The following section, Management’s Discussion and Analysis of Operations, provides an overview of the consolidated financial statements of Fujitsu Limited (the “Company”) and its consolidated subsidiaries (together, the “Group”) for the year ended March 31, 2008 (fiscal 2007). Forward-looking statements in this section are based on management’s understanding and best judgment as of March 31, 2008.

Annual Report 2008

Transmyocardial laser revascularization (TMR) has been increasingly used during the past years in patients suffering from severe diffuse coronary artery disease. The therapy is based upon the creation of transmyocardial channels in the free wall of the left ventricle by means of a laser. Several prospective, controlled, randomized studies were able to show that after TMR 70% of the patients operated on experienced a marked decline in angina symptoms and an increase in physical endurance and quality of life. These effects seem o last for years, and a TMR procedure can then be repeated. Whereas the regional and global myocardial function seems not to be influenced by transmyocardial laser revascularization, the question of an improvement in myocardial perfusion is still unanswered. Diabetic patients seem to be less likely to respond to the laser treatment and to carry a significant higher risk for death during the first postoperative year. Like several other study groups we found the TMR channels created by a CO2 laser closed by fibrin clots, erythrocytes and macrophages in the first postoperative days. There were no connections obvious between the channels and the ventricular cavity. Within the surrounding of the channels, however, we observed a marked neoangiogenesis. Induction of angioneogenesis seems to by the underlying principle of TMR. CO2 laser TMR does not result in significant injury to the myocardium.

Untersuchungen zu klinischem Stellenwert und zugrundeliegenden Mechanismen der transmyokardialen Laserrevaskularisation

Abciximab (c7e3; ReoProR ; Centocor, Inc., Pennsylvania, USA), a Fab fragment of the chimeric human-murine monoclonal antibody directed against platelet glycoprotein IIb/IIIa receptors, has been shown to reduce acute ischemic complications in patients undergoing percutaneous coronary interventions (PCI). However, its use has been associated with an increased incidence of bleeding events. The aim of this study is to examine the frequency of bleeding complications and to identify clinical variables associated with it in our patients. We prospectively recorded incidence of bleeding complications in 344 consecutive patients who underwent PCI with adjunctive use of abciximab (Ab). Clinical predictors for patients who developed bleeding complications with Ab were compared with the nonbleeders. Major bleeding occurred in six patients (1.7%) one of whom had pulmonary hemorrhage and one had intracranial hemorrhage. Minor bleeding occurred in 20 (5.8%) patients. Thrombocytopenia was seen in 13 (3.9%) patients of which four (1.2%) were mild, four (1.2%) were severe, and five (1.5%) were profound. Multivariate analyses showed that female gender and the "bail-out" use of Ab were risk factors for bleeding complications. The rate of major bleeding complications and thrombocytopenia were low and comparable with published trials. Female patients and those who received Ab as a "bail-out" were at higher risk of developing bleeding complications. (J Interven Cardiol 2005;18:33-37)

Predictors of bleeding complications and thrombocytopenia with the use of abciximab during percutaneous coronary intervention.

Objectives: The use of arterial grafts in coronary bypass surgery requires a high degree of cardiac stabilization, traditionally achieved with cardiopulmonary bypass and cardioplegic arrest. The Medtronic-Utrecht Octopus has recently been developed as an advanced cardiac stabilization device, based on its unique suction method for regional epicardial immobilization and retraction. The objective of this study was to investigate the feasibility of using this device to enable total arterial revascularization on the beating, working heart. Methods: From May 1997 to November 1998, off-pump coronary artery bypass using exclusively arterial grafts was performed in 125 selected patients (108 males), aged 2682 years (mean 61:1 ^ 10:5 years). Coronary artery immobilization was achieved with the Octopus, which uses local epicardial suction and avoids cardiac compression. Aortic anastomoses were avoided: both internal thoracic arteries and the right gastroepiploic artery were used as pedicle grafts in all but one case. All radial artery grafts and one right internal thoracic artery were used as Ygrafts from the left internal thoracic artery. There were four surgical approaches: sternotomy (98 patients), left anterior small thoracotomy (20 patients), anterolateral thoracotomy (six patients) and a subxiphoid approach in one patient. Results: Sternotomy: 187 grafts were performed in 98 patients (mean 1.9 grafts per patient). There were 99 grafts to anterior wall vessels, 47 grafts to posterior wall vessels and 41 grafts to lateral wall vessels. Left anterior thoracotomy: 20 patients had a single graft to the left anterior descending artery (LAD). Left anterolateral thoracotomy: three patients had a single graft to a circumflex branch, while three had composite grafts to the LAD and circumflex systems. Subxiphoid: one patient had a single graft to the posterior descending branch of the right coronary artery. There were no peri-operative deaths in any group. No patient required conversion to cardiopulmonary bypass. Three patients required conversion from a limited-access approach to sternotomy. There was one re-operation for bleeding. Postoperative stay was 27 days (mean 3:6 ^ 1:1; median 3 days) for anterior thoracotomy, 3‐4 days (mean 3:5 ^ 0:6) for anterolateral thoracotomy, and 378 days (mean 6:6 ^ 8:7; median 4 days) for sternotomy. There were two late deaths in salvage patients; no patient has required cardiac intervention or re-operation. Conclusions: The Octopus maintains excellent local cardiac immobilization ‐ enabling the routine use of arterial grafts in off-pump coronary surgery. It allows easy access to anterior wall vessels on the heart, and relatively straightforward access to the posterior wall. Circumflex branches are graftable with careful case selection and adjunctive technical maneuvers. q 1999 Elsevier Science B.V. All rights reserved.

/pdf/off-pump-arterial-grafting-125-cases-using-the-medtronic-28lqit08x7.pdf

Off-pump arterial grafting: 125 cases using the Medtronic-Utrecht Octopus

OBJECTIVES Minimally invasive coronary revascularization (MICR) involves minimally invasive direct coronary artery bypass grafting (MIDCAB) and robotic-assisted coronary artery bypass grafting (RCABG), and hybrid coronary revascularization (HCR) aims to combine MICR/RCABG on left anterior descending (LAD) and percutaneous coronary interventions (PCI) on non-LAD lesions. We performed a systematic review and metaanalysis to compare clinical outcome after MICR and HCR. METHODS A metaanalysis was carried out through searching PubMed, EMBASE, Web of Science, and Medline for comparative studies evaluating the primary and secondary clinical end points. RESULTS A systematic literature search identified 8 observational studies that satisfied our inclusion criteria, including being suitable for metaanalysis; the studies were between 1990 and 2018 and included 1084 cases of HCR and 2349 cases of MICR. Metaanalysis of these studies showed that HCR was associated with a reduced need for ICU LOS (WMD -11.46 hours, 95% CI, -18.76 ~ -4.25, P = .02), to hospital time (WMD -1.34 hours, 95% CI, -2.42 to 0.26, P < .01), and blood transfusion (OR 0.43, 95% CI, 0.31-0.59, P < .00001) than MICR. Comparisons of individual components showed no significant difference in terms of in-hospital mortality, MACCE, shock, myocardial infarction (MI), long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding). CONCLUSIONS HCR was noninferior to MICR in terms of in-hospital mortality, MACCE, shock, MI, long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding), whereas HCR was associated with a reduced need for ICU LOS, hospital time, and blood transfusion than MICR and less infection than MICR. Further randomized studies are warranted to corroborate these observational data.

/pdf/minimally-invasive-cabg-or-hybrid-coronary-revascularization-4mxsv7talw.pdf

Minimally Invasive CABG or Hybrid Coronary Revascularization for Multivessel Coronary Diseases: Which Is Best? A Systematic Review and Metaanalysis.

BACKGROUND Abciximab, a monoclonal antibody to platelet glycoprotein IIb/IIIa receptor, has been shown to be effective in reducing ischemic complications after coronary angioplasty in recent trials. However, little is known about its efficacy and safety when used in Asian patients. METHODOLOGY Based on our abciximab registry, we performed a retrospective analysis of 115 Asian patients who received the antiplatelet agent while undergoing percutaneous coronary intervention in our centre. They constituted 18.4% of the total number of patients undergoing percutaneous revascularisation during the corresponding period. The majority of the patients were males (84%). The mean age of the cohort was 54 and the mean weight was 70 kg. The ethnic composition of the study population was: Chinese 54%, Indians 21%, Malays 19% and Others 6%. All patients received aspirin 100 mg and weight-adjusted heparin before the procedure. Abciximab may be administered on a preplanned basis prior to the procedure or be given as a 'bailout' strategy. RESULTS There was a high clinical success rate of 95.8% and low incidence of ischemic complications when abciximab was given during coronary angioplasty. There were 0% Q myocardial infarction, 3.3% non-Q myocardial infarction and 0.8% death in our series. Bleeding complications were uncommon at 7.6%, predominantly involving the groin and gingiva. Thrombocytopenia occurred in 5.8% of patients. Abciximab was noted to increase the procedural activated clotting time (ACT) by 38 seconds when given concomitantly with heparin. The mean maximal procedural ACT achieved was 323 +/- 51 seconds. CONCLUSIONS Abciximab may be used safely and efficaciously in Asian patients undergoing coronary angioplasty. The drug confers protection against ischemic complications during the procedure whether it is administered electively or as a 'bailout'. There is however, a need to redefine the heparin regime for our patients, given the high ACT obtained when abciximab is administered.

The use of abciximab in coronary angioplasty--an Asian centre's experience.

Currently, 3 methods of myocardial revascularisation are available for the treatment of coronary artery disease: i) coronary artery bypass grafting (CABG); ii) percutaneous transluminal coronary angiography (PTCA), and iii) transmyocardial laser revascularisation (TMR). Until recently, these procedures were performed exclusive to one another. We report 2 cases of minimally invasive direct coronary artery bypass grafting with subsequent PTCA, and 1 case of staged PTCA followed by TMR performed at our institution. We discuss the role of hybrid procedures in the current era of treatment of ischaemic heart disease.

Hybrid cardiac revascularisation surgery.

Background: Minimally invasive cardiac surgery is a new and promising approach to the treatment of coronary artery disease allowing surgery to be performed through smaller incisions with lesser morbidity. Methodology: From November 1995 to February 1997, ten minimally invasive direct coronary artery bypass (MIDCAB) grafts were performed. The left internal mammary artery was used to bypass the left anterior descending coronary artery (LAD) through a limited left anterior thoracotomy. Patients: There were seven males and three females and their ages ranged from 42 to 72 years (mean = 60 years). Two patients had prior interventional procedures. Cardiopulmonary bypass was used in the first two patients. Two patients were converted to conventional surgery early in the series. Results: There was no mortality nor major morbidity. Mean post-operative hospital stay was seven days. To date, three patients have had post-operative angiography confirming the patency of the left internal mammary artery to LAD anastomosis. Conclusion: Early results of the MIDCAB procedure are encouraging. However, the definitive place of such procedures awaits longer term follow-up.

Minimally invasive direct coronary artery bypass.

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The use of abciximab in coronary angioplasty--an Asian centre's experience.

Hybrid cardiac revascularisation surgery.

Minimally invasive direct coronary artery bypass.