Annual Report of Cardiovascular Surgery 2009

Nagasaki University
2009.1〜2009.12

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 Deaths

12

〜Overall〜

Ⅰ. Number of Operations and Surgical mortality
Division

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

CardiacThoracic

157
45157
46

4 (2.5)3 (6.7)4 (2.5)3 (6.7)

Car. + Thoracic

8800

Total

210

211

7 (3.3)7 (3.3)

Abdominal aorta
Periphearal artery

743074301 (1.4)1 (3.3)

1 (1.4)1 (3.3)Operations

250
200

Car+Thorac.
Thoracic
Cardiac150
100
50
0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

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

6281595457430

52 (83.8)
71 (87.6)
5 (100)5 (55.5)
33 (61.1)(6 . )
68 (91.9)
12 (40.0)

4 (6.5)8 (9.9)002 (3.7)006 (9.7)
2 (2.5)04 (44.5)
199 (35.
(35.2))
6 (8.1)18 (60.0)

Total

315

246 (78.1%)

14 (4.4%)

55 (17.5%)

Ⅲ. Age Distribution

ThoracicIschemic
Valve

80

1860

25

1140
200

15
3

8
611-4950-59

182160-6940

168670-7980-

〜Summary of Cardio-Vascular Division〜

Ⅰ. Number of Operations and Surgical Mortality
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality
(%)

87(8)
77(1)
5987

1 (1.5)

1 (1.5)77

2 (2.6)2 (2.6)590
1 (11.1)0
1 (11.1)

53(2)
(19)
74(34)
30

54

3 (5.6)3 (5.6)74

1 (1.4)

1 (1.4)30

1 (3(3.3)
3)

1 (3(3.3)
3)

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

Concomitant Procedure
Valvular(only): 69 cases
CABG(only): 62 cases
Thoracic aorta(only): 46 cases
Valvular + CABG: 12 cases
Valvular + Thoracic aorta: 5 cases
Valvular + Congenital: 1 cases
CABG + Thoracic aorta: 3 cases

Ⅱ. Valvular Heart Disease
No. Cases

No. OPOP mortality （%)

Hosp. mortality (%)

Aortic *MitralTricuspid
Pulmonary

38
25
2038
25
20

1 (2.6)000

1 (2.6)000

Combined
Cbi d
A+M
M+T
A+M+T

8
1228
12
20000

Total

8787

1 (1.5)

1 (1.5)* Bentall ope 2casesa)) M-repair
MiDiagnosis
MRMSr

MsRMSMSRTotal

MVR (%)

Repair (%)

3200003211 (25.6%)

32 (74.4%)

Etiology
Congenital

Infectious

Degenerative

Ischemic

DCM042233

Post ope. follow up
Jet area

No. Ope

Post ope. (discharge)

Follow((〜12M))non to trivial(0-2cm2)

3230

28

mild(2-4cm2)022

mild to moderate(4-8cm2)

001moderate to severe(8cm2- )001b) Valve Substitutes implanted
p64 Prostheses

MechanicalTissueTotal

AVRMVRTVR
PVR

237002545048
1150Total

303464

Ⅲ. Ischemic Heart Disease

Total

Isolated CABG

OP. mortality(%)

Hosp. mortality(%)

SVD
DVDTVDLMT

1543424433124002 (5.9)
0002 (5.9)
0Total77622 (2.6)( )2 (2.6)( )Off pump CABG : 12 casesa) Conduit

On pump beating CABG : 8 cases

195 ( 2.5 / patient )Artery

SVG

Cases

SVD
DVD
TVD
LMT

9357
336552301543424Total

102 (52.3%)

93 (47.7%)77b) Anastomoses

222 ( 2.7 patient )b’) Anastomoses by OPCAB
29 ( 2.4 / patient )No. Anastomoses

No. Cases (%)

No. Anastomoses

No. Cases (%)

12345616152419211234524510Total

77Total

12Total anast.

210

Total anast.

29c) Anastomoses

No.
Anastomos
es123456No. OP

SVDDVDTVD
LMT

1500
10
32100
1
14
90015
400
2000
101543424Total

161524192177

Total anast.

16307276

106210c) Graft patency

Anastomoses

Examined

PatentRate**

Stenosis*Rate***

SVG

1087474

100

0100Artery102828198.8

098.8

LITA
RITA
GEA

643265422653
21698.1
95.5
10000098.1
95.5
100

Total

210

156(74.2%)

15498.7(%)

098.7(%)

Intervention : 1 caseRedo CABG : 1 case

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

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

41

410000

5

500

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Cardiac
Cdi tumor
Constrictive pericarditis
Coronary AV fistula
DCM VAS implantation
Transplantation
Others1211221211220001 (100)000001 (100)00Total991 (11.1)

1 (11.1)

ASD
PDA
Total

Ⅴ. Others

Ⅵ. Maze operation

No. Cases

Sinus recovery(%)

Atricure
Cryoablation

261
55083.3

Total

8675.0

Ⅶ. Vascular Diseasea) Replacement site
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Thoracic
Ascending aorta
Hemiarch
Total arch
Descending aorta(Stent graft)Thoracoabdominal Ao.

018
1123(19)1018
1124(19)10
1 (5.6)1 (9.1)1 (4.2)0
1 (5.6)1 (9.1)1 (4.2)

00

Total

53

54

3 (5.6)3 (5.6)

No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Abdominal aorta(Stent graft)
Peripheral artery

74(34)
3074(34)30

1 (1.4)0
1 (3(3.3)
3)

1 (1.4)0
1 (3(3.3)
3)

Total

104

104

2 (1.9)2 (1.9)b) Classification of Thoracic aorta
No.
Cases

Hosp. mortality (%)ⅠⅡⅢaⅢb30
17123022 (6.7)
2 (11.8)
2 (16.6)000ⅠⅡⅢaⅢb1323350000024
31015
11 (4.2)
01 (10.0)
00Dissecting
Acute

Chronic

True
AscendingArch
DescendingThoracoabdominal

Operation method

Total arch replacement
Hemiarch replacement (+Bentall)
Stent Graft

3122

Total arch replacement(+AVR)
Hemiarch replacement (+AVR)
Hemiarch replacement +Bentall
Descending aorta replacement
Stent graft

13135

Total arch replacement(+CABG)
Hemiarch replacement(+AVR)
Descending aorta replacement(+CABG)
Stent graftThoracoabdominal Ao. replace.

722121c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality(%)

Abdominal aorta
AAA
Non-ruptured
Ruptured
ASO

74
69
65
4
5

1 (1.4)
1 (1.5)01 (25.0)0Peripheral
Pi hl arteryt
ASO
Acute arterial occlusion
Aneurysm
TraumaticOthers309116
131 (3(3.3)
3)
1 (11.1)
0000O
Operationti method
th dGraft replacement
Stent Graft35
34

Ao-bifemoral bypass
Plasty41Thrombectomy
Bypass grafting
Grafting
PlastyCoil embolization

117561

〜 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

U-AP OMI HD ASO

2009/1/27

緊

19

CABG ｘ 2 LV plasty

2009/2/14

無SepsisLC

2009/10/27

準緊

37

CABG x 3

2009/12/2

有腸管虚血

ASR

2009/6/17

待機9

2009/6/25

有AMI

AD(A) malperfusion

2009/1/13

緊1

部分弓部置換 MVR CABG

2009/1/14

無AMI

TAA P/O TAAA HD

2009/3/26

待機21

Stent garfting 頚動脈再建

2009/12/6

無脳梗塞

AD(A) malperfusion AMI

2009/12/31

緊shock

弓部全置換術 CABG

2010/1/1

無AMI

DCM

2009/7/1

緊27

LVAS装着術

2009/7/27

無肺出血

ASO

2009/3/30

待機38

Axillo-bi femoral bypass

2009/5/7

無sepsisruptured AAA

2009/3/20

緊1grafting

2009/3/21

無腸管虚血

年
齢

Cardiac 3 cases
12

3○田 ○子

○中 ○蔵

○崎 ○子

FM

F777579

AMI

AVR

CABG

Thoracic aorta 3 cases

12

3

○嶋 ○子

○目 ○信

○永 ○夫

F

M

M

8367

50

Other and Abdominal aorta 3 cases

12

3○本 ○奈

○岡 ○子

○橋 ○江

FFF207578

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。