Annual Report of Cardiovascular Surgery 2012

Nagasaki University
2012.1～2012.12

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
Ⅴ.
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 (%)

CardiacThoracic

2214722347

6 (2.7)07 (3.1)
1 (2.1)

Car. + Thoracic

8800

Total

276

278

7 (2.5)8 (2.9)Abdominal aorta
Peripheral artery

542554251(1.9)01(1.9)0Operations

300
250

Car+Thorac.
CThThoracic
Cardiac

200
150
100
5001999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20122Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic
ValvularCongenital
Otherso ac c aorta
ao ta
Thoracic
Abdominal aorta
Peripheral artery

67127
8225455425

47 (70.1)
121 (95.3)
6 (75.0)
12 (54.1)
35 (6(64.8).8)
46 (85.2)
9 (36.0)

7 (10.4)
2 (1.6)02 (9.1)
1 ((1.9).9)00

13 (19.4)
4 (3.1)
2 (25.0)
8 (36.4)
188 (33.3)
8 (14.8)
16 (64.0)

Total

357

276 (77.3%)

12 (3.4%)

69 (19.3%)

Ⅲ. Age Distribution

ThoracicIschemic

80

Valve

60

21
1420

25

40
20
0

3
3
125
10838-49

50-59

60-69

55

70-79

3781580-84

47485-

～Summary of Cardio-Vascular Division～

Ⅰ. Number of Operations and Surgical Mortality
No. Cases

No. OP.

OP. mortality(%)

Hosp. mortality(%)

133(14)
92
925

135

3 (2.2)3 (2.2)92925

2 (2.2)
1(11.1)0

3 (3.3)
1 (11.1)
055
(8)
(16)
54(15)2555

1 (1.8)1 (1.8)54

1(1.9)

1 (1.9)25

00

Cardiac
Valvular(redo)
Ischemic
Congenital
Others
VascularThoracic aorta(redo)(Stent graft)
Abdominal aorta(Stent graft)
P i hPeripheral
l arteryt

Concomitant Procedure
Valvular(only): 106 cases
CABG(only): 67 cases
Congenital(only): 5 cases
Others : 17 cases
Thoracic aorta(only): 47 cases
Valvular + CABG: 17 cases
Valvular + Thoracic aorta: 5 cases
Valvular + Congenital: 3 cases
V l l + Others:
ValvularOth : 4 cases
CABG + Thoracic aorta: 3 cases
CABG+ Others: 3 cases
Valvular + CABG + Others: 1 case4

Ⅱ. Valvular Heart Disease
No. Cases

No. OPOP mortality （%)

Hosp. mortality (%)

Aortic *Mitral
Tricuspid
Pulmonary

5249
3053
49
401(1.9)0001(1.9)000Combined
A+M
A+T
M+T
A+M+TM+T+P

3217613217611(33.3)001(16.7)01(33.3)001(16.7)
0Total133

135

3 (2.2)3 (2.2)* 自己弁温存大動脈基部置換術 2cases 大動脈弁形成術 3casesa) Mitral valve disease
Diagnosis
MRMSr

MsR

MS

MSR

Total

MVR (%)

Repair (%)

5801

1060

10 (14.2%)

60 (85.8%)b) Mitral valve repair
Etiology
Congenital

Infectious

Degenerati
veprolapse

Degenerati
vedilatation

Rheumatic

Ischemic

DCM

16374345

Post ope. follow up
Jet areaOpe

Post ope. (discharge)

Follow((～12M))

non to trivial(0-2cm2)

6055

34

mild(2-4cm2)

04

11

mild to moderate(4-8cm2)

001moderate to severe(8cm2- )0105c) Valve Substitutes implanted
p71 Prostheses

MechanicalTissue

Total

AVR
MVR
TVR
PVR

18
70042
3
1060
10
10

Total

25(35.2)

46(64.8)71d) 右小開胸下心臓手術 (MICS)
Procedures

CaseMP

22

PVL repair + TAP

1ASD

2

PFO

1Total26

6

Ⅲ. Ischemic Heart Disease
Total

Isolated CABG

OPOP.
mortality(%)( )Hosp. mortality(%)

SVD
DVDTVDLMT

9183035

252634001(3.3%)
1(2.9%)

002(6.7%)1(2.9%)

Total

9267()
2(2.2%)

3(3.3%)()Off pump CABG : 33ases

On pump beating CABG : 9cases (1 case converted from Off pump)a) Conduit

227 ( 2.5 / patient )Artery

SVG

Cases

SVD
DVD
TVD
LMT

517484751747
419183035

Total

117 (52.4%)

110 (47.6%)

92b) Anastomoses

230( 2.5 patient )b’) Anastomoses by OPCAB
31 ( 2.1 / patient )No. Anastomoses

No. Cases (%)

No. AnastomosesNo. Cases (%)

1234561926311420123455121420

Total

92

Total

33Total anast.

230

Total anast.

797c) Anastomoses

No.
Anastomos
es12345No. OP

SVDDVDTVD
LMT

890
21851203141400
10400
119183035Total

19263114292

Total anast.

1952935610230d) Graft patency

Anastomoses

Examined

PatentRate**

Stenosis*Rate***

SVG

113

434195 395.3

290 790.7

Artery

117

4948

98.0

391.8

LITA
RITAGEARA80297130
162129162196.7
100100100120093.3
93.1
100100Total

230

157(77.7%)

154

98.1 (%)

594.9 (%)

Intervention : 2 case

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

8

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality
(%)

Hosp.
mortality (%)

ASD
VSD
PDA
TOF
Ebstein
VSA(Valsalva)

2
1
1
2
1
2

2
1
1
21
2

0
001(50)000001(50)00T t lTotal

991(11 1)
1(11.1)1(11 1)1(11.1)No.
Cases

No. OP.

OP. mortality(%)

Hosp. mortality(%)

Cardiac tumor
Constrictive pericarditis
VSP/LV aneurysm
Bleeding / LV rupture
PEOthers

52642652642
6000000000000

Total

252500Ⅴ. Others

Ⅵ. Maze operation
No. Cases

Sinus recovery(%)

Cryoablation

94

44.4%

Total

94

44.4%

9Ⅶ. Vascular Diseasea) Replacement site
No.
Cases

No. OP.

OP. mortality
(%)

Hosp.
mortality (%)

ThoracicA
Ascending
di aortatHemiarch
Total arch
Descending aorta(Stent graft)Thoracoabdominal Ao.

481421(16)8481421(16)80000（0）00001(4.7)（1）
0Total55

55

01（1.8）No.
Cases

No. OP.

OP. mortality
(%)

Hosp.
mortality (%)

54(15)
2554(15)251(1.8)001(1.8)
0079

79

1 (1.2)

1 (1.2)

Abdominal aorta(Stent graft)
P i hPeripheral
l arteryt
Total10b) Classification of Thoracic aorta
No.
NCasesHosp.
Hmortality (%)ⅠⅡⅢaⅢb22137321000000Ⅰ
ⅡⅢaⅢb9230400000333816
60001 (6.3)
0Dissecting
Acute

ChronicTrue
Ascending
ArchDescendingThoracoabdominal

Operation method
Ascending aorta replacement
Hemiarch replacement(+AVR)
Total arch replacement(+MP)
Stent Graft

2533

Total arch replacement
Hemiarch replacement
Descending aorta replacement
Thoracoabdominal Ao. replace.

322
2

Total archreplacement(+CABG/MP/TAP)
Reimplantation(+MVR)
Hemiarch replacement(+AVR)
Descending aorta replacement
Stent graftThoracoabdominal Ao. replace.

8213136c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality( )(%)

Abdominal aorta
AAA
Non-ruptured
Ruptured
ASO

5452
49
3
201(1.9)1(2.0)00

Graft replacement
Stent Graft

37
15

Aorto-femoral bypass

2Peripheral artery
ASO
Acute arterial occlusion
Aneurysm
Traumatic
Others25
9114
10000000

Thrombectomy
Bypass grafting
PlastyOthers1191311

Operation method

～ Summary of Hospital Death ～No.

氏名性診断

手術日緊/待術後日数

術式

死亡日

剖検

死因

AS ＭＳＲ TR HD MAC

2012/2/24

待機16

AVR MVR TAP

2012/3/6

無左室破裂

AMI IABP HD p/o CEA

2012/4/30

緊急

90

CABG

2012/7/25

無Sepsis 脳出血

AMI CD(B) p/o TEVAR

2012/5/9

緊急

12

CABG

2012/5/19

無bleeding

R PS MR TR p/o
Re/ TOF p/o/ TAP

2012/8/1

待機25

Re-RVOTR MP TVR

2012/8/20

無右心不全

MS ASR HD ＮＯＭＩ

2012/9/25

待機29

AVR MVR 大量小腸切除2012/10/29

無ＮＯＭＩ

年齢Cardiac 7cases

123456

○原 ○子

○口 ○勝

○岡 ○ヨ○田 ○則

○平 ○臣

○田 ○子

FＭＦＭＭＦ6269

83

6265
ＡＳ

ＰＭＩ

2012/10/11

待機12

ＡＶＲ

ＣＡＢＧ

2012/10/20

無ＬＯＳ

ＶＴ

2012/12/11

待機5ＣＡＢＧ

2012/12/15

無ＶＴ ＭＮＭＳ

CD(B) 大動脈-食道瘻

2012/3/29

緊急55

TEVAR(stent graft)

2012/7/28

無食道廔

ＡＡＡ OMI p/o CABG OCI

2012/11/22

待機18

Y grafting

2012/12/9

有bleeding

83
ＡＰ

7○浦 ○

Ｍ

82

Thoracic aorta 1 case
1○永 ○雄M

69

Abdominal aorta 1 case
1○松 ○幸M6112各種データの解釈1)) OP mortality:l
術後 日以内 全死亡
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