Annual Report of Cardiovascular Surgery 2016

Nagasaki University
2016.1～2016.12

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
Ⅶ. VAD
Ⅷ. Vascular Disease10

3. Summary of Hospital Deaths

12457999

～Overall～Ⅰ. Number of Operations and Surgical mortalityDivision

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

CardiacThoracic

179
40184
42004 (2.2)
0Car. + Thoracic2424

1 (4.2)

1 (4.2)

Total

243

250

1 (0.4)5 (2.0)Abdominal aorta
Peripheral artery

4320

43
20

2 (4.7)
02 (4.7)
0Operations

2

Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic
ValvularCongenital
OthersVAD
Thoracic aorta
Abdominal aorta
Peripheral artery

47112
91636443
20

35 (74.4)101(90.2)
9 (100)9 (56.3)
2 （66.6)
34 (53.1)
34 (79.1)
6 (30.0)

6 (12.8)
4 (3.6)05 (31.3)
02 (3.1)
1 (2.3)3 (15.0)6(12.8)7 (6.3)02 (12.5)
1 （33.3）
28 (44.8)8 (18.6)
11 (55.0)

Total

314

230(73.2)

21 (6.7)

63 (20.1)

Ⅲ. Age Distribution

3

～Summary of Cardio-Vascular Division～

Ⅰ. Number of Operations and Surgical Mortality

No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

134(14)
62(0)
938
2136

0

2 (1.5)62

1 (1.6)3 (4.8)941
300002 (4.9)
064(4)(10)
44(16)2066

1 (1.5)

1 (1.5)44

2 (4.5)2 (4.5)

2000

Cardiac
Valvular(redo)
Ischemic(redo)
CongenitalOthers
VAD
VascularThoracic aorta(redo)(Stent graft)
Abdominal aorta(Stent graft)
Peripheral artery

Concomitant Procedure
Valvular(only): 86 cases
CABG(only): 44 cases
Congenital (only): 6 case
Others(only): 9 cases
Thoracic aorta(only): 41 cases
Valvular + CABG: 7 cases
Valvular + Thoracic aorta: 13 cases
Valvular + Others: 21 cases
Valvular + Thoracic aorta + Others: 1 cases
CABG + Others: 4 cases
Valvular +CABG + Thoracic: 2 cases
Valvular + Congenital: 2 cases
Valvular + Congenital+ Others: 1 case
Congenital + Valvular +Thoracic 1 caseThoracic aorta + CABG: 6 caseThoracic aorta + Abdominal aorta : 1 caseThoracic aorta + Others : 1 case
VAD only :1 case
VAD + Valvular: 2 case4

Ⅱ. Valvular Heart Disease
No. Cases

No. OP.

OP mortality （%)

Hosp. mortality (%)

Aortic *Mitral
Tricuspid
Pulmonary

56
35
4056
36
4000000000

Combined
A+M
M+T
A+M+T
A+T

723
52723
5200000
1 (4.3)01 (50.0)

Total

132

133

02 (1.5)*: Reimplantation 4 cases, 大動脈弁形成術 5 cases, Reimplantation+ 大動脈弁形成術 5 cases
Bentall 3 cases, TAVI: Tranfemoral 7cases, Transapical 1casea) Mitral valve disease
Diagnosis
MRMSrMsR

MSMSR

Total

MVR (%)

Repair (%)

67006275

21 (28.0)

54 (72.0)b) Mitral valve repair
Etiology
Congenital

Infectious

DegenerativeRheumatic

Ischemic

DCM

Other02430162

Post ope. follow up
Jet area

Intra. Op.

Post ope. (～discharge)

Follow(～12M)

non to trivial(0-2cm2)

5049

21mild(2-4cm2)

456

mild to moderate(4-8cm2)

001moderate to severe(8cm2- )0005c) Valve Substitutes implanted

79 Prostheses

MechanicalTissueTotal

AVRMVRTVR
PVR

2215
1034
6
1056
21
20Total

384179d) Minimally Invasive Cardiac Surgery
Procedures

No.Cases

MP*30(2)

MVR**

13(5)

AVR

1ASD/PFO

5TP***

1MIDCAB

0LA mass/ thrombus

2Total52( )内はredo症例数*)

MP isolated
MP+TAP
MP+MazeMP+LAAP
MP+TAP+Maze
MP+TAP+PFO

1293141**)

MVR isolated
MVR+Maze
MVR+TAP
MVR+TAP+LAAP
MVR+TVR
MVR+PFO closure

712111***)

TP+ASD

1LAAP:左心耳閉鎖

6Ⅲ. Ischemic Heart Disease

Total

Isolated CABG

OP. mortality(%)

Hosp. mortality(%)

SVD
DVD
TVD
LMT

15321234219201 (6.7)000

3 (20.0)000Total6245

1 (1.6)3 (4.8)

Conventional CABG : 33 cases
Off pump CABG : 28 cases
On pump beating CABG : 1 casesa) Conduit

160 ( 2.5 / patient )ArterySVG

Cases

SVDDVDTVD
LMT

543134

11236
28

153
2123Total

747762b) Anastomoses
158 ( 2.5 / patient )b’) Anastomoses by OPCAB
79 ( 2.8 / patient )No. Anastomoses

No. Cases (%)

No. Anastomoses

No. Cases (%)

1234
514(22.6)
11 (17.7)
29 (46.8)
6 (9.7)2 (3.2)123
4
52 (7.1)
4 (14.3)
19 (67.9)
3 (10.7)
0

Total Cases

62

Total Cases

28Total anast.

157

Total anast.

797c) Anastomoses
No.
Anastomoses

12345No. OP.

SVDDVDTVD
LMT

1500011180
11513013200201632123

Total

1611296263

Total anast.

1622872410159

No. of grafts

Examined

PatentPatentcy
Rate(%)

Stenosis*

StenosisRate(%)

SVG

77

70

66

94.3

45.7

Artery74

6751
2300462100462000100
95.2
000
1000
4.8
00152

137

132

96.4

53.6d) Graft patency

LITA
RITA
GEARA
Total

Intervention : 0 case

*Stenosis : ≧90%

8Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

63006300000000009900No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Cardiac tumor
Thrombus/ CAT
Surgical ventricular repair
Bleeding (LV rupture)
Maze
Morrow
Pericardiectomy
LAAP
Other

3
3
6015
1175338015117
5000000000002 (25.0)000000

Total

41

43

02 (4.7)

ASD
VSD
PDA
VSA(Valsalva)
Total

Ⅴ. Others

Ⅵ. Maze operation
No. Cases

Sinus recovery(%)

Cryoablation

151173.3

PV isolation

000151173.3

Total

Ⅶ. VAD
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

Nipro LVAS

0000HeartMateⅡ
DCM(Bridge to Transplantation)

2300

Total

2

3009

Ⅷ. Vascular Diseasea) Replacement site
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

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

111102416(11)4111102416(11)40001 (4.2)
0(0)
0000
1 (4.2)0(0)0Total66

66

1(1.5)

1(1.5)

No. Cases

No. OP.

OP. mortality(%)

Hosp. mortality(%)

43(16)
2043(16)202 (4.7)(1,(2.3))02(4.7)(1,(2.3))063

63

2 (3.2)2 (3.2)

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

Hosp. mortality (%)

Dissecting
AcuteⅠⅡⅢaⅢb

144251(7.1)
000Ⅰ
ⅡⅢaⅢb

11180000

71
134500000ChronicTrue
RootAscendingArch
DescendingThoracoabdominal

Operation method
Root replacement
Bentall
Bentall+Total arch replacement
Reimplantation+TAR
Ascending aorta replacement
Hemi arch replacement
Total arch replacement (TAR)
Total arch replacement+Open stent
TAR+Descending aorta replacement
Descending aorta replacement
Thoracoabdominal aorta replacement
Stent Graft
Stent Graft+Debranch

1221005412081

Root replacement
Bentall
Reimplantation
Reimplantation+TAR+OSG
Ascending aorta replacement
Hemi arch replacementTotal arch replacement
Total arch replacement+Open stentTAR+Descending aorta replacement
Descending aorta replacement
Thoracoabdominal aorta replacement
Stent Graft
Stent Graft+Debranch061106613320c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality(%)

Abdominal aorta
AAA
Non-ruptured
Ruptured
ASO

4340
30

2 (4.7)
1 (2.5)
1 (33.3)
0

Peripheral artery
ASO
Acute arterial occlusion
Aneurysm
TraumaticOthers

4801700000Operation method
Graft replacement
Stent Graft

2716

Thrombectomy
Bypass grafting
PlastyOthersResection

5842
111

～ Summary of Hospital death ～No.

氏名性 年 診断別 齢 術式

手術日
死亡日

緊急度
剖検

術後日数
死因

＊１
＊２

Cardiac 4cases
12

川○ ○ホ○ 女 74

高○ 宏○

男 73

3

岩○ 明○

女 84

4

木○ ○

女 79

AMI, VSP

2016/1/15

準緊急67（－）

VSP閉鎖術、CABG

2016/3/22

無脳梗塞

（－）

AS, TR, 透析困難症

2016/4/1

緊急

32

61.2

AVR, TAP

2016/5/3

無PH, 右心不全

81.4

AMI, VSP

2016/11/2

準緊急74（－）

VSP閉鎖術、CABG

2017/1/15

無腸管虚血（－）

MR, TR, caf, LC

2016/12/16

予定

345.4

MP, TAP, Maze (MICS)

2017/1/19

無肝不全

21.7

AAD (Stanfod A), CPA

2016/8/15

緊急3（－）

弓部大動脈置換, CABG

2016/8/18

無脳梗塞

（－）

AAA rupture, post EVAR

2016/7/6

緊急1（－）

EVAR

2016/7/7

無出血性ショック

（－）

AAA

2016/9/12

予定18（－）

腹部大動脈人工血管置換

2016/9/30

無不明、ACS?

（－）

Thoracic 1case
1

吉○ 光○

男 62

Abdominal 2cases
1

2

山○ 幸○

福○ 一○

男 85

男 80

＊１：Japan score 手術死亡 発生予測値＊２：Japan score 手術死亡＋主要合併症 発生予測値（主要合併症：Stroke, Newly dialysis, Prolonged ventilation >24hrs,Deep sternal wound infection, Reoperation for bleeding）
基本的にJapan Score Ver.4から算出。(#)はJapan Score 2 より算出

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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。（2013～）
７）Graft patency：冠動脈CTによる評価が増加したため、分類をPatent, Stenosis(含:occlusion)とした。（2014～）

8)MVR術後のperivalvular leakage症例に対する修復術は術式をRepairとし、EtiologyをOtherとした。
9)2016年のTAVI開始ともない、TAVI Transfemoral approach, Transapical approachのいずれもCardiac, Valvular, Tissue valveとしてカウントしている。

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