Annual Report of Cardiovascular Surgery 2013

Nagasaki University
2013.1～2013.12

1. Overall
Ⅰ. Number of Operations and Surgical Mortality
Ⅱ. Mode of Operation
Ⅲ. Age Distribution

Page233

2. Summary of CardioVascular Division
Ⅰ. Number of Operations and Surgical Mortality
Ⅱ. Valvular Heart Disease
Ⅲ. Ischemic Heart Disease
Ⅳ. Congenital Heart Disease
Ⅴ. Others
Ⅵ. Maze operation
Ⅵ. Vascular Disease

45799910

3. Summary of Hospital Deaths12

～Overall～Ⅰ. Number of Operations and Surgical mortality
Division

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

CardiacThoracic22151

224
522(0.9)1(2.0)

4(1.8)
1(2.0)

Car. + Thoracic

9900

Total

281

285

3(1.1)

5(1.8)

Abdominal aorta
Peripheral artery

4625

47
263(6.4)03(6.4)0Operations

300
250

Car+Thorac
Thoracic
Cardiac

200

150
100
500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20132

Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic
ValvularCongenital
OthersThoracic aorta
Abdominal aorta
Peripheral artery

86123
61060
47
26

71(82.6)
115(93.4)
5(83.3)6(60.0)34(56.7)40(85.1)
14(53.8)9(10.4)4(3.3)
1(16.4)2(20.0)3(5.0)
02(7.7)6(7.0)
4(3.3)
01(10.0)23(38.3)7(14.9)10(38.5)

Total

358

285 (79.6%)21(5.9%)52(14.5%)

Ⅲ. Age Distribution

100
90
80
70
60
50
40
30
20
100

ThoracicIschemic

21

Valve

1731

13
26
2

1313
6
313-49

18

50-59

44
2360-69

2170-79803

～Summary of Cardio-Vascular Division～

Ⅰ. Number of Operations and Surgical Mortality

No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

131(5)
94(1)712134

1(0.8)

2(1.5)

94

2(2.1)

3(3.2)

712000061(8)(12)
46(19)
25

62

1(1.6)

1(1.6)

47

3(6.4)

3(6.4)

26

00

Cardiac
Valvular(redo)
Ischemic(redo)
Congenital
Others
VascularThoracic aorta(redo)(Stent graft)
Abdominal aorta(Stent graft)
Peripheral artery

Concomitant Procedure
Valvular(only): 111 cases
CABG(only): 80 cases
Congenital (only): 6 cases
Others: 10 cases
Thoracic aorta(only): 51 cases
Valvular + CABG: 12 cases
Valvular + Thoracic aorta: 10 cases
Valvular + Congenital: 1cases
Valvular + Others: 1 cases
CABG + Thoracic aorta: 1 cases
CABG + Others: 1 case4Ⅱ. Valvular Heart Disease
No. Cases

No. OP.

OP mortality （%)

Hosp. mortality (%)

Aortic *Mitral
Tricuspid
Pulmonary

64
49
1064
52
100
0001(1.6)000

Combined
A+M
M+TA+M+T

6926921(16.7)001(16.7)
00Total131

134

1(0.7)

2(1.6)* Bentall 2 cases, 大動脈基部形成(Reimplantation) 3 cases, 大動脈弁形成術 6 casesa) Mitral valve diseaseDiagnosis
MRMSr

MsRMSMSR

Total

MVR (%)

Repair (%)

60006369

11 (15.9%)

58 (84.1%)b) Mitral valve repair
Etiology
Congenital

Infectious

DegenerativeRheumatic

Ischemic

DCM

Other1

936

2

361

Post ope. follow up
Jet area

No. Op.

Post ope. (discharge)

Follow(～12M)

non to trivial(0-2cm2)

58

51

38

mild(2-4cm2)

04

3

mild to moderate(4-8cm2)

00

1moderate to severe(8cm2- )0135c) Valve Substitutes implanted

73 Prostheses

MechanicalTissueTotal

AVRMVRTVR
PVR

1980043300621100Total

27(37.0)46(63.0)73d) Minimally Invasive Cardiac Surgery
Procedures

CaseMP*

24MVR

2ASD/PFO

4LA mass/ thrombus

2Total32*)MP isolated 22, MP+ASD 1, MP+TAP 1

6

Ⅲ. Ischemic Heart Disease

Total

Isolated CABG

OP. mortality(%)

Hosp. mortality(%)

SVD
DVD
TVD
LMT

6185020414422001100111Total

94802(2.1)

3(3.2)Off pump CABG : 26ases
On pump beating CABG : 5cases (1 case converted from Off pump)a) Conduit

230 ( 2.5 / patient )Artery

SVGCases

SVDDVDTVD
LMT

51869
26

216256961850
20

Total

11811294b) Anastomoses
247 ( 2.6 /b’) Anastomoses by OPCAB
53 ( 2.0 / patient )patient )No. Anastomoses

No. Cases (%)

No. Anastomoses

No. Cases (%)

123
4513(13.8)
28(29.8)
37(39.4)
13(13.8)3(3.2)

12
3
4
57(27.0)11(42.3)8(30.7)00

Total Cases

94

Total Cases

26

Total anast.

247

Total anast.

537c) Anastomoses
No.
Anastomoses

12345No. OP.

SVDDVDTVD
LMT

54311
119702269019300
306185020Total

13283713394Total anast.

1356

111

5215247

Anastomoses

Examined

PatentRate**

Stenosis*Rate***

SVG

112

91

86

94.5

594.5

Artery

118

81

79

97.5

495.1

LITA
RITA
GEA
RA

81
32
5058
212056
212
096.5
100
1000

3
100

94.8
95.2
1000

Total

348

253(70.6%)

244

95.6 (%)

1394.0 (%)d) Graft patency

Intervention : 3 cases*Stenosis : ≧90%**patency rate (excl.stenosis)*** patency rate (incl.stenosis)

8

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

5101510100000000

7700

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Cardiac tumor
Thrombus/ CAT
Surgical ventricular repair
VAS implantation
Bleeding
OthersAccessory Mitral Valve 1
PA dissection 1
SVC occlusion 1

242013242013000000000000Total121200No. Cases

Sinus recovery(%)

Cryoablation

13538.4

PV isolation

20015533.3

ASDVSDPDA
VSA(Valsalva)
Total

Ⅴ. Others

Ⅵ. Maze operationTotal

9Ⅶ. Vascular Diseasea) Replacement site
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

ThoracicRoot
Ascending aorta
Hemiarch
Total arch
Descending aorta(Stent graft)Thoracoabdominal Ao.

5130
1920(11)551301920(11)50001(5.2)
0000001(5.2)
000Total

62621(1.6)

1(1.6)

No. Cases

No. OP.

OP. mortality(%)

Hosp. mortality(%)

46(19)
2547(19)263(6.5)003(6.5)
0071

733(4.2)

3(4.2)

Abdominal aorta(Stent graft)
Peripheral artery
Total10b) Classification of Thoracic aorta
No.
Cases

Hosp. mortality (%)ⅠⅡⅢaⅢb

21
17
13
3
10

1 (1.9)1 (5.9)1 (7.7)
000Ⅰ
Ⅱ
ⅢaⅢb

6000
6000004181016500000

Dissecting
Acute

Chronic

True
Ascending
ArchDescendingThoracoabdominal

Operation method

Root replacement (Bentall 1)
Ascending aorta replacement
Total arch replacement(+Descending)Stent Graft1970

Total arch replacement
Descending aorta replacement
Stent graft

222

Root replacement(Bentall 1/ Reimplantation (+HAR/+TAR) 3 )Ascendingaorta
replacement(+AVR/+AVP)
Total arch replacement(+CABG/+AVP)
Descending aorta replacement
Stent graft
Stent graft+Neck bypass
Thoracoabdominal Ao. replace.

4497825c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality(%)

Abdominal aorta
AAANon-ruptured
Ruptured
ASO

46
46
40
603(6.5%)3(6.5%)
03(50.0%)0Graft replacement
Stent Graft28
19

Peripheral artery
ASO
Acute arterial occlusion
Aneurysm
TraumaticOthers

2669902000000

Thrombectomy
Bypass grafting
PlastyOthers91253

Operation method11

～ Summary of Hospital death ～

No.

氏名

性年
齢診断

手術日

緊/待

術後日数

術式

死亡日

剖検

死因

uAP

2013/2/28

緊急9CABG

2013/3/9

無脳幹梗塞

uAP(LMT)2013/7/5

待機56

CABG

2013/9/30

無重症肺炎

ASR, HD2013/9/12

緊55

AVR

2013/11/6

無NOMI

AR, MR, AP

2013/11/22

待機20

AVR, MVR, CABG

2013/12/12

無SMA塞栓AD(A)2013/4/1

緊急

9

Total Arch Replacement

2013/4/11

無NOMI

AAA rupture

2013/1/9

緊

8grafting2013/1/17

無MOF

AAA rupture

2013/6/30

緊

9grafting2013/7/9

無NOMI

AAA rupture

2013/11/15

緊

2grafting2013/11/17

無MOF

Cardiac 4 cases
1234

原◯ 弘

松◯ 日◯治濱◯ ス◯ミ

山◯ 啓◯

M

M

F

M

80

69

71

71

Thoracic aorta 1case
1

西◯ 彰◯

M

77

Abdominal aorta 3 cases123

犬◯ シ◯エ出◯ ト◯太◯ 勝M

M

M

90

85

8312各種データの解釈
1)OP mortality: 術後30日以内の全死亡。
Hospital mortality:術後院内での全死亡。 (他科転科後の他病死も含む。他院転院後の手術関連死も含む)
2)Mode of Operation: 二つ以上のカテゴリーを含む手術は主病変と考えられるいずれかのカテゴリーに分類。
3)Number of Operations and Surgical : 各手術手技の延べ数を合算。
例:CABG+MP+As.Ao.置換→Ischemic, Valvular, Thoracic aortaのそれぞれに加算。
Bentall1,Reimpantation→ Valvular, Thoracic aortaのそれぞれに加算。
4)Valvular Heart Disease: 弁に対する操作を行った (付加手術の有無にかかわらず)症例数、手術数を計算。
5)Ischemic Heart Disease: CABGを行った (付加手術の有無にかかわらず)症例数を計算。
6)Vascular Disease: Bentall, ReimplantationはReplacement siteを新たにRootに分類。ただしReimpantation+Total Arch ReplacementでもRootとする。

13