JAPANESE JOURNAL OF CARDIOVASCULAR SURGERY Editor in Chief : Yoshikatsu Saiki Vol. 55, No. 2, March 2026 CONTENTS

Preface

• Surgeon’s Professionalism and the Perspective of “The Team”: Reflections on the 2026 Revision Proposals of Medical Fees　K. Nawata

Original

• Prevention of Surgical Site Infection in High-Risk Patients after Open Heart Surgery by Closed Incision Negative Pressure Therapy　R. Imada et al. 　41
  Prevention of Surgical Site Infection in High-Risk Patients after Open Heart Surgery by Closed Incision Negative Pressure Therapy
  

  Ryo Imada＊	Fumiya Ono＊	Yushi Yamashita＊
  Shuji Nagatomi＊	Naoki Tateishi＊	Koji Tao＊
  Tamahiro Kinjo＊

  
  

  (Department of Cardiovascular Surgery, Kagoshima Medical Center＊, Kagoshima, Japan)
  

  ［Objective］ The incidence of surgical site infection （SSI） following open heart surgery has been documented to range from 1-10%. A particular concern is deep sternal wound infection （DSWI）, which is a serious complication associated with a high mortality rate, significant reduction in patient quality of life, and increased medical costs due to prolonged hospitalization. Various methods have been reported to prevent SSI, and closed incision negative pressure therapy （ciNPT） for closed surgical wounds has been covered by insurance in Japan since April 2021 to prevent SSI in high-risk cases. In our hospital, ciNPT was introduced in July 2021 and has been actively used in patients for whom it is indicated. The aim of this study was to evaluate the effectiveness of ciNPT in preventing SSI after open heart surgery in patients at high risk of SSI. ［Methods］ In the course of open heart surgery with median sternotomy carried out between 2020 and 2022, 306 patients deemed to be at high risk of SSI were included in the study. The term “high-risk patients” was defined as individuals suffering from one of the following conditions: severe obesity （BMI ≥ 30）, diabetes mellitus with HbA1c ≥ 7.0%, bilateral internal thoracic artery harvest, chronic maintenance dialysis, oral steroids, oral immunosuppressive drugs, prolonged surgery （duration＞8 h）, revision surgery, skin disease that may interfere with wound healing, or active infectious disease. Patients were divided into a ciNPT group （161 cases） using ciNPT and a control group （145 cases） using standard dressings. A statistical study of SSIs within 30 days of surgery was performed. ［Results］ The total SSI （ciNPT group: 5 cases vs. control group: 12 cases; p=0.04） demonstrated a significant decrease. Although no significant differences were observed in superficial SSI （ciNPT group: 3 cases vs. control group: 4 cases; p=0.71） and DSWI （ciNPT group: 2 cases vs. control group: 8 cases; p=0.05）, a decreasing trend was observed. Multivariate analysis showed that ciNPT was a preventive factor for SSI, reducing the incidence of SSI by 73.2% （odds ratio 0.268; 95% confidence interval 0.081~0.891）．［Conclusion］ It is suggested that ciNPT in patients at high risk of SSI may reduce SSI.

   

  Jpn. J. Cardiovasc. Surg. 55: 41-46（2026）

  Keywords：surgical site infection; closed incision negative pressure therapy; median sternotomy

  
  

Case Reports

• ［Congenital Heart Disease］
• A Case of ccTGA with Tricuspid Regurgitation Treated by PA Banding, Adjustment after Anatomical LV Dysfunction, and Achieving Double Switch Operation 　G. Maeno et al. 　47
  A Case of ccTGA with Tricuspid Regurgitation Treated by PA Banding, Adjustment after Anatomical LV Dysfunction, and Achieving Double Switch Operation
  

  Genki Maeno＊	Toshimichi Nonaka＊	Takahisa Sakurai＊
  Hideyuki Okawa＊	Takuya Osawa＊	Aoi Kato＊
  Hajime Sakurai＊＊

  
  

  （Japan Community Health Care Organization Chukyo Hospital＊, Nagoya, Japan, and Cardiovascular Surgery, Nagoya University Hospital＊＊, Nagoya, Japan）
  

  The treatment strategy for congenitally corrected transposition of the great arteries (ccTGA) without ventricular septal defect (VSD) or the need for pulmonary artery intervention remains undefined. Recent reports suggest that pulmonary artery banding (PAB) is effective in managing worsening tricuspid regurgitation (TR) in such cases. At our institution, PAB has been actively performed during infancy to control TR and preserve the option of anatomical repair. For patients meeting criteria for repair after PAB, a double switch operation (DSO) is performed. We report a rare case of ccTGA where PAB was initially effective, but systemic ventricular dysfunction developed due to delayed DSO. PAB loosening improved cardiac function, enabling successful DSO. This case highlights the importance of timely surgical intervention and the potential role of PAB adjustment in preserving systemic ventricular function and facilitating anatomical repair.

   

  Jpn. J. Cardiovasc. Surg. 55: 47-51（2026）

  Keywords：ccTGA; PA banding; double switch operation

  
  
• ［Acquired Cardiovascular Surgery］
• A Case of Tricuspid Valve Repair Using Lead Fixation and Spiral Suspension Techniques　Y. Yokoyama and T. Emmoto 　52
  A Case of Tricuspid Valve Repair Using Lead Fixation and Spiral Suspension Techniques
  

  Yuichiro Yokoyama＊	Takeshi Emmoto＊

  
  

  （Yotsuba Circulation Clinic＊, Matsuyama, Japan）
  

  Tricuspid valve leaflets can be physically impeded by the presence of transvenous ventricular pacemaker leads. Observing tricuspid regurgitation over time is necessary after implantation. Recently, the implanted portion has been recommended at the ventricular septum rather than the apex, raising concerns about further interference with the valve leaflets. Because the leads run from various angles, the pathophysiology of tricuspid regurgitation differs in each case. One treatment option involves replacing the endocardial lead with epicardial lead and performing tricuspid valve replacement. However, epicardial leads are not compatible with magnetic resonance imaging （MRI）, and the long-term outcomes following tricuspid valve replacement are not satisfactory. Therefore, repairing the valve while preserving the lead in the endocardial portion is preferable. In this case, we performed a tricuspid valve repair using the lead fixation and spiral suspension techniques to address the severe tricuspid regurgitation caused by lead interference with the valve leaflets and tethering due to right ventricular enlargement. It is essential to achieve a complete repair, even in complex cases of tricuspid valve regurgitation.

   

  Jpn. J. Cardiovasc. Surg. 55: 52-56（2026）

  Keywords：lead fixation; spiral suspension; tricuspid valve repair

  
  
• Successful Mitral Valve Repair Using Leaflet Augmentation and Secondary Chordal Cutting in the Subacute Phase of Ischemic Mitral Regurgitation　D. Sato et al.　57
  Successful Mitral Valve Repair Using Leaflet Augmentation and Secondary Chordal Cutting in the Subacute Phase of Ischemic Mitral Regurgitation
  

  Daiki Sato＊	Masato Nakajima＊	Ikumi Osawa＊
  Takahito Yokoyama＊	Yasutoshi Tsuda＊

  
  

  (Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital＊, Kofu, Japan)
  

  We report a case of a 60-year-old man with severe ischemic mitral regurgitation （IMR） caused by posterior leaflet tethering following myocardial infarction. In the subacute phase, mitral valve plasty was successfully performed using a combination of leaflet augmentation with autologous pericardium and secondary chordal cutting. The patient had an uneventful postoperative course, and follow-up echocardiography at five years demonstrated sustained mitral valve competence and improved left ventricular function. This case suggests that mitral valve repair combining leaflet augmentation and chordal cutting may be an effective surgical strategy for IMR in the subacute phase, particularly when ventricular manipulation is limited. Jpn.

   

  J. Cardiovasc. Surg. 55: 57-60（2026）

  Keywords：ischemic mitral regurgitation; mitral valve plasty; leaflet augmentation; secondary chordal cutting

  
  
• A Case of Successful Staged Management of Severe Double-Valve Disease in an Elderly Patient Using BAV, MICS, and TAVI　R. Tohma et al.　61
  A Case of Successful Staged Management of Severe Double-Valve Disease in an Elderly Patient Using BAV, MICS, and TAVI
  

  Ryo Tohma＊	Hidekazu Nakai＊	Akitoshi Yamada＊
  Yoshihisa Morimoto＊	Kunio Gan＊	Tatsuro Asada＊

  
  

  (Department of Cardiovascular Surgery, Kita-Harima Medical Center＊, Ono, Japan)
  

  Treating double-valve disease in elderly patients is challenging due to high surgical risk and concern for postoperative decline in activities of daily living (ADL). We present a case of staged, minimally invasive management combining balloon aortic valvuloplasty (BAV), totally endoscopic mitral valve plasty (MICS-MVP), and transcatheter aortic valve implantation (TAVI) in an 86-year-old woman. The patient presented with dyspnea and was diagnosed with severe mitral regurgitation (MR) due to posterior leaflet prolapse and severe aortic stenosis (AS). Heart failure persisted despite medical therapy. BAV was performed on hospital day 4, followed by totally endoscopic MICS-MVP. Three months later, TAVI was successfully completed. Each procedure was completed without complications, and the patient was discharged with preserved ADL after both MICS and TAVI. A staged approach combining BAV, MICS-MVP, and TAVI can be safe and effective in elderly patients with severe double-valve disease.

   

  Jpn. J. Cardiovasc. Surg. 55: 61-64（2026）

  Keywords：elderly; double valve disease; staged treatment; minimally invasive cardiac surgery; transcatheter therapy

  
  
• Mitral Valve Repair in a Case with Anomalous Origin of the Left Circumflex Artery　Y. Ohtomo et al. 　65
  Mitral Valve Repair in a Case with Anomalous Origin of the Left Circumflex Artery
  

  Yuki Ohtomo＊	Yurie Ohtomo＊	Tadashi Kitamura＊＊
  Nobuyuki Yamamoto＊

  
  

  (Department of Cardiovascular Surgery, Hokuto Hospital＊, Obihiro, Japan, and Department of Cardiovascular Surgery, Jichi Medical University＊＊, Tochigi, Japan)
  

  Anomalous origin of the left circumflex coronary artery is considered benign and asymptomatic in most cases. However, some cases with complication have been reported during aortic valve and mitral valve surgery due to their anatomical location. We report a case of mitral valve repair for mitral valve prolapse with anomalous origin of the left circumflex coronary artery. A 59-year-old woman presented with weight gain and dyspnea. Echocardiography revealed a mitral valve prolapse due to A1 chordal rupture, and we planned a mitral valve repair. Preoperative coronary computed tomography angiography showed anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva, running through the aortomitral curtain. To avoid ischemic events in the left circumflex artery, we chose a band instead of a ring for annuloplasty. In addition, we performed reconstruction with artificial chordae tendineae to A1, consequently postoperative echocardiography showed no valve regurgitation. Postoperative coronary computed tomography angiography showed a sufficient gap between the left circumflex coronary artery and the annuloplasty band. If we chose a ring for annuloplasty, significant interference with the left circumflex artery would likely have occurred.

   

  Jpn. J. Cardiovasc. Surg. 55: 65-68（2026）

  Keywords：anomalous origin; left circumflex coronary artery; mitral valve prolapse; annuloplasty

  
  
• Minimally Invasive Aortic Valve Replacement for Severe Aortic Regurgitation in a Patient with Osteogenesis Imperfecta　H. Fujii et al. 　69
  Minimally Invasive Aortic Valve Replacement for Severe Aortic Regurgitation in a Patient with Osteogenesis Imperfecta
  

  Hiromi Fujii＊	Joji Ito＊	Minoru Tabata＊, ＊＊

  
  

  (Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center＊, Urayasu, Japan, and Cardiovascular Surgery, Juntendo University Hospital＊＊, Tokyo, Japan)
  

  The patient was a 45-year-old man with osteogenesis imperfecta with a height of 113 cm and a weight of 28 kg. He had been under observation for asymptomatic severe aortic regurgitation for four years. However, over the past year, he experienced rapid deterioration in left ventricular function and required multiple hospitalizations for heart failure. He presented with severe scoliosis, markedly reduced left ventricular ejection fraction （20%）, and restrictive ventilator impairment （vital capacity: 0.98 L）. Due to his high surgical risk, he was deemed inoperable at another institution and was referred to our hospital. Given the risk of sternal complications associated with sternotomy, we opted for a minimally invasive aortic valve replacement （AVR） via a thoracoscopic right mini-thoracotomy approach. Postoperatively, prolonged inotropic support was required to manage heart failure, but there were no bone-related complications or surgical site infections. The patient was discharged home on postoperative day 53. At five years after surgery, he remains free from heart failure and has returned to an active lifestyle, including playing wheelchair tennis.

   

  Jpn. J. Cardiovasc. Surg. 55: 69-72（2026）

  Keywords：MICS; AVR; aortic regurgitation; osteogenesis imperfecta; connective tissue disease

  
  
• ［Aortic Disease］
• En Bloc Resection and Reconstruction of the Inferior vena cava and Abdominal Aorta Invaded by a Retroperitoneal Tumor in a Patient with a Previously Implanted IVC Filter　H. Ueda et al.　73
  En Bloc Resection and Reconstruction of the Inferior vena cava and Abdominal Aorta Invaded by a Retroperitoneal Tumor in a Patient with a Previously Implanted IVC Filter
  

  Hideyasu Ueda＊	Kenji Iino＊	Masaki Ushijima＊
  Ai Sakai＊	Yu Nosaka＊	Hiroki Nakabori＊
  Yoshitaka Yamamoto＊	Akira Murata＊

  
  

  (Department of Cardiovascular Surgery, Kanazawa University＊, Kanazawa, Japan)
  

  The patient is a 31-year-old male diagnosed with a retroperitoneal tumor that has invaded the inferior vena cava. A thrombus was also noted in the common iliac vein, prompting the placement of an inferior vena cava （IVC） filter before surgery. The retroperitoneal tumor is an abdominal lymph node metastasis of a malignant teratoma, and the patient received preoperative chemotherapy. He was subsequently referred to our department for surgical intervention. The Cattell-Braasch technique was used to access the inferior vena cava at the confluence of the bilateral renal veins. The tumor invaded the inferior vena cava and abdominal aorta. To achieve complete resection, it was necessary to perform an en bloc resection that included both vessels. The inferior vena cava was clamped at the site of IVC filter placement and replaced with an ePTFE graft. The abdominal aorta was replaced with a Dacron graft. Postoperative CT showed graft patency and no IVC filter-related complications. The patient remains disease-free at 2 years.

   

  Jpn. J. Cardiovasc. Surg. 55: 73-77（2026）

  Keywords：IVC filter; IVC reconstruction

  
  
• A Case of IgG4-Related Multiple Saccular Abdominal Aortic Aneurysms Treated with Aortic Graft Replacement and Corticosteroid Therapy　D. Kaku et al. 　78
  A Case of IgG4-Related Multiple Saccular Abdominal Aortic Aneurysms Treated with Aortic Graft Replacement and Corticosteroid Therapy
  

  Daisuke Kaku＊	Hidekazu Hirai＊	Tadahiro Murakami＊
  Hiroyuki Seo＊

  
  

  (Department of Cardiovascular Surgery, Saiseikai Noe Hospital＊, Osaka, Japan)
  

  Saccular aneurysms are extremely rare among IgG4-related abdominal aortic aneurysms (AAA), accounting for only a small percentage of reported cases. Here, we describe an unusual case of multiple saccular aneurysms caused by IgG4-related disease that was successfully treated with a combination of surgical graft replacement and corticosteroid therapy. A 73-year-old man was incidentally found to have multiple saccular aneurysms measuring 30 and 35 mm in the infrarenal abdominal aorta on computed tomography (CT) performed for follow-up of benign prostatic hyperplasia. The CT revealed periaortic soft tissue thickening, left ureteral stenosis, and hydronephrosis. Contrast-enhanced CT revealed a mantle sign, and the serum IgG4 level was elevated to 178 mg/dl. Based on these findings, IgG4-related AAA was suspected and aortic graft replacement was performed. Intraoperatively, the aortic wall was markedly thickened and glistening, with dense adhesions to the surrounding tissues. Histopathological analysis of the resected aortic wall fulfilled the diagnostic criteria for IgG4-related disease and established a definitive diagnosis. Although postoperative CT showed partial improvement in the left ureteral stenosis and hydronephrosis, mild residual inflammation persisted. To address this, oral prednisolone 20 mg/day was administered on postoperative day 30. Follow-up CT at 6 months demonstrated complete resolution of the ureteral obstruction and hydronephrosis. The steroid dose was gradually tapered with no recurrence of inflammation, serum IgG4 elevation, or new aneurysmal formation. Prednisolone was discontinued 24 months after surgery, and the patient remains stable under long-term follow-up. This rare case highlights the importance of recognizing IgG4-related disease as a cause of saccular aortic aneurysms, and highlights the clinical significance of combining surgical intervention with corticosteroid therapy to achieve durable disease control and prevent recurrence.

   

  Jpn. J. Cardiovasc. Surg. 55: 78-82（2026）

  Keywords：IgG4-related disease; abdominal aortic aneurysm; inflammatory aneurysm

  
  
• Coronary Anastomotic Pseudoaneurysm Rupturing into the Right Atrium 22 Years after Aortic Root Replacement　A. Kosaka et al. 　83
  Coronary Anastomotic Pseudoaneurysm Rupturing into the Right Atrium 22 Years after Aortic Root Replacement
  

  Atsumi Kosaka＊	Keisuke Kanda＊	Naotaka Motoyoshi＊

  
  

  (Department of Cardiovascular Surgery, Osaki City Hospital＊, Osaki, Japan)
  

  A man in his 50s, who had undergone aortic root replacement with a mechanical valve for annuloaortic ectasia in his 30s, presented with epigastric discomfort 22 years after the initial surgery. He was subsequently found to have right-sided heart failure. Contrast-enhanced computed tomography demonstrated a pseudoaneurysm at the right coronary artery anastomosis site. The pseudoaneurysm had ruptured into the right atrium, creating a left-to-right shunt and resulting in right-sided heart failure. Surgical repair included patch closure of the right coronary artery anastomosis, coronary artery bypass grafting to the proximal right coronary artery (#1), and closure of the right atrial shunt. Pseudoaneurysm formation at coronary anastomosis sites has been associated with the inclusion technique during aortic root replacement. The introduction of the Carrel patch technique has markedly decreased the incidence of such aneurysms. Perforation of a pseudoaneurysm into the right atrium remains exceedingly rare. We describe this unusual case of right atrial perforation due to a coronary anastomotic pseudoaneurysm despite the use of the Carrel patch technique, and provide a brief review of the literature.

   

  Jpn. J. Cardiovasc. Surg. 55: 83-88（2026）

  Keywords：aortic root replacement; coronary anastomotic pseudoaneurysm; right atrial perforation

  
  
• ［Peripheral Artery Disease］
• A Case of Suspected Mycotic Posterior Tibial Artery Aneurysm Secondary to Bacteremia due to Pneumonia　Y. Nakamura and H. Takagi　89
  A Case of Suspected Mycotic Posterior Tibial Artery Aneurysm Secondary to Bacteremia due to Pneumonia
  

  Yuhi Nakamura＊	Hisato Takagi＊

  
  

  （Department of Cardiovascular Surgery, Shizuoka Medical Center＊, Shizuoka, Japan）
  

  Mycotic aneurysms involving distally to the popliteal artery are rare, and reports of mycotic posterior tibial artery (PTA) aneurysms are even more limited. In most cases, underlying conditions are severe such as infective endocarditis or infection related to implanted devices. We report a case of a mycotic PTA aneurysm that developed following pneumonia-induced bacteremia and conduct a review of previously reported cases in the English literature. A 77-year-old man with aspiration pneumonia complained of right lower extremity pain due to deep vein thrombosis. On the 26th day of hospitalization, painfully induration developed suddenly in the right calf, and a 39×49 mm PTA aneurysm was diagnosed. Semi-urgent aneurysmectomy without reconstruction was performed. Despite no postoperative complications, the patient subsequently suffered from COVID-19 worsening his pneumonia and died of respiratory failure on the 73rd day. Mycotic PTA aneurysms are rare, and no treatment protocol has been established. According to our literature review, there has been no reports of aneurysm-related mortality. Underlying conditions in most cases, however, are severe such as infected endocarditis and bacteremia, and the prognosis of mycotic PTA aneurysms may be poor.

   

  Jpn. J. Cardiovasc. Surg. 55: 89-93（2026）

  Keywords：posterior tibial artery; peripheral artery aneurysm; mycotic aneurysm

  
  

Progress in Cardiovascular Surgery (2024)

• Recent Progress in the Surgical Treatment for Advanced Heart Failure　T. Nishimura　94

Editor’s Post Script

• Y. Ochiai