Annual Report of Cardiovascular Surgery 2018

Nagasaki University
2018.1～2018.12

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 Disease

45-6
7-8
99101011-13

3. Summary of Hospital Deaths

14-15

～Overall～Ⅰ. Number of Operations and Surgical mortality

Division

No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Cardiac270263

4 (1.5)6 (2.3)

Car. + Thoracic1212

1 (8.3)1 (8.3)Thoracic50

50

2 (4.0)2 (4.0)

Total

332

323

7 (2.2)9 (2.8)Abdominal aorta

35

350

1 (2.9)Peripheral22

21

2 (9.5)2 (9.5)

Operations
350
12300

50
8250

47

952

10433

150

619920

924
4
22

3
15

7219

47

8

1146

43

24
35
42

58

30
42

33
270
221

100
136

1562

5
200

11148

160

159

177
142

151

139

150

157

164

165

224

202

207
184

174

500
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
CardiacThoracic

Car+Thorac

2

Ⅱ. Mode of Operation
Total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic

59

46 (78.0)

9 (15.3)

4 (6.8)

Valvular194

169 (87.1)

13 (6.7)

12 (6.2)

Congenital

6

6 (100)00

Others22

11 (52.4)

6 (28.6)

5 (22.7)

Thoracic aorta51

17 (33.3)

5 (9.8)29 (54.7)

Abdominal aorta35

27 (77.1)

1 (2.9)7 (20.0)

Peripheral artery22

9 (40.9)

1 (4.5)12 (54.5)

Total

389

285 (73.3)

35 (9.0)69 (17.7)

Ⅲ. Age Distribution

100
1690
80
14237060

181150

64030

5458

447

844202718

100-49

50-59

60-69
Valve

Ischemic

70-79

80-Thoracic

3

～Summary of Cardio-Vascular Division～
Ⅰ. Number of Operations and Surgical Mortality
OP. mortality

Hosp. mortality

(%)

(%)

199

3 (1.5)4 (2.0)

(28)

(21)

0(1) (4.8)

Ischemic

79

77

2 (2.6)2 (2.6)(redo)(2)(2)

Congenital

13

1300

Others35

35

3 (8.6)

4 (11.4)

Thoracic aorta

71

70

3 (4.3)3 (4.3)(redo)(8)(8)00(Stent graft)

(8)

(8)

00

Abdominal aorta3636

1 (2.8)2 (5.6)(Stent graft)

(23)

(23)

1 (2.8)2 (8.7)

Peripheral artery22

21

2 (9.5)2 (9.5)

No. OP.

No. Cases

Valvular206(redo)

Cardiac

VascularConcomitant Procedure

Valvular (only): 143 cases
CABG (only): 49 cases
Congenital (only): 7 cases
Others (only): 19 cases
Thoracic aorta (only): 47 cases
Valvular + CABG: 24 cases
Valvular + Thoracic aorta: 23 cases
Valvular + Congenital: 6 cases

Valvular + Others: 11 cases
CABG + Others: 5 cases
4Ⅱ. Valvular Heart Disease
No. OP.

No. Cases

OP mortality （%)

Hosp. mortality (%)

Aortic *1031002 (2.0)

2 (2.0)Mitral65

6300Tricuspid

7700

A+M

9900

M+T

20

190

1 (5.3)

A+M+T

2

200

A+T

2

21 (50.0)

1 (50.0)

Total

208

202

3 (1.5)4 (2.0)Combined*: AVR 61, Bentall 6, Reimplantation 5, Reimplantation +AVP 2, Total Root Remodeling 2,Total Root Remodeling +AVP 11, TAVI-TF 29, -SA 2, direct Ao 1a) Mitral valve disease
DiagnosisMRMSMSR

Total

MVR (%)

Repair (%)

83839418 (19.1)

76 (80.9)b) Mitral valve repair
Etiology
Congenital

Infectious

Degenerative

Rheumatic

Ischemic

DCM

Other

01157

2

616

Post ope. follow up
Jet area

Intra. Op.

@ discharge

Follow(～12M)

non to trivial (0-2cm2)

68

60

27

Mild (2-4cm2)

81314

mild to moderate, (4-8cm2)

02

1

moderate to severe, (8cm2- )0105c) Valve Substitutes implanted

MechanicalTissue

Total

AVR

2671*97MVR12618TVR000PVR

011Total

3878116* (TAVI弁32例を含む)
d) Minimally Invasive Cardiac Surgery

Procedures

No. OP.

MP*42 (2)

MVR**9 (1)AVR

1ASD/PFO

8TP2MIDCAB

0LA mass/ thrombus

2Total65( )内はredo症例数*) MP isolated
22MP+TAP
6MP+Maze
8MP+TAP+Maze
4MP+TAP+LAAP 1MP+TAP+Maze+LAAP 1**) MVR単独
5MVR+Maze
3MVR+LAAP 1
LAAP:左心耳閉鎖
6Ⅲ. Ischemic Heart Disease
Total

Isolated CABG

OP. mortality (%)

Hosp. mortality (%)

SVD

20300DVD

18102 (11.1)

2 (11.1)

TVD

312600LMT

10900Total

79482 (2.5)

2 (2.5)

Conventional CABG: 63 cases
Off pump CABG: 13 cases
On pump beating CABG: 3 casesa) Conduit

178 (2.3 / patient)
ITA

SVG

Cases

SVD

11920

DVD

162118

TVD

36

62

31

LMT

141410Total

77101

178/79 casesb) Anastomosesb’) Anastomoses by OPCAB
183 (2.3 / patient)No.
Anastomoses

35 (2.7 / patient)No.

No. Cases (%)

Anastomoses

No. Cases (%)

120 (25.3)

12 (15.4)

221 (26.6)

22 (15.4)

331(39.2)

37 (53.8)

47 (8.9)42 (15.4)

5050

Total Cases

79

Total Cases

13Total anast.

183

Total anast.

357c) AnastomosesNo.

12345No. OP.

SVD

20000020

DVD01710018TVD

0026

5031

LMT

0442010Total

2021317079

Total anast.

204293280183

Anastomosesd) Graft patency

No. of grafts

Examined

PatentPatency Rate (%)

SVG

105928895.7

Artery

77

69

69100

LITA

655858100

RITA

121111100

182

161

15797.5Total*Stenosis : ≧90%

8

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

ASD/PFO

111100

VSD

1100

PDA

1100

Total

131300Ⅴ. Others

No. OP. No. Cases

OP. mortality

Hosp. mortality

Cardiac tumor

7700

Thrombus/ CAT6611

Surgical ventricular repair

5500

VAS implantation

550

1

Bleeding (LV rupture)

2

1

11

Pericardiectomy

1111

Morrow / Myectomy

4400

LAAP

8800

不整脈手術

343400

Other3300Total

7574

3 (4.1)4 (5.4)

9Ⅵ. Maze operationDevice

SR recover / Total cases

Full Maze* , n = 14

cryo-ICE

7/14 (50.0)

LA Maze** , n = 17

cryo-ICE

11/17 (64.7)

PV isolation only, n=3

RF (Clamp type）

2/3 (66.7)

Total 34

20/34 (58.8)* PV isolation + mitral isthmus ablation + RA Maze** PV isolation + mitral isthmus ablation

Ⅶ. VAD

No. OP.

No.
Cases

OP. mortality (%)

Hosp. mortality (%)

Nipro LVAS

0000HeartMateⅡ

5*5*01 (20.0)

Total5501 (20.0)*Pump exchange 1 case10

Ⅷ. Vascular Diseasea) Replacement siteNo.
OP.

No. Cases

OP. mortality (%)

Hosp.

mortality(%)

Thoracic
Root

18180

1 (5.6)

Ascending aorta

131300Hemiarch

1

100

Total arch

19

1900

Descending aorta

9900(Stent graft)

(8)

(8)

(0)

(0)

Thoracoabdominal Ao.

772 (28.6)

2 (28.6)

Total

67

67

2 (3.0)3 (4.5)

No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Abdominal aorta3636

1 (2.8)2 (5.6)(Stent graft)

(23)

(23)

1 (4.3)2 (8.7)

Peripheral artery22

21

2 (9.5)2 (9.5)

Total

5857

4 (7.0)6 (10.5)11b) Classification of Thoracic aorta
No. Cases

Hosp. mortality (%)

Dissection
AcuteⅠ
ⅡⅢaⅢb

26
21
4
10

1 (3.4)1 (4.8)000

ChronicⅠ
Ⅱ
ⅢaⅢb

1000
4001(25.0)00

True
RootAscending
ArchDescendingThoracoabdominal

14387
600001 (16.7)

Root replacement
Bentall
Reimplantation
Total Root RemodelingBentall + Ascending
Reimplantation + Ascending
Total Root Remodeling+ Ascending
Bentall + TAR
Reimplantation + TAR
Total Root Remodeling + TAR
Bentall + TAR+OSG
Reimplantation + TAR + OSG
Total Root Remodeling + TAR + OSG

18229311000001Ascending aorta replacement
Hemiarch replacement
Total arch replacement (TAR)
TAR+OSG81127Descending aorta replacement
Thoracoabdominal aorta replacement
TEVAR
Debranch TEVAR

278012c) Classification of Abdominal aorta, peripheral artery
No. CasesHosp. mortality (%)

Operation method

Abdominal aorta

362 (5.5)AAA

342 (5.9)

Graft replacement

13

Scheduled241 (4.2)

Stent Graft

23

Impending rupture or

101 (10.0)

ASO

20

Peripheral artery

222 (8.7)

Thrombectomy

7

ASO

60

Bypass grafting

7

Acute arterial occlusion

82 (25.0)

Plasty7

Aneurysm

50

Resection0

Traumatic

20

Others1Others

10

Ruptured13

～ Summary of Hospital death ～No

Age SexOpe date
POD (days)

Emergency
Autopsy

Risk factors
Cause of death*1*2

MR, TR, redo (3回目)

2018/2/23

ElectiveLC, Child-Pugh B, MELD score14,30.0

MP, TAP64

Not done

気道出血, NOMI

左房内血栓、右房内血栓

2018/2/23

Emergency

Septic shock, DIC, Systemicembolism

両房血栓除去、左心耳閉鎖、
Maze

11

Not done

下腿壊死、DIC, NOMI

収縮性心膜炎（拘束性心外膜炎,放射線性心筋症）、食道癌CRT後

2018/5/3

Urgent放射線性肺臓炎、心膜剥離術20

Not done

再膨張性肺水腫、LOS（ECMO）

Elective

Re-do, , IP

DxOperation procedures

Cardiac 6 cases

12

3

4

5

6

69

77

74

567886

MFM

M

DCM, low EF,p/o MVR, TVR, CABG、
2018/8/8
CRF o HD68.9
86.5
4.3
40.6
73.9
82.3

L-VAD (HM-Ⅱ)

47

Not done

SAH

AS, AP, HD

2018/10/26

Elective

CRF on HD, ASO

AVR, CABG-1

5

Not done

Bradycardia、ShockTAVI中の左室穿孔
左室穿孔部修復、TAP

2018/11/29
25

Emergency
Not done

Steroid user, High age
MOF

TAAA, Chronic AD

2018/1/18

Elective

動脈の高度石灰化(-)

3

Not done

DIC, NOMI(-)

2018/8/29
17
2018/10/21
8

UrgentNot done
Emergency
Not doneHigh age, 多発性骨髄腫
脾損傷、DIC, NOMI
Shock, 冠動脈閉塞
LOS(-)(-)(-)(-)

Elective
Not done
Emergency
Not done

CRF on HD
NOMIShock, High age
直腸穿孔、敗血症

(-)
(-)
(-)
(-)

Emergency
Not done
Emergency
Not doneHigh age, SMA閉塞
腸管虚血
DIC、Shock
全身の虚血壊死、MOF

(-)
(-)
(-)
(-)

FM

62.0

5.937.1(-)(-)

Thoracic 3 cases
161

M

282

M

381

M

胸腹部全置換、上行全弓部置換術
TAAA impending rupture
胸腹部全置換術
AAD type A
Bentall operation, 上行置換術

Abdominal 1 cases
182

M

AAAEVAR290

M

右内腸骨瘤破裂EVAR, coil embolism

2018/1/24
91
2018/8/28
20

急性動脈閉塞
血栓除去
腹部大動脈急性閉塞
Axillo-bifemoral bypass

2018/8/10
32018/12/28
11

Peripheral 2 cases
1 88F2 51

F＊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。

14

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。

15