最新の心臓血管外科治療 : 今求められている治療とは

The number of major cardiovascular surgery keeps continuously increasing in Japan. Recently, less invasive cardiovascular surgery has attracted attention. Minimally invasive cardiovascular surgery（MICS）through right or left mini-thoracotomy, which is the representative strategy of less invasive surgery, has been widely applied to not only valve surgery but also coronary bypass grafting. MICS procedure, which does not require sternotomy, enable the patient to return to normal life earlier and its small incision is cosmetically popular with the patient.
Another promising and important strategy is the endovascular treatment utilizing catheter devices including transcatheter aortic valve implantation（TAVI）and thoracic endovascular aortic repair（（T）EVAR）. Because the endovascular treatment does not need cardiac arrest or cardiopulmonary bypass system, operation time can be shorter and amount of bleeding can be less compared to the conventional surgeries. Although good long-term durability of devices has not been proved yet, the endovascular treatment will continue evolving with newly developed devices.
As for treatment for end-stage heart failure, there are some problems. The number of heart transplantation remains small due to donor shortage in Japan. As technology advances, left ventricular assist devices（LVAD）become smaller and more reliable. Additionally，“Destination Therapy” was installed in Japan this year. Therefore, the number of patients with LVAD will dramatically increase in Japan. In such a situation, regenerative therapy is one of the hopeful solutions. Its universal and clinical application is eagerly awaited.
We, cardiovascular surgeons, should keep making progress being familiar with the new technique of these less invasive cardiovascular surgery and various novel devices to offer the latest medical care to the regional people.