Department of Cardiovascular Surgery

Introduction

Department of cardiovascular surgery specialize in surgical treatment of cardiac and/or thoracic aortic diseases predominantly in the adult.

Our motto is "treat patients as we want to be treated." In Japan, hospitals and/or doctors ranking simply based on case volume are greatly advocated, and some information might be kind of advertisement to get more profile. However, priority during any treatment of any disease should be highly secure efficacy. Above anything, we have been aiming at best quality treatment all the time.

Reliable therapeutic strategy is also crucial. We usually carry out steadfast and conventional treatments, not novel ones with few evidences, and explicitly show our strategy to patients and their relatives.

We tightly interact with cardiologists, intensivists, clinical engineers, and experts from other divisions. We assess patients' status-quo and analyze what needs to be done. Therapeutic strategy is often decided based on discussion during joint conferences with cardiologists that are held twice a week. Consequently, while some patients are recommended to undergo large scale surgery, non-surgical therapy or observation might be a choice in someone else. We believe always making fair decision would also make our department trustworthy.
Joint surgery with surgeons from another division is sometimes necessary. All patients are basically accommodated even if they are critically ill or in emergency. In these settings, any measures and contrivances are adopted to make the operation safer.

Incidentally, department of cardiology is in charge of pacemaker therapy and patients with cardiovascular diseases that surgery is NOT indicated. Department of vascular surgery takes charge of patients with peripheral vascular disease below abdominal aorta.

Basically, we do not accept regular outpatient clinic visit just for observation. Patients are referred to other nearby facilities, including those who had undergone surgery at this hospital. Therefore, patients discharge after they become stable, not only objectively but, to some extent, subjectively rest they feel worried or were obliged to leave too early.

Patient care at our department

Those who are scheduled for surgery usually admit to the hospital 5 or 6 days earlier, at 2 PM. Within a couple of days, patient together with close relatives would get detailed explanation of the surgery and are expected to give informed consent.
General principles for some diseases are shown below. All surgical procedures are carried out under general anesthesia.

1. Angina pectoris and myocardial infarction:
   Coronary arteries perfuse myocardium. Coronary artery bypass surgery is indicated for patients with obstructive lesions in these vessels.
   Conventionally, this procedure has been carried out under extracorporeal circulation and cardiac arrest, but off-pump beating heart bypass surgery has become very common these years. Contrary to expectation, however, short term results of these two methods are almost equivalent, and long term result of off-pump surgery is poorer than that of conventional one.
   Since our outcome of conventional bypass surgery has been well acceptable, it is our first choice. Off-pump surgery is selected out in patients whom this option is beneficial.
   We have aggressively treated patients with acute myocardial infarction if necessary, and have repaired life-threatening ventricular septal perforation many times.
2. Valvular disease:
   Most patients with dysfunctional heart valve used to undergo valve replacement. During such surgery, dysfunctional valve is resected and prosthesis is sewn into place.
   Mitral regurgitation of various etiologies has been increasing these years. For these patients, we repair the native valve whenever possible because of bunch of merits. To date, our repair rate has been satisfactory.
   Aortic valve diseases, stenosis in particular, have been increasing as well. However, valve replacement is still a standard procedure because aortic valve repair achieves long lasting benefit only in limited patients. Transcatheter aortic valve implantation is not performed at this hospital at the moment.
   There are two types of valve prosthesis: mechanical and biological. Both have advantages and disadvantages, and either of them is used taking patients' situation and background into consideration.
   Incidentally, we have carried out lots of surgery for infective endocarditis.
3. Aortic disease:
   Prosthetic graft replacement is the method of choice for aortic aneurysm and aortic dissection.
   Emergencies and complex procedures are common. Moreover, this subgroup includes many frail patients like elderly, those with severe atherosclerosis, those with significant comorbidities, etc. Therefore, aortic surgery patients tend to need special care to preserve organ function such as brain, spinal cord, kidney, etc. We aim at risk reduction by employing adequate measures.
   In some cases, stented graft prosthesis is used either via chest wound or via peripheral arteries (transcatheter endovascular repair: TEVAR).
4. Miscellaneous (congenital heart disease, cardiac tumor, atrial fibrillation, etc.)
   Patients with uneventful postoperative recovery leave the ICU and are enrolled in rehabilitation program in 2 days, and would be free from drip infusion in around 4 day. Majority of patients discharge from the hospital 2 or 3 weeks later.

Main diseases

• Angina pectoris
• Myocardial infarction
• Ventricular aneurysm
• Heart valve disease (mitral insufficiency and stenosis, aortic valve stenosis and insufficiency, dysraphism, tricuspid insufficiency, etc.)
• Thoracic aortic aneurysm
• Dissection of aorta
• Aortic dissection
• Adult congenital heart disease (atrial septal defect, ventricular septal defect, pulmonary valve stenosis, etc.)
• Cardiac tumors
• Atrial fibrillation
• Abnormal cardiac rhythm

(Some patients are treated not by surgeon but by cardiologists, following the assessment.)

Target Symptoms

Symptoms of major cardiovascular disease are shown below. Even if one has some of these, it does not always imply surgery is indicated.
chest pain, anterior chest discomfort, shortness of breath, palpitation, dyspnea, irregular pulse, back pain, etc.
enlarged cardiac silhouette on X-ray, abnormal findings on electrocardiogram, etc.

Treatment results

Medical staff

Name	Job Title	Position	Specialized Field	Credentials
別宮　好文 (Beck Yoshifumi)	Professor
岡田　至弘 (Okada Norihiro)	Instructor

Outpatient clinic

To the Medical Institutions

1) Patient referral

(1) Documents with as much information as possible are appreciated.

(2) Please feel free to fax or make a booking in advance, but they are not necessary.

Postoperatively, stable patients are usually referred back. Limited number of patient with special needs (physical condition, discretion, etc.) can be followed up at institutions we regularly visit or, rarely, at our Cardiology department.

2) Enrollment to residency program / application for a position

Our department specializes in treatment for cardiac and thoracic aortic diseases in the adult. Since workforce is still insufficient in comparison to case volume, you can get bunch of clinical experience in this field if you become a member. To be accredited as a board cardiovascular surgeon, however, experiences in other fields (congenital, peripheral vascular) are also required. As this is a member of Tokyo University cardiac surgery group, you can work for some other member hospitals for a while.
You can get a degree of medical doctor (PhD).
On weekday, we usually start to work at 7:30 AM. There is no regular overnight duty. On Sundays and holidays, stuffs take turn for daytime shift.