Annual Report of Cardiovascular Surgery 2017

Nagasaki University
2017.1～2017.12

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

173
42

174
42

1(0.6)
1(2.4)

4 (2.3)1(2.4)

Car. + Thoracic

29

30

00Total244

2462(0.8)

5 (2.0)Abdominal aorta
Peripheral artery

43
23

44
231(2.3)
01 (2.3)
0Operations

2

Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic
ValvularCongenital
OthersThoracic aorta
Abdominal aorta
Peripheral artery

31
125
514
71
44
23

24(77.4)
114(91.2)
4(80.0)8(57.2)40(56.4)
34(77.3)
6(26.1)4(12.9)7(5.6)
01(7.1)4(5.6)
3(6.8)
2(8.7)

3(9.7)
4(3.2)
1(20.0)5(35.7)27(38.0)7(15.9)15(65.2)

Total

313

230(73.5)21(6.7)62(19.8)

Ⅲ. Age Distribution

3

～Summary of Cardio-Vascular Division～

Ⅰ. Number of Operations and Surgical Mortality

No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality
(%)

153
(19)
54(4)
649

155

1(0.7)

2(1.3)

54

1(1.8)

1(1.8)651

01(1.9)

02(3.9)71(6)(4)
43(12)
2372

1(1.4)

1(1.4)

44

1(2.3)

1(2.3)

2300

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

Concomitant Procedure
Valvular(only): 80 cases
CABG(only): 24 cases
Congenital (only): 4 cases
Others(only): 12 cases
Thoracic aorta(only): 42 cases
Valvular + CABG: 19 cases
Valvular + Thoracic aorta: 22 cases
Valvular + Others: 31 cases
Valvular + Thoracic aorta + Others: 1 case
Valvular +CABG + Thoracic: 8 cases
Valvular + Congenital+ Others: 2 cases
Thoracic aorta + CABG: 3 cases
Valvular + Thoracic aorta + CABG + Others: 1 case4

Ⅱ. Valvular Heart Disease
No. Cases

No. OP.

OP mortality （%)

Hosp. mortality (%)

Aortic *Mitral
Tricuspid
Pulmonary

77
31
4080
31
4001(3.2)0001(3.2)
00

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

111854

1118
5
4

00
0
0001(20.0)
0Total1501531(0.7)

2(1.3)*: AVR 58, AVP 2, Bentall 4, Reimplantation 6, Reimplatation +AVP 3,Total Root Remodeling 6, Total Root Remodeling +AVP 10, TAVI-TF 16, TAVI-TA 1a) Mitral valve disease
Diagnosis
MRMSr

MsRMSMSR

Total

MVR (%)

Repair (%)

58004466

9 (13.6)

57 (86.4)b) Mitral valve repair
Etiology
Congenital

Infectious

DegenerativeRheumatic

Ischemic

DCM

Other

0550

0020

Post ope. follow up
Jet area

Intra. Op.

Post ope. (～discharge)

Follow(～12M)

non to trivial(0-2cm2)

5047

11mild(2-4cm2)333

mild to moderate(4-8cm2)

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

89 Prostheses

MechanicalTissueTotal

AVRMVR
TVR
PVR

2551053*
40178911Total

315889* TAVI valve 17個を含むd) Minimally Invasive Cardiac Surgery
Procedures

No.Cases

MP*33(3)MVR**2(1)AVR

1ASD/PFO

4TP

1MIDCAB1(1)LA mass/ thrombus

1Total43( )内はredo症例数*)

MP isolated
19
MP+TAP
1MP+Maze
3
MP+TAP+Maze
8
MP+TAP+Maze+LAAP 2**)

MVR+Maze
MVR+TAP+Maze

1LAAP:左心耳閉鎖

6Ⅲ. Ischemic Heart Disease

Total

Isolated CABG

OP. mortality(%)

Hosp. mortality(%)

SVD
DVD
TVD
LMT

18715141
411700001(5.6)
000Total

542301(1.9)

Conventional CABG : 41 cases
Off pump CABG : 9 cases
On pump beating CABG : 4 casesa) Conduit

109 ( 2.0 / patient )Artery

SVG

Cases

SVD
DVD
TVD
LMT

3820
15

15
72516

18
71514Total

4663

109 conduits / 54casesb) Anastomoses
109 ( 2.0 / patient )b’) Anastomoses by OPCAB
18 ( 2.0 / patient )No. Anastomoses

No. Cases (%)

No. Anastomoses

No. Cases (%)

1234523(42.6)
10(18.5)
18(33.3)
3(5.5)
0123453(33.3)
3(33.3)3(33.3)00

Total Cases

54

Total Cases

9Total anast.

109

Total anast.

187c) Anastomoses
No.
Anastomoses

12345No. OP.

SVD
DVDTVD
LMT

18
1040
4
3
302
9
700
300000

18
71514

Total

23

10

183054

Total anast.

23

2054

120

109

No. of grafts

Examined

PatentPatentcy
Rate(%)

Stenosis*

StenosisRate(%)

SVG

635452

96.3

23.7

Artery4642421000034
12003012003012001001000000109969497.922.1d) Graft patency

LITARITA
GEARA
Total

Intervention : 0 case

*Stenosis : ≧90%

8

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality
(%)

410
1

410
1000
00000

6600

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Cardiac tumor
Thrombus/ CAT
Surgical ventricular repair
Bleeding (LV rupture)
Maze
Morrow
Pericardiectomy
LAAP
Other31343230433144323043001(25.0)00000000
2 (50.0)000000Total

53

541(1.9)2(3.7)ASD
VSD
PDA
VSA(Valsalva)
Total

Ⅴ. Others

Ⅵ. Maze operation
Cryo Ablation（Old type)

RF:AtriCure(Pen type）

RF:Atricure（Clamp type）

CryoICE(Total)

Full Maze

6/7(85.7%)

（ー）

（ー）

12/16(75.0%)

18/23(78.3%)

LA Maze

1/1(100%)

3/5(60.0%)

（ー）

（ー）

4/6(66.3%)

PV isolation
only（ー）（ー）

2/3（66.7%）（ー）

2/3(66.7%)

Total

7/8(87.5%)

3/5(60.0%)

2/3（66.7%）

12/16(75.0%)

24/32(75.0%)＊洞調律復帰数／対象患者数

Ⅶ. VAD
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

Nipro LVAS

1100HeartMateⅡDCM(Bridge to Transplantation)

1

100

Total

2

2009

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.

22153246(3)12315
3246(3)
100001(0)000001(0)0Total7172

1(1.4)

1(1.4)

No. Cases

No. OP.

OP. mortality(%)

Hosp. mortality(%)

43(13)
2344(16)230001(2.3)
0066

67

01(1.5)

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

Hosp. mortality (%)

Dissection
AcuteⅠⅡ
ⅢaⅢb

21
40
1

0000ⅠⅡⅢaⅢb00040001(25.0)203153100000

ChronicTrue
RootAscending
ArchDescendingThoracoabdominalOperation method
Root replacement
Bentall+Ascending
Bentall+TAR+OSG
Reimplantation+TAR+OSG
Ascending aorta replacement
Hemi arch replacement
Total arch replacement (TAR)
Total arch replacement+OSG
Descending aorta replacement
Thoracoabdominal aorta replacement
Stent Graft
Stent Graft+Debranch

111
113
552010

Root replacement
Bentall
Bentall+Asecending
Reimplantation
Reimplantation+Asecending
Total Root Remodeing
Total Root Remodeing+TAR
Ascending aorta replacement
Total arch replacement(TAR)
TAR+OSGTAR+OSG+Stent graftDescending aorta replacement
Thoracoabdominal aorta replacement
Stent Graft
Stent Graft+Debranch

1131131310411120c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality(%)

Abdominal aorta
AAA
Non-ruptured
Ruptured
ASO
Others

413741
100001(100)Peripheral artery
ASO
Acute arterial occlusion
Aneurysm
Traumatic
Others41100800000

Operation method
Graft replacement
Stent Graft
Bypass(Iliac artery→SMA)

30
121Thrombectomy
Bypass grafting
PlastyOthersResection11471011

～ Summary of Hospital death ～年 性 診断齢 別 術式
Cardiac 4cases

手術日
死亡日

No.

162 男

272 男

371 男

467 男

緊急度
剖検

術後日数
死因

＊１
＊２

AR, MSR, TR, 肝硬変

2017/7/12

予定4445.5%

AVR, MVR, TAP

2017/8/25

無肝不全

83.2%

AP, HD, p/o AVR

2017/10/6

予定

4836.5%

CABG

2017/11/23

無敗血症

66.5%

DCM, MR, af

2017/11/10

予定

20（－）

MP, 左室形成術,Maze

2017/11/30

無LOS（－）ICM, LV aneurysm

2017/12/8

凖緊急38（－）

左室形成術2018/1/15

無LOS（－）

Chronic AD(DeBakey Ⅲb)

2017/11/28予定1（－）

下行大動脈置換2017/11/29

無DIC（－）AAD (DeBakey Ⅰ), SMA閉塞

2017/3/29

緊急263（－）

Iliac Artery - SMA Bypass

2017/12/17

無腸管虚血（－）

Thoracic 1case
150 男

Abdominal 2cases
176 女＊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, Deepsternal wound infection, Reoperation for bleeding）
基本的にJapan Score Ver.4から算出。

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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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