The Great Web of Percy Harrison Fawcett

Health - Greetings

Hello everybody, my name is Akimitsu Yamaguchi, director of the department of cardiovascular surgery at Ishinkai Yao General Hospital. The surgical treatment for cardiac diseases has been rapidly changing over the past twenty years. When I started to perform cardiac operations, the surgical results in cardiac operations were still rather bad.
But thanks to the development of cardiac surgery, especially over the past ten years, such as the development and improvement of surgical equipment, improvement of heart-lung machines and artificial organs, and the development of the technique of myocardial protection, has resulted in the performance of exceedingly safe operations.

In our facilities, the average time for an operation for the replacement of prosthetic valves for cardiac valvular disease is 154 minutes. In cases where a coronary artery bypass for ischemic heart diseases is performed, depending on the type of graft (blood vessel), we average 185 minutes.
Thus, one of the reasons why we have been able to perform these operations in such a short time is due to an improvement in the technique of myocardial protection. Previously, with the cooling of heart-lung machines and cardiologic solution, an operation was carried out in a slight hypothermic state. But now heart-lung machines are not cooled and blood cardiologia is used. Operations are performed at nearly normal temperature (body temperature) and this produces good results.
Wherever possible, we try to perform open heart surgery without homologous blood transfusion by stocking up on the patient's own blood before surgery. This has made it possible for 80% of our patients to undergo an operation without homologous blood transfusion.
In the case of cardiac valvular disease, because of increasing number of aged patients, our selection is not a mechanical valve but a tissue valve taking into consideration the social background of the patient.
Furthermore, we try to adopt a valve plasty.
The surgical techniques for ischemic heart diseases (e.g. angina pectoris, myocardial infarction) have been greatly changing recently.

The amazing development of catheter intervention (catheterization) and the result of initial treatment for acute myocardial infarction has made rapid improve. Thus coronary artery bypass is adopted for more complicated coronary lesions.
To continue to improve the "quality of life" of patients, we aim to perform high-level operations with arterial grafts (e.g. internal thoracic artery, gastroepiploic artery, radial artery).
There has also been a change in the method of bypass. In the past, approximately 20 cm of skin-incision and total median sternotomy used to be performed. But now, if only one bypass to left anterior descending artery is performed, small thoracotomy (approx. 10 cm) is performed and MIDCAB (Minimally Invasive Direct Coronary Artery Bypass), which is a method of bypass to the left anterior descending artery with the left internal thoracic artery without cardiolegic arrest, is adopted. If one or more bypass is required, we adopt a method of bypass that is also performed without cardiolegic arrest and the use of heart-lung machines.
We also perform surgical treatments (Batista operation, Dor operation) for left ventricular aneurysm after myocardial infarction, ischemic cardiomyopathy and dilated cardiomyopathy. And we have achieved excellent results.
The operation of the replacement of prosthetic valves for cardiac valvular disease can be performed without median longitudinal sternotomy and with only several-cm-incision to skin and sternum. So we believe this will greatly help patients in their rehabilitation after an operation and make it possible for them to return to work or society.

Usually a patient who needs to have a cardiac surgery operation doesn't visit the surgical department in a hospital. First, he/she visits a clinic or local hospital, then doctors there introduce the patients concerned to our department. So all our staff try to supply the best medical care in cooperation with cardiologists and cardiac surgeons.
We always offer the best care. We also do our best to fulfill the wishes of our patients.

History

In November 1991, Tsutomu Nishii and Yoshihiro Hamada ( Nara Medical University, 3rd Surgery ) set up the division of cardiovascular surgery and an open heart surgery was started in 1992.
Akimitsu Yamaguchi was invited to be the director in December 1996.
Hiroshi Kumano (head physician), Satoshi Kato (physician) and Yamaguchi treat patients.
They work together with talented personnel from Nara Medical University, 3rd surgery and Osaka City University Hospital, general surgery 2. As of March 2000, the total number of operations was 565.