider LV restoration surgery, especially when ischemic mitral regurgitation or ischemic cardiomyopathy is present.  Depending the patient’s anatomy, etiology and dysfunction of LV, we choose new reparative method of mitral valve, or replacement with total preservation of papillary muscles, or LV restoration as required, so that we can maximize the LV function after the surgery.

For inquiry, send e-mail to komeda@heart-center.or.jp