Annual Report of Cardiovascular Surgery 2008

Nagasaki University
2008.1〜2008.12

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 Deaths

121

〜Overall〜

Ⅰ. Number of Operations and Surgical mortality
Division

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

CardiacThoracic

148
47

149
47

1 (0.7)2 (4.3)2 (1.3)2 (4.3)

Car. + Thoracic

9900Total

204

205

3 (1.5)4 (1.9)Abdominal aorta
Periphearal artery

4226

4226

1 (2.3)01 (2.3)
0Operations

2

Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic
ValvularCongenital
OthersThoracic aorta
Abdominal aorta
Peripheral artery

64
65
71456
42
26

54 (84.3)
65 (100)
7 (100)7 (50)
31 (55.4)
34 (82.9)
12 (46.2)

5 (7.8)00
2 (14.3)
4 (7.1)005 (7.8)00
5 (35.7)
21 (37.5)
8 (19.5)
14 (53.8)

Total

274

210 (76.6%)

11 (4.0%)53 (19.3%)

Ⅲ. Age Distribution

3

〜Summary of Cardio-Vascular Division〜

Ⅰ. Number of Operations and Surgical Mortality
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality
(%)

71(4)
76(3)
7
1471

0

1 (1.4)77

1 (1.3)

1 (1.3)

7
140
0

0
0

56
(11)
42(18)2656

2 (3.6)
1 (1.8)1 (2.4)00

2 (3.6)
1 (1.8)1 (2.4)00

Cardiac
Valvular(redo)
Ischemic(redo)
Congenital
Others
VascularThoracic aorta(Stent graft)
Abdominal aorta(Stent graft)
Peripheral artery4226

Concomitant Procedure
Valvular(only): 65 cases
CABG(only): 64 cases
Thoracic aorta(only): 47 cases
Valvular + CABG: 10 cases
Valvular + Thoracic aorta: 6 cases
CABG + Thoracic aorta: 3 cases

4

Ⅱ. Valvular Heart Disease
No. Cases

No. OPOP mortality （%)

Hosp. mortality (%)

Aortic *Mitral
Tricuspid
Pulmonary

41
24
10

41
24
1000001 (2.4)
000Combined
A+M
M+T32320000Total

717101 (1.4)* Bentall ope 3casesa) M-repair
Diagnosis
MRMSrMsRMSMSR

Total

MVR (%)

Repair (%)

210000218 (27.5%)

21 (72.5%)

Etiology
Congenital

Infectious

Degenerative

Ischemic

DCM

121620

Post ope. follow up
Jet area

No. Ope

Post ope. (discharge)

Follow(〜12M)

non to trivial(0-2cm2)

21

20

18

mild
(2-4cm2)

0

1

3

mild to moderate(4-8cm2)000moderate to severe(8cm2- )0005b) Valve Substitutes implanted

53 Prostheses

MechanicalTissue

Total

AVR
MVR
TVR
PVR

204002441044810Total

2429536Ⅲ. Ischemic Heart Disease

Total

Isolated CABG

OP. mortality(%)

Hosp. mortality(%)

SVD
DVD
TVD
LMT

20102720

13724
20

00
1 (3.7)000
1 (3.7)0Total7764

1 (1.3)

1 (1.3)

Off pump CABG : 28 casesa) Conduit

176

On pump beating CABG : 9 cases( 2.2 / patient )Artery

SVG

Cases

SVD
DVD
TVD
LMT

14124521910382720102720Total

92 (52.3%)

84 (47.7%)77b) Anastomoses

181 ( 2.4 / patient )b’) Anastomoses by OPCAB
60 ( 2.1 / patient )No. Anastomoses

No. Cases (%)

No. Anastomoses

No. Cases (%)

12345172330
7012345710
1100

Total

77

Total

28

Total anast.

181

Total anast.

607c) Anastomoses

No.
Anastomoses

12345No. OP

SVDDVDTVD
LMT

17000272120320
70061000019102820

Total

1723307077

Total anast.

174690280181

Anastomoses

ExaminedPatentRate**

Stenosis*Rate***

SVG

89747094.6

193.2

Artery92777698.7

197.4

LITA
RITA
GEA

65
17105514854
14898.1
10010000
198.1
10087.5

Total

181151(83.4%)

14696.7(%)

295.4(%)c) Graft patency

Intervention : 0case

Redo CABG : 1 case

8*Stenosis : ≧90%**patency rate (excl.stenosis)*** patency rate (incl.stenosis)

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

616100007700No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Cardiac tumor
Constrictive pericarditis
VSP
RCC tumor thrombus
Transplantation
Others431213431213000000000000

Total

141400No. Cases

Sinus recovery(%)

Atricure
Cryoablation

261650100

Total8787.5

ASDPDATotal

Ⅴ. Others

Ⅵ. Maze operation

9Ⅶ. Vascular Diseasea) Replacement site
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

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

1141720(11)41141720(11)40
1 (7.1)00
1 (5)00
1 (7.1)00
1 (5)0Total56

56

2 (3.6)2 (3.6)

No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Abdominal aorta(Stent graft)
Peripheral artery

42(18)
2642(18)26

1 (2.4)00

1 (2.4)00Total68

68

1 (1.5)

1 (1.5)10b) Classification of Thoracic aorta
No.
Cases

Hosp. mortality
(%)

24
17132
202 (8.3)
1 (5.9)1 (7.7)000

712311 (14.3)0001 (100)3231015400000Dissecting
AcuteⅠⅡⅢaⅢb
ChronicⅠ
ⅡⅢaⅢbTrue
Ascending
ArchDescendingThoracoabdominal

Operation method
Total arch replacement(+Bentall)
Hemiarch replacement
Stent Graft

5102

Total arch replacement(+AVR)
Hemiarch replacement
Descending aorta replacement
Stent graft

22
12

Total arch replacement(+CABG)
Hemiarch replacement(+Bentall)
Descending aorta replacement
Stent graftThoracoabdominal Ao. replace.

112874c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality(%)

Abdominal aorta
AAA
Non-ruptured
RupturedASO

4241338
11 (2.4)
1 (2.4)01 (12.5)0Peripheral artery
ASO
Acute arterial occlusion
Aneurysm
Traumatic

26
128
5
10000011Operation method
Graft replacement
Stent Graft23
18

Ao-bifemoral bypass

1Thrombectomy
Bypass grafting
PlastyPTA/Stent

8115
2

〜 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

U-AP OMI

2008/4/1

緊8On pump beating CABG

2008/4/9

無MOF

AR TAA Mediastinitis

2008/7/1

待機190

AVR Grafting

2009/1/7

無脳出血AD(A)2008/1/2

緊

1

Hemiarch replacement

2008/1/3

無出血性shock

CD(B) HT

2008/12/10

待機27

Stent garfting

2009/12/6

有逆行性解離Ruptured AAA

2008/7/20

緊8Grafting

2008/4/28

無MOF

Cardiac 2cases

12

チ○ バ○

松○ 正○

M

M

83

67

Thoracic aorta 2 cases

12

野○ 末○

寺○ 茂○

M

M

61

60

Abdominal aorta 1case

1澤○ フ○

F

81

12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。ただし、CABG＋弁/大血管手術はそれぞれ弁、大血管手術としてカウント。Bentall手術は大血管手術としてカウント。
3) Number of Operations and Surgical Mortality: 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。
Bentall OP→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: Ascending aortaに対する手術はBentall OPを含む。

13