Kyobu geka. The Japanese journal of thoracic surgery
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The recent 10-year progress and prospective views of the Board Certificated Cardiovascular Surgeon in Japan were described. Although total framework of the Japanese Board of Medical Specialist is not yet established, the certification standards of the Board Certificated Cardiovascular Surgeon and training hospital were substantially revised in 2005 and 2006 for increasing those quality. Hereafter, we should tackle to make new systems for the trainee's registration, gaining of incentive for the Board Certificated Cardiovascular Surgeon, and education of coworkers in surgical fields.
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Graduate and postgraduate education in the specialty of cardiovascular and general thoracic surgery may become more attractive by turning by itself to focus on producing competitive specialists and by having mature specialty boards to aim at. For this to accomplish consensus must be formed among hospital surgeons who are now united through specialty associations. In our country specialists may reasonably be less than 1000 in number in each thoracic specialty to call for specialist doctor's fee.
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Artificial heart or heart transplantation are required for the treatment of profound heart failure. Total artificial heart (TAH) and ventricular assist system (VAS) were developed from late 1950s and 2 extracorporeal pneumatic Japanese VASs (Toyobo VAS and Zeon VAS) were introduced to clinical field from 1980. Now, over 850 patients were applied several types of VASs including Japanese VASs. ⋯ Small size implantable left VAS (LVAS) are required and several types of non-pulsatile pump, including 2 Japanese made centrifugal pumps, are under clinical trials. And destination therapy by using implantable pulsatile LVAS for end-stage heart failure patients has been started in United States and is performed in United States and Europe. In near future, artificial heart and heart transplantation will be selected according to the conditions of the patients with profound heart failure.
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Mesenteric ischemia is a dreaded complication of acute type A aortic dissection. From January 1994 to December 2004, 134 patients with acute type A aortic dissection were operated. Eleven patients showed postoperative mesenteric ischemia. ⋯ Our strategy to manage these patients is as follows; patients who are suffering mesenteric and/or lower extremity ischemia preoperatively, or those whose computed tomography (CT) shows stenosis, obstruction, or dissection of the superior mesenteric artery, should be recognized as high-risk patients of postoperative mesenteric ischemia. Their mesenteric circulation should be examined directly with laparotomy after the central repair. If the mesenteric circulation seems to be suboptimal, iliac artery-superior mesenteric artery bypass should be performed.
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From June 2003 to November 2006, transapical aortic cannulation was performed in 73 patients (41 men and 32 women, mean age 63 years, 64 hemiarch repair and 9 total arch replacement) with acute type A aortic dissection. A 1-cm incision was made in the apex of the left ventricle, and a 7-mm soft and flexible cannula was passed through the apex and across the aortic valve until positioned in the ascending aorta under guidance by transesophageal echocardiography. ⋯ There were no malperfusion events. Our results showed that transapical aortic cannulation was secure and useful for repair of acute type A aortic dissection.