Annual Report of Cardiovascular Surgery 2014

Nagasaki University
2014.1～2014.1～2014.12

1. Overall
Ⅰ. Number of Operations and Surgical Mortality
Ⅱ. Mode of Operation
Ⅲ. Age Distribution

Page
233

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
Ⅵ. Vascular Disease

45799910

3. Summary of Hospital Deaths12

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

Division

No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality (%)

CardiacThoracic

198
58

202
62

2(1.0)
1(1.6)

6(3.0)
2(3.2)

Car. + Thoracic

111100

Total

267

275

3(1.1)

8(2.9)

Abdominal aorta
Peripheral artery54
1654
161(1.9)01(1.9)0Operations

300
Car+Thorac
250

Thoracic
Cardiac

200
150
100
50
02

Ⅱ. Mode of Operation
total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic
ValvularCongenital
OthersThoracic aorta
Abdominal aorta
Peripheral artery

60
125
3
1463
55
1851(85.0)
121(96.8)3(100)
5(35.7)37(58.7)
46(83.6)4(22.2)4(6.7)
3(2.4)
03(21.4)01(1.8)4(22.2)5(8.3)
1(0.8)
06(42.9)26(41.3)8(14.6)10(55.6)

Total

338

267(79.0)15(4.4)56(16.6)

Ⅲ. Age Distribution

100
90
80
70
60
50
40
30
20
100

ThoracicIschemic
Valve

25

15

18

21
13
7

50
6

3
3

12

12

12

32
19-49

50-59

60-69

70-79803

～Summary of CardioCardio-Vascular Division～
Division～

Ⅰ. Number of Operations and Surgical Mortality

No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

141(17)
79(1)
535

144

2(1.4)

5(3.5)

7901(1.7)5360
00060(5)(10)
54(11)
1664

1(1.6)

2(3.1)

541(1.9)1(1.9)

1800

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

Concomitant Procedure
Valvular(only): 92 cases
CABG(only): 51 cases
Congenital (only): 2 cases
Others(only): 12 cases
Thoracic aorta(only): 47 cases
Valvular + CABG: 17 cases
Valvular + Thoracic aorta: 10 cases
Valvular + Congenital: 2 cases
Valvular + Others: 22 cases
CABG + Thoracic aorta: 7 cases
CABG + Others: 2 cases
Congenital + Others: 1 case
Valvular +Ischemic + Thoracic: 1case4

Ⅱ. Valvular Heart Disease
No. Cases

No. OP.

OP mortality （%)

Hosp. mortality (%)

Aortic *Mitral
Tricuspid
Pulmonary

57
45
4057
46
4
01(1.8)01(25.0)03(5.3)1(2.2)
1(25.0)0Combined
A+M
M+T
A+M+T
A+T

10
2062

1020
6200000000Total

144

145

2(1.4)

5(3.4)* Bentall 3 cases, Reimplantation 4 cases, 大動脈弁形成術 2 cases, Reimplantation+Reimplantation+ 大動脈弁形成術 3 casesa) Mitral valve disease
Diagnosis
MRMSrMsRMSMSR

Total

MVR (%)

Repair (%)

7600238121 (25.9%)

60 (74.1%)b) Mitral valve repair
Etiology
Congenital

Infectious

DegenerativeRheumatic

Ischemic

DCM

Other

0249

1422

Post ope. follow up
Jet area

Intra. Op.

Post ope.
ope. (～(～discharge)

Follow(～Follow(～12M)

non to trivial(0(0-2cm2)

5953

34

mild(2--4cm2)(2157mild to moderate(4(4-8cm2)011moderate to severe(8cm2(8cm2- )0105c) Valve Substitutes implanted

85 Prostheses

MechanicalTissueTotal

AVRMVRTVR
PVR

30130035
61065
1910Total

43(50.6)

42(49.4)85d) Minimally Invasive Cardiac Surgery
Procedures

No.Cases

MP*

32(3)

MVR**

7(3)

ASD/PFO

3(0)

TP***

2(0)

MIDCAB1(0)LA mass/ thrombus

3(1)

Total

48

( )内はredo症例数*) MP isolated 23,
MP+TAP 3
MP+Maze 4
MP+TAP+Maze 2**) MVR isolated 6MVR+Maze 1***) TP isolated 1
TP+Maze 1

6Ⅲ. Ischemic Heart Disease

Total

Isolated CABG

OP. mortality(%)

Hosp. mortality(%)

SVD
DVDTVDLMT

20182516412211400001(5.0)
000

Total

795101(1.3)

Off pump CABG : 18cases
On pump beating CABG : 7casesa) Conduit

184 ( 2.3 / patient )ArterySVG

Cases

SVDDVD
TVD
LMT

1223
4320

1118312620
1825
16Total

988679b) Anastomoses
190 ( 2.4 / patient )b’) Anastomoses by OPCAB
41 ( 2.3 / patient )No. Anastomoses

No. Cases (%)

No. Anastomoses

No. Cases (%)

1234518(22.8)
24(30.4)
26(32.9)9(11.4)2(2.5)

123452(11.1)
9(50.0)7(38.9)00

Total Cases

79

Total Cases

18

Total anast.
anast.

190

Total anast.
anast.

417c) Anastomoses
No.
Anastomoses

12345No. OP.

SVD
DVDTVD
LMT

170
10

3
15
3
30
2
13
110
16
200
2020
18
25
16

Total

1824

26

9274

Total anast.

1848

78

3610190

Anastomoses

Examined

PatentPatentcy
Rate(%)

Stenosis*

StenosisRate(%)

SVG

86807796.3

33.7

Artery989694

97.9

22.1

68
282066282065
2720

98.5
96.4
10001100

1.5
3.600184

176(95.7%)

171

97.252.8d) Graft patency

LITARITA
GEA
RA
Total

Intervention : 1 cases*Stenosis : ≧90%

8

Ⅳ. Congenital Heart Disease
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality
(%)

5000

5000000000005500No.
Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

Cardiac tumor
Thrombus/ CAT
Surgical ventricular repair
Bleeding (LV rupture)
VAS implantation
MazeOthers
Morrow713221771323170000000000003300Total

353600No. Cases

Sinus recovery(%)

Cryoablation

171270.6

PV isolation

000171270.6

ASD
VSD
PDA
VSA(Valsalva
VSA(Valsalva)
Valsalva)

Total

Ⅴ. Others

Ⅵ. Maze operation

Total

9

Ⅶ. Vascular Diseasea) Replacement site
No. Cases

No. OP.

OP. mortality (%)

Hosp. mortality(%)

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

10122
1719(9)4101221719(9)400001(5.3)
000001(5.9)
1(5.3)
00

Total

64

64

1(1.6)

2(3.1)

No. Cases

No. OP.

OP. mortality(%)

Hosp. mortality(%)

54(11)
1654(11)181(1.9)001(1.9)0081

83

1(1.2)

1(1.2)

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

Hosp. mortality (%)ⅠⅡⅢaⅢb2821182
102(7.1)
1(4.8)
1(7.7)
000ⅠⅡⅢaⅢb700251(14.3)0001(20.0)

368112123000000Dissecting
Acute

ChronicTrue
Root
Ascending
ArchDescendingThoracoabdominal

Operation method
Root replacement
Bentall+Total arch replacement
Reimplantation
Ascending aorta replacement
Hemi arch replacement
Total arch replacement (TAR)
Total arch replacement+Open stentDescending aorta replacement
Thoracoabdominal aorta replacement
Stent Graft32111241511Root replacement
Bentall
Reimplantation
Reimplantation+TAR
Ascending aorta replacement
Hemi arch replacement
Total arch replacement
Total arch replacement+Open stent
TAR+Descending aorta replacement
Descending aorta replacement
Thoracoabdominal aorta replacement
Stent Graft
Stent Graft+Debranch

8161
1011113371c) Classification of Abdominal aorta, peripheral artery
No.
Cases

Hosp. mortality(%)

Abdominal aorta
AAA
NonNon-ruptured
RupturedASO
IVC trauma

54535030
11(1.9)01(2.0)000

Graft replacement
Stent Graft
IVC repair

42111Peripheral artery
ASO
Acute arterial occlusion
Aneurysm
TraumaticOthers

1827620000000Thrombectomy
Bypass grafting
PlastyOthers

8451Operation method11

～ Summary of Hospital death ～

No.

氏名性年
齢診断

手術日

緊/待

術後日数

術式

死亡日

剖検

死因

MR, DCM

2014/1/10

待機218

redo MVR

2014/8/16

無LOS, Sepsis

AS

2014/1/16

待機58

AVR

2014/3/15

無PMI, LV rupture, MOF

AS, HD, LC

2014/8/13

待機81

AVR

2014/11/2

無LOS, MOF, 縦隔炎

TR, CTEPH*

2014/6/13

緊急8TVR

2014/6/21

無LOSAS

2014/6/13

待機12AVR

2014/7/1

無大動脈解離, MOF

uAP, HD

2014/12/8

緊急57

CABG

2015/2/3

無LOS, 縦隔炎

Cardiac 6 cases
123456

高○ 勝○

片○ 政○

松○ 涼

脇○ 道○

坂○ 若○

井○ 希

M

MM

M

FF

70

79

69

50

73

42
*:CTEPH:慢性血栓塞栓性肺高血圧症

Thoracic aorta 2 cases
1

2

馬○満○夫

佐○田○基

M

M

AD(A)

2014/1/28

緊急

44

Total Arch Replace.

2014/3/13

無脳幹梗塞

CD(B)

2014/11/13

緊急1Des. Aorta Replace.

2014/11/14

無Malperfusion, MOF

7873

Abdominal aorta 1 case
1

犬○ 貞○

M

66

AAA

2014/6/23

待機6Grafting

2014/6/29

無術後出血, MOF

12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。

13