Annual Report of Cardiovascular Surgery 2020

Nagasaki University

2020.1.1～2020.12.31

1. Overall

Page

Ⅰ. Number of Operations and Surgical Mortality

2

Ⅱ. Mode of Operation

3

Ⅲ. Age Distribution

3

2. Summary of Cardiovascular Division
Ⅰ. Number of Operations and Surgical Mortality

4

Ⅱ. Valvular Heart Disease

5- 6

Ⅲ. Ischemic Heart Disease

7-8

Ⅳ. Congenital Heart Disease8

Ⅴ. Others

9

Ⅵ. Maze operation

9

Ⅶ. VAD

9Ⅷ. Vascular Disease

10-12

3. Summary of Hospital Deaths

13

4. Annotations

14

~ Overall~Ⅰ. Number of Operations and Surgical mortality
Division

No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Cardiac

275 (62*)272 (62*)

3 (1.1)3 (1.1)

Car. + Thoracic

8800Thoracic

58

58

2 (3.4)2 (3.4)341 (62*)338 (62*)

5 (1.5)5 (1.5)

Abdominal aorta

33

3300Peripheral

30

29

00

Total

404

400

5 (1.2)5 (1.2)

Total

*TAVI

400
350

812300
8250

47 52

200
150

9315

4 6 933 19 201024

92 74 1933
221184347 46

5160 159
136 148

156235

24 30
42

42

270
177

202 207157 164 165
142 151 139 150

24 58511158221 224

10050247275

184 174

50

2000
2001
20022003
2004
2005
2006
2007
2008
2009
201020112012201320
142015201620172018201920
200Cardiac

Thoracic

2Car+Thorac

Ⅱ. Mode of Operation
Total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic

51

38 (74.5)5 (9.8)8 (15.7)

Valvular199

178 (89.4)

12 (6.0)

9 (4.5)Congenital

85 (62.5)

03 (37.5)

Others22

10 (45.5)

1 (4.5)

11 (50.0)

Thoracic aorta

61

29 (47.5)

2 (3.3)30 (49.2)

Abdominal aorta

3329 (87.9)

04 (12.1)

Peripheral artery30

8 (26.7)

8 (26.7)

14 (46.7)

Total

404

297 (73.5)

28 (6.9)79 (19.6)

Ⅲ. Age Distribution

120

100

21167802860141340

75
59

20

62

4
115

15-49

50-59

35

0
Valve

60-69
Ischemic

370-79Thoracic80-

~ Summary of Cardio-Vascular Division ~Ⅰ. Number of Operations and Surgical Mortality
No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Valvular214

213

3 (1.4)3 (1.4) #1, 2, 3(redo)

(35)

(34)

00Ischemic

707000(redo)

(1)

(1)

00

Congenital

151500Others

55

5200

Thoracic aorta

6666

2 (3.0)2 (3.0) #4, 5(redo)

(7)

(7)

00

(Stent graft)

(22)

(22)

00

Abdominal aorta

35

3500

(Stent graft)

(16)

(16)

00

Peripheral artery

353400

Cardiac

VascularConcomitant Procedure
Valvular (only): 143 cases

Valvular + Congenital: 4 case

CABG (only): 38 cases

Valvular + Others: 36 cases

Congenital (only): 8 cases

CABG + Thoracic aorta: 3 cases

Others (only): 23 casesCABG + Others: 7 cases

Thoracic aorta (only): 52 cases

Thoracic + Extra: 3 case

Valvular + CABG: 20 cases

Congenital + Others: 0 case

Valvular + Thoracic aorta: 7 cases
Valvular + Thoracic aorta + CABG: 1 case
Valvular + Congenital + Others: 2 case
Valvular + + CABG + Others: 5 case4

Ⅱ. Valvular Heart Disease
No. OP.

No. Cases

OP mortality

Hosp. mortality

Aortic *126

126

22 #1, 3

Mitral36

3600Tricuspid

7700Pulmonary

5500

A+M *

161600M+T

17171

1#2

A+M+T *

5500A+T *2200Total

2142143 (1.4)

3 (1.4)

Combined*: AVR 70, Bentall 3, Reimplantation only 3, Reimplantation +AVP 1, AVP only 2, Total Root
Remodeling only 2, Total Root Remodeling +AVP 7, TAVI-TF 62a) Mitral valve disease
Diagnosis
MRMSMSRTotal

MVR (%)

Repair (%)

67

5375

13 (17.3)

62 (82.7)

Congenital

Infectious

Degenerative

Rheumatic

Ischemic

DCMOthers

111493128b) Mitral valve repair
Etiology

Post ope. follow up
Intra. Op. n = 61Follow(〜12M), n = 61

non to trivial (0-2cm2)

47

44

Mild (2-4cm2)1313

mild to moderate, (4-8cm2)

1 (re-MP)4moderate to severe, (8cm2- )00Jet area5c) Valve substitutes implanted
MechanicalTissue

Total

AVR

18115*

133*

MVR

7613TVR

000PVR

055Total

25126

151*
(TAVI: 62 cases)d) Minimally invasive cardiac surgery
Procedures

No. Op.

MP*

29 (4)

MVR**

4 (2)

AVR

2ASD/PFO

4TP3MIDCAB

0LA mass/ thrombus

2Total41() redo*) MP isolated (±Maze, LAAP) 22
MP+TAP (±Maze, LAAP)

7**) MVR isolated (±Maze, LAAP) 3
MVR+TAP

1LAAP: LA Appendage plication

6Ⅲ. Ischemic heart disease
Total

Isolated CABG

Op. Mortality

Hosp. Mortality

SVD

25800DVD

16700TVD

191600LMT

131200Total

734300Conventional CABG: 54 cases
Off pump CABG: 13 cases
On pump beating CABG: 6 casesa) Conduit

2.0 / patient
ITA

SVG

Cases

SVD

121527DVD

151715TVD

193619LMT

161613Total

6285147 / 74 casesb) Anastomoses
No. Anastomoses

2.1 / patient
No. Cases (%)

127 (37.0)

217 (23.3)

325 (34.2)

44 (5.5)

Total Cases

73

Total anast.

1527b’) Anastomoses by OPCAB

2.0 / patient

No. Anastomoses

No. Cases (%)

15 (38.5)

23 (23.1)

35 (38.5)

Total Cases

13

Total anast.

26c) Anastomoses
No. Anastomoses

1234No. OP.

SVD

25

10026

DVD

0132015TVD

0017219LMT

236213

Total cases

271725473

Total anast.

27347516152d) Graft patency
No. of grafts

Examined

PatentPatency Rate (%)

Artery625959100

LITA

56

5353100

RITA

666100SVG

86787798.7

Total

148137136

99.3

Ⅳ. Congenital heart disease
No. Cases

No. OP.

OP. mortality

Hosp. mortality

ASD/PFO

9900

VSD

2200

PDA

4400Total

1515008

Ⅴ. Others
No. OP.

No. Cases

OP. mortality

Hosp. mortality

Cardiac tumor

3300

Thrombus/ CAT

2200

Surgical ventricular repair

1100VAS implantation

1100Bleeding (LV rupture)

111100Pericardiectomy

2200

Morrow / Myectomy

3300LAAP

131300Atrial Fibrillation Surgery

303000Pulmonary endarterectomy

0000

Other7700Total

747400Ⅵ. Maze operationDevice

SR recover / Total cases

Full Maze*, n = 1

cryo-ICE

1/1 (100)

LA Maze**, n = 21

cryo-ICE

17 / 21 (81.0)

Atri-cure (Clamp type）

3 / 8 (37.5)

PV isolation only, n=8Total, n = 30

21 / 30 (70.0)* PV isolation + mitral isthmus ablation + RA Maze, ** PV isolation + mitral isthmus ablation

Ⅶ. VAD
No. OP.

No. Cases

OP. mortality

Hosp. mortality

Nipro LVAS

0000

HeartMate Ⅲ

1100Total

11009

Ⅷ. Vascular diseasea) Replacement site (Thoracic)
No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

661

1 #4

10

1000

4400

1919

1

1 #5

23

23

00(20)

(20)

(0)

(0)

4

400(2)

(2)

0066

66

2 (3.0)2 (3.0)Root
Ascending aorta
Hemiarch
Total arch
Descending aorta(Stent graft)Thoracoabdominal aorta(Stent graft)
Totalb) Classification of Thoracic aorta

No. Cases

Hosp. mortality

Acute272Ⅰ

15

1 #5

Ⅱ

70Ⅲa

20Ⅲb

3

1 #4

Chronic

60Ⅲa

30Ⅲb

30True

350

Root

40

Ascending20Arch80Descending

180

Thoracoabdominal

30Dissection

10

Operation method
Root replacement
Bentall4

Reimplantation3

Total Root Remodeling2

Bentall + Ascending2

Reimplantation + Ascending

1

Bentall + TAR

2

Reimplantation + TAR

1

Ascending aorta replacement

14

Hemiarch replacement5Total arch replacement (TAR)

12

TAR + OSG

3TAR+ Descending aorta replacement

2Descending aorta replacement

4Thoracoabdominal aorta replacement

1TEVAR

23

Debranch TEVAR

111c) Classification of Abdominal aorta, peripheral artery
No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Abdominal aorta

35

3500(Stent graft)

(16)

(16)

00

Peripheral artery

35

3500Total

70

7000

No. Cases

Hosp. mortality

Operation method

350310Graft replacement

18

Impending rupture

10EVAR

15Ruptured30others

1ASO

20Others

20390

ASO

70Thrombectomy

7Acute arterial occlusion

80

Bypass grafting

8Aneurysm

40Plasty

14

Traumatic

100

Resection0Others

100Others

10Abdominal aorta
AAA

Peripheral artery12

~ Summary of hospital death ~NoAgeGenderDx

Ope date

Emergency

Risk factors*1

Operation procedures

POD (days)

Autopsy

Cause of death*2

CRF on HD, ASO, DM, Caf

39.6

Cardiac 3 cases
Severe AS, uAP,
12

378

71

71

3/25

Urgency

AVR, CABG

8Not done

NOMI, MOF

65.4

AIE, MR, TR12/9

Urgency

Septic shock, CI

58.4

MVR, TAP16

Not done

Cerebral hemorrhage

83.5

Severe AS, AP,

12/11

Elective

CRF on HD, ASO, steroid

35．4

AVR, CABG, F-F bypass21

Not done

MOF

55．2

AAD

10/6

Emergency

p/o AVR, redo

19.8

1

Not done

MOF

41.7

7/25

Emergency

Malperfusion

39.0

2

Not done

Massive CI

72.6

F

M

FThoracic 2 cases

477

M
基部置換＋上⾏置換
AAD

569

M

基 部 形 成 、 TAR, CABG
(Salvage)

Abdominal: 0 case
Peripheral 0 case

＊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。

13

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。
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 としてカウントした。
10) TRR は Cardiac/Valve/Aortic に分類した。
（2017〜）
11) Number of Operations and Surgical（各⼿術⼿技の延べ数）における死亡率算出の対象から、⼼肺停⽌蘇⽣後や PCPS を要するような重症⼼不全症例、術中の予期しない冠動脈閉塞に対する追加バイパス術などの Salvage ⼿術を除外することとした。なお、Mode of Operation（主たる⼿術をカウント、重複なし）では従来通り全ての死亡症例を含んで算出した。
（2019〜）
12) Number of Operations and Surgical における死亡数の欄に死亡症例の通し番号を追記した。
（2019〜）

14