Jpn J Extra-Corporeal Technology 45（2）：95 − 100, 2018

［Revision republication］

Data analysis of the perfusion registry in Japan
Aggregate data between 2014 and 2016
Tetsuya Kamei 1），Shoji Kubota 2），Chihiro Saito 3），Kiyoshi Yoshida 4），Makoto Hibiya 1）

Abstract
The Japanese Society of Extra-Corporeal Technology in Medicine ( JaSECT) established the Japanese Perfusion
Database and started its operation in 2013. This database collects pre-surgery physical findings of patients who
have undergone perfusion during cardiovascular surgery, as well as perfusion conditions and outcomes. The
purpose is to tabulate and analyze data on a nationwide scale. In this study, we analyzed 6,956 cases of adult(age 16 and up) cardiovascular surgery performed with perfusion. The data was collected over three years, fromJanuary 1, 2014 to December 31, 2016. In Japan, perfusion is most frequently performed with valve surgery,followed by aortic surgery and coronary artery bypass grafting (CABG). Differences according to type of surgery
are discovered by analyzing the perfusion registry, which suggests that collecting this data is useful. It should be
noted, however, that data analyzed for this study was obtained from only 30 institutions, so it did not represent theentire country. The results also show large variations for some data items. In the future, data accuracy is expected
to increase as efforts are made to modify the input interface and more institutions participate in the registry tocatalog more cases.
Key words：cardiopulmonary bypass，database，case registry，extra-corporeal circulation

Ⅰ．Introduction

The database then went into operation in 2013. 1-4)

The Japanese Society of Extra-Corporeal Technol-

The registry entries are designed to improve theogy in Medicine ( JaSECT) established the Japanese

extra-corporeal technology from the standpoint of

Perfusion Database to collect pre-surgery physicalperfusionists, so they differ from the entries of thefindings of patients who undergo perfusion during

Japan Adult Cardiovascular Surgery Database run bycardiovascular surgery, as well as the perfusion con-the Japan Cardiovascular Surgery Database ( JCVSD).

ditions and outcomes. The purpose is to tabulate and

There were originally 177 entry items in five catego-

analyze the data on a nationwide scale. As prepara-ries: 1) Demographic and Case Detail, 2) Circuit andtion for database development, the perfusion registryPriming, 3) Perfusion, 4) Fluid volume management,

project began in 2009 by studying similar overseas ac-

and 5) Lab data. Of the 177 items, 46 were multiple-

tivities and conducting national surveys of data input

choice and the remaining 131 required text answers.

environments at institutions performing perfusion.

The entries increased to 251 with outcome-related

The Japanese Society of Extra-Corporeal Technology in Medicine

Corresponding Author：Tetsuya Kamei

1）School of Health Sciences, Fujita Health University

School of Health Sciences, Fujita Health2）Department of Clinical Engineering, Asahikawa City Hospital

University3）Graduate School of Medicine, Fujita Health University

1-98, Dengakugakubo, Kutsukake-cho,4）Department of Clinical Engineering, Osaka University Hospital

Toyoake, Aichi, 470-1192, Japan［Received December 22, 2017：Accepted May 10, 2018］

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items added in 2016. After the registry started inhas been approved by the Epidemiology and Clinical2013, registrant institutions increased to 38, with reg-Research Ethical Review Committee of Fujita Healthistered cases 8,962 as of October 2017.

University (date of approval: July 18, 2017 ).

Ⅱ．Objective

Ⅳ．Results
own

Table 1 shows patient gender and age by type of

databases to catalog data on cardiovascular surgeries

surgery, based on data collected in the three years

carried out with perfusion. However, to accuratelyfrom 2014 to 2016. When classified by type, valve

monitor the state of the surgery in Japan, data must

surgery had the highest number of cases at 3,020,

be properly gathered, maintained, and put to goodfollowed by 1,711 for aortic surgery and 790 for CABG.

use. Accordingly, the JaSECT Perfusion Database

The breakdown by age indicates 2,585 patients in

is updated every six months with data collected

their 70s, 1,871 in their 60s, and 1,127 in their 80s.

from each institution. In this study, to examine theWhen cross-tabulated by age and type of surgery, thecurrent status of perfusion in Japan, we compiled data

largest group comprised patients in their 70s who hadcollected in the three years from 2014 to 2016 andvalve surgery, followed by patients in their 60s whoanalyzed patient information and basic perfusion pa-

had valve surgery, and then patients in their 70s who

rameters by type of surgery.

had aortic surgery.

Medicalinstitutions

often

createtheir

Table 2 shows patient height, weight, body surface

Ⅲ．Objective and Methods

area, and BMI by type of surgery. The tallest patient

The Perfusion Database contains 6,956 cases of adultheight was 161.9±8.8 cm for CABG and other surgery,(age 16 and up) cardiovascular surgery performed

but heights did not differ much by type of surgery.

with perfusion during the three years from January

The heaviest weight was 62.5±12.1 kg for CABG, and1, 2014 to December 31, 2016. For patients who werethe lowest was 56.0±12.0 kg for congenital surgery.

non-consenting, we excluded their results from our

The largest body surface area was 1.679±0.185 m 2 foranalysis such as missing values and abnormal values.

CABG, and the lowest was 1.572±0.188 m2 for CABG

Compiled Demographic and Case Detail data

and valve surgery. As for BMI, the normal weightcomprises gender, age, height, weight, body surface

range of 18.5-25 had the highest percentage, followed

area, and BMI. BMI is divided into five levels：underby the obesity level-1 range (25-30), and the under-

18.5, 18.5-under 25, 25-under 30, 30-under 35, andweight range under 18.5, for all types of surgery. The

35 and over to indicate the percentage of each in

only exception was congenital surgery, for which thethe different surgeries. “Circuit and Priming” datasecond and third places were reversed.

comprises arterial filter, pre-bypass filter, arterial

Table 3 shows the current status of circuit con-pump, biopassive coating area, pH management,

figuration. The use rate of arterial filters was as highblood volume, total priming volume, and priming

as 99.5％ whereas that of pre-bypass filters was onlyof non-blood transfusion. Data on pH management

20.8％. Roller pumps accounted for 16.1％ of arterialindicates its percentage in each type of surgery. Usepumps in use. As for the biopassive coating area, “allrates are indicated for arterial and pre-bypass filters,

but cannulae” accounted for 69.4％, the highest score

as well as for arterial pumps that are represented

for all kinds, followed by “limited component” 19.2％,

by roller pumps. Perfusion data comprises pump“tip to tip” 11.3％, and “none” 0.1％.

time, clamp time, deep body temperature measure-

Table 4 shows pH management and priming volume

ment sites, and highest blood temperature (arterial

by type of surgery. As for pH management, alpha-statflow). As for the temperature measurement sites, per-was most frequently used in all types of surgery: 95.8

centages of each are shown by type of surgery. The％ in CABG and 69.8％ in aorta. Use of both alpha-highest blood temperature (arterial flow) is divided

stat and pH-stat was higher in aortic surgery thaninto four levels: under 37℃, 37-under 38℃, 38-underin other types. As for the blood volume, the largest

39℃, and 39-under 40℃.

volume was 487.5±170.3 mL for CABG, followed by

We used JMP ® 12 (SAS Institute Inc.) to prepare

427±204.2 mL for aortic surgery and 384.6±173.6

and statistically analyze the above data. This researchmL for CABG and valve surgery. The largest total

96

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Jpn J Extra-Corporeal Technology 45（2），2018

Table 1

Characteristic of patients by operation type（gender, age）
type of surgery

gendern＝6,955age
n＝6,954

isolated
CABG

isolated
valve

CABG and CABG and
valve
other

aorta

congenital

other

total

male

614

1,670

421

103

1,092

56

273

4,229

female

176

1,350

263

22

  619

74

221

2,725

NA

   0

     0   1   0     0   0   0     1

total

790

3,020

685

125

1,711

130

494

6,955

＜20

   0

    14   0   0     4   7   0    25

20-29

   1

    25   1   0    1416   8    65

30-39

   7

    54   3   2    29

12

15

  122

40-49

32

  127

10

   4

  123

18

56

  370

50-59

104

  307

36

   9

  197

24

77

  754

60-69

282

  755

155

37

  474

37

131

1,871

70-80

284

1,185

303

56

  610

14

133

2,585

80-90

78

  539

170

15

  251

   2

72

1,127

＞＝90

   1

    14   7   2     9   2    35

total

789

3,020

685

125

1,711

494

6,954

130

CABG：coronary artery bypass graft / NA：not available

Table 2

Characteristic among patients by operation type（hight, weight, BMI, body surface area）
type of surgery

hight（cm）
n＝6,953weight（kg）
n＝6,955
body surface area（m2）n＝6,953

BMI
n＝6,952mean

isolated
CABG

isolated
valve

161.5

158.5

CABG and CABG and
valve
other
156.9

161.9

aorta

congenital

other

161.6

160.0

160.1
10.1

SD

8.8

10.2

9.7

8.8

10.3

10.7

N

790

3,020

685

125

1,709

130

494

mean

62.5

56.6

56.2

61.0

62.0

56.0

58.4

SD

12.1

12.0

11.2

12.2

13.3

12.0

11.9

N

790

3,020

685

125

1,711

130

494

mean

1.679

1.588

1.572

1.661

1.672

1.589

1.620

SD

0.185

0.198

0.188

0.189

0.211

0.204

0.195

N

790

3,020

685

125

1,709

130

494

＜18.5

36
（12.7％）

385（12.7％）

77（11.2％）

8（6.4％）

124（7.3％）

27（20.8％）

51（10.3％）

18.5-25

485（61.4％）

2,013（66.7％）

448（65.4％）

81（64.8％）

1,054（61.7％）

79（60.8％）

332（67.2％）

25-30

218（27.6％）

521（17.3％）

141（20.6％）

32（25.6％）

428（25.1％）

22（16.9％）

93（18.8％）

30-35

44（5.6％）

91（3.0％）

16（2.3％）

3（2.4％）

88（5.2％）

2（1.5％）

15（3.0％）

35＜

7（0.9％）

10（0.3％）

3（0.4％）

1（0.8％）

14（0.8％）

0（0.0％）

3（0.6％）

total

790

3,020

685

125

1,708

130

494

CABG：coronary artery bypass graft / BMI：body mass index / SD：standard deviation

priming volume was 1,361.3±261.0 mL for aortic

Table 5 shows pump time, clamp time, and deep

surgery, followed by 1,192.8±270.8 mL for CABG

body temperature measurement sites by type ofand valve surgery, and 1,179.3±280.7 mL for CABG

surgery. The longest pump time was 240.8±102.4 min

and other surgery. The highest priming of non-bloodfor CABG and other surgery, followed by 232.6±109.4

transfusion was 96.9％ for congenital surgery, and themin for aorta surgeries and 212.0±74.8 min for CABG

lowest (79.5％) for CABG and valve surgery.

and valve surgery. The longest clamp time was

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129.9±52.2 min for CABG and valve surgery, followedfrom perfusion records and protocols. Accumulation

by 125.2±64.2 min for CABG and other surgery andof such data has made it possible to analyze the status

119.2±68.3 min for aorta. In all types of surgeries,

of cardiovascular surgery performed with perfusion

deep body temperature was most often measured atin Japan.

the bladder, followed by nasopha and rectal sites. For

In Japan, perfusion is most frequently performed

congenital surgery, however, the second and third

during valve surgery, followed by aortic surgery andplaces were reversed.

then CABG. Differences by type of surgery have been

Table 6 shows the distribution of highest blood

discovered through the analysis of perfusion registrydata, suggesting the usefulness of collecting it.

temperature (arterial flow). Temperatures under
37℃ accounted for the highest percentage at 53.2％,

Data analyzed for this study was collected fromfollowed by 37-under 38℃ at 39.8％, 38-under 39℃ at

30 institutions that participated in the project from

5.8％, and 39℃ and over at 0.5％.

January 1, 2014 to December 31, 2016. They accountfor only 5％ of about 580 Japanese institutions that are

Ⅴ．Discussion

reported by JACVSD to be performing cardiovascu-

The Japanese Perfusion Database started its

lar surgery with perfusion (as of October 2017 ). We

registry operation in 2013. Data items unique to Japan

must therefore note that the data does not represent

were added to those that are comparable with data inthe entire country. Since the research was conducted

databases overseas.

by multiple institutions, the analyzed data also had

5-7 )Data is gathered continuously

missing values and abnormal values. Although these
Table 3values were excluded before data compilation, someCurrent status of circuit configuration
N

ratio

entries had a large standard deviation (SD), which

6,920

99.5％

means large fluctuations in data. In the future, the

1,450

20.8％

1,118

16.1％

accuracy of registered data is expected to increase

8

0.1％

limited component

1,334

19.2％

all but cannulae

4,829

69.4％

tip to tip

785

11.3％

arterial filter
pre-bypass filter
arterial pump headroller pumpnone

biopassive coating area

SD：standard deviation

as efforts are made to modify the input interface andmore institutions participate in the registry to catalog
more cases. We must continue to maintain and expand
the database and promote its use.

N＝6,956

Table 4pH management and priming volume by operation type
type of surgery

pH management
n＝6,954

blood vol（mL）
n＝911
total priming vol（mL）
n＝6,942

isolated
CABG

isolated
valve

CABG and CABG and
valve
other

alpha stat757
（95.8％）

2,380（78.8％）

546（79.7％）

pH stat23（2.9％）

369（12.2％）

both8（1.0％）

No
total

aorta

congenital

other

111
（88.8％）

1,195（69.8％）

108（83.1％）

439（89.0％）

74（10.8％）

7（5.6％）

130（7.6％）

16（12.3％）

38（7.7％）

270（8.9％）

65（9.5％）

7（5.6％）

385（22.5％）

6（4.6％）

16（3.2％）

2（0.3％）

1（0.0％）

0（0.0％）

0（0.0％）

1（0.1％）

0（0.0％）

0（0.0％）

790

3,020

685

125

1,711

130

493

mean

487.5

379.7

384.6

323.3

427.0

280.0

366.0

SD

170.3

171.4

173.6

106.4

204.2

0.0

184.1

N

32

441

140

12

247

4

35

mean

1,085.7

1,160.8

1,192.8

1,179.3

1,361.3

1,051.9

1,093.7

SD

263.7

254.3

270.8

280.7

261.0

254.0

330.1

788

3,015

684

125

1,707

130

493

95.9

85.4

79.5

90.4

85.5

96.9

92.9

N

priming of non blood transfusion（％）

CABG：coronary artery bypass graft / SD：standard deviation98

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Jpn J Extra-Corporeal Technology 45（2），2018

Table 5

Measurement region of CPB time and deep body temperature by operation type
type of surgery

pump time（min）
n＝6,953

isolated
valve

CABG and CABG and
valve
other

mean

147.8

166.3

212.0

SD

54.8

73.8

74.8

aorta

congenital

other

240.8

232.6

134.0

163.0

102.4

109.4

59.8

100.3

N

789

3,020

685

125

1,711

130

493

mean

59.1

113.2

129.9

125.2

119.2

70.6

90.9

SD

57.7

49.8

52.2

64.2

68.3

45.7

62.4

N

602

3,006

684

119

1,598

127

434

bladder607（41.8％）

2,371（43.7％）

489（39.4％）

93（41.2％）

1,321（35.2％）

96（42.9％）

376（46.1％）

jugular0（0.0％）

1（0.0％）

1（0.1％）

0（0.0％）

14（0.4％）

0（0.0％）

0（0.0％）

nasopha350（24.1％）

1,383（25.5％）

325（26.2％）

57（25.2％）

1,073（28.6％）

53（23.7％）

183（22.5％）

rectal336（23.1％）

931（17.2％）

259（20.9％）

46（20.4％）

873（23.3％）

60（26.8％）

182（22.3％）

esophagus

87（6.0％）

489（9.0％）

90（7.3％）

22（9.7％）

175（4.7％）

12（5.4％）

45（5.5％）

tympanic

57（3.9％）

181（3.3％）

54（4.4％）

5（2.2％）

233（6.2％）

3（1.3％）

22（2.7％）other16（1.1％）

72（1.3％）

23（1.9％）

3（1.3％）

61（1.6％）

0（0.0％）

7（0.9％）

total

1,453

5,428

1,241

226

3,750

224

815

clamp time（min）
n＝6,570

cumulate number oftemperature
measuirement site

isolated
CABG

CABG：coronary artery bypass graft / SD：standard deviation

Table 6

Distribution of blood temperature（arteria flow）

blood temp.

No

ratio

＜37

3,671

53.2％

37-38

2,750

39.8％

38-39

  399

   5.8％39-40    32   0.5％NA    52   0.8％

total

6,904

100.0％

NA：not available

ro National Hospital◦Shin Taura, Nayoro City Hospital◦Toru Hirose, Mitsui Memorial Hospital◦Toru Yasuda, Jichi Medical University Saitama Medical
Center◦Shin-ichi Nishida, Saitama Cardiovascular and Respiratory
Center◦Kouichi Kanai, Hidaka-kai Group, Hidaka Hospital◦Makoto Anno, Gunma Cardiovascular Center◦Takahiro Matsumura, Hokushin General Hospital◦Takeshi Kamizono, Shizuoka General Hospital◦Kengo Okitsu, Shizuoka City Shizuoka Hospital〈Acknowledgements〉◦Mitsuru Sago, Medical Corporation Choshinkai Toyohashi

This research was supported by the institutions below, par-Heart Centerticipants in the perfusion registry project. We are deeply◦Yasunori Yamamoto, Anjo Kosei Hospitalgrateful to all these institutions and their data managers for◦Shigeyuki Ueda, Nagoya Medical Center

their kind cooperation.

◦Kazuhiro Goto, Nagoya University Hospital◦Masatoshi Kojima, Social Medical Corporation Daiyukai, Dai-

〈Appendices〉

yukai General Hospital

Participate Institutions and Data-managers for the JaSECT◦Yoshihiro Otsubo, Ichinomiya Municipal Hospital

Perfusion Registry◦Tomoaki Yamashiro, Fujita Health University Hospital◦Akio Aramichi, Medical Corporation Sun Plaza Shin-Sapporo◦Yasuko Enya, Regional Independent Administrative Corpo-

Cardiovascular Hospitalration Gifu Prefectural General Medical Center◦Tetsuya Kakizaki, Medical Corporation Sapporo Heart Cen-

◦Masaki Yoshida, University Hospital, Kyoto Prefectural Uni-ter, Sapporo Cardiovascular Center

versity of Medicine◦Osamu Sagae, Hokkaido University Hospital◦Yoshitomo Kubo, Japan Labor Health and Welfare Organi-◦Shoji Kubota, Asahikawa City Hospitalzation Osaka Rosai Hospital◦Toshifumi Matsumoto, National Hospital Organization Obihi-

体外循環技術◦Akira Hatanaka, Takanohara Central Hospital

Vol.45

No.2

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◦Kazuyuki Nagata, Sakakibara Heart Institute of Okayama◦Shota Yamamoto, Yamaguchi-ken Saiseikai Shimonoseki
General Hospital◦Masanobu Tsurumoto, Tokushima Prefectural Central Hospital◦Tomotaka Takeshima, Kochi Medical School Hospital◦Chikara Okajima, Matsuyama Red Cross Hospital◦Shinichiro Hara, National Hospital Organization Kyushu
Medical Center◦Yasuyo Kasano, Saiseikai Kumamoto Hospital◦Osamu Sakurai, Kanazawa University Hospital◦Yuji Kinoshita, National Hospital Organization Kanazawa
Medical Ceter◦Mamoru Ieki, Kouseiren Takaoka Hospital◦Toru Kikuchi, Tohoku Medical and Pharmaceutical University Hospital◦Haruaki Matsukawa, Osaki Citizen Hospital◦Koichi Honma, Nihonkai General Hospital(In random order)
The authors declare that they have no COI.

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