Annual Report of Cardiovascular Surgery

2023

Nagasaki University

2023.1.1～2023.12.31

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

10

Ⅷ. Vascular Disease

11-13

3. Summary of Hospital Deaths

14

4. Annotations

15

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

No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Cardiac234 (58*)

230 (58*)

1 (0.4)2 (0.9)Car. + Thoracic

2019

1 (5.0)1(5.0)

Thoracic7876

1 (1.3)2 (2.6)332 (58*)

325 (58*)

3 (0.9)5 (1.5)

Abdominal aorta

44

4400Peripheral

38

38

00

Total

414

407

3 (0.7)5 (1.2)Total*TAVI mainly performed by Cardiovascular medicine

400
350

812300
8250

315

4 6 9
33 19 201024

92 74 1933
2281143
47 46

1562

535

221 224
160 159177

142 151 139 150

157 164 165

202 207

0Cardiac

Thoracic

2Car+Thorac

7842

184 174

50

1662

24 30
4258

2060

270

100
136 14851

1147 52

200
150

50

924 58 13247

275
240

222 234

Ⅱ. Mode of Operation
Total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic

57

50 (87.7)

4 (7.0)3 (5.3)

Valvular

157

145 (92.4)

9 (5.8)3 (1.9)Congenital

55 (100)

00

Others23

15 (65.2)

3 (13.0)

5 (21.7)

Thoracic aorta90

44 (48.9)

8 (8.9)38 (42.2)

Abdominal aorta

4438 (86.4)

06 (13.6)

Peripheral artery

3812 (32.4)

3 (8.1)23 (59.5)

Total414309 (74.6)

27 (6.5)

78 (18.8)

Ⅲ. Age Distribution

9080
29706050

22182140

3020
1068167173716
32216

70-49

50-59
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

Valvular174

174

00(redo)

(11)

(11)

00

Ischemic

74

72

00(redo)

(1)

(1)

00

Congenital

9900Others

504902 #1, 2Thoracic aorta

10198

1 #4

3 #3, 4, 5(TEVAR)

(19)

(19)

00(redo)

(12)

(12)

00

Abdominal aorta

454500(EVAR)

(24)

(24)

00

Peripheral artery

404000

Cardiac

VascularConcomitant Procedure
Valvular (only): 118 cases

Valvular + Congenital: 0 case

CABG (only): 50 cases

Valvular + Others: 20 cases

Congenital (only): 4 cases

CABG + Thoracic aorta: 5 cases

Others (only): 19 cases

CABG + Others: 0 cases

Thoracic aorta (only): 66 cases

Thoracic

Valvular + CABG: 16 cases

Congenital + Others: 1 case

Valvular + Thoracic aorta: 15 cases
Valvular + Thoracic aorta + CABG: 1 case
Valvular + Congenital + Others: 2 cases
Valvular + + CABG + Others: 2 cases

4Extra: 3 cases

Ⅱ. Valvular Heart Disease
No. OP.

No. Cases

OP mortality

Hosp. mortality

Aortic *114

114

00Mitral

30

3000Tricuspid

4400Pulmonary

1

100A+M *101000M+T

111100A+M+T *5

500A+T *1

100Total

176

17600Combined*: AVR 49, Bentall 5, Reimplantation +AVP 7, Total Root Remodeling only 1, Total Root
Remodeling +AVP 2, TAVI-TF 63a) Mitral valve disease
Diagnosis
MRMS / MSRTotal

MVR (%)

Repair (%)

45

95415 (28.3)

39 (71.7)

Congenital

Infectious

Degenerative

Rheumatic

Ischemic

Tethering

Others03290304b) Mitral valve repair
Etiology

Post ope. follow up
Jet area

Intra. Op. n = 39

At discharge, n=39

Follow(～12M), n = 19

non to trivial (0-2cm2)

34

34

12Mild (2-4cm2)

557

mild to moderate, (4-8cm2)000moderate to severe, (8cm2- )0005c) Valve substitutes implanted
MechanicalTissueTotal

AVR

17100 (63*)

117 (63*)

MVR

11415TVR

000PVR011Total

18115 (63*)

133 (63*)*TAVId) Minimally invasive cardiac surgery
Procedures

No. Op.

MP*

19 (0)

MVR**

3 (1)

AVR

4ASD/PFO

6TP2 (1)

MIDCAB

0LA mass/ thrombus

5Total39 (2)() redo*) MP isolated (±Maze, LAAP) 17
MP+TAP (±Maze, LAAP)

2**) MVR isolated (±Maze, LAAP) 2
MVR+TAP

1LAAP: LA Appendage plication

6Ⅲ. Ischemic heart disease
Total

Isolated CABG

Op. Mortality

Hosp. Mortality

SVD

20700DVD

14800TVD

393100LMT

2200Total

75

4800

Conventional CABG: 35 cases
Off pump CABG: 8 cases
On pump beating CABG: 32 cases.

a) Conduit

2.5 / patient
ITA

SVG

Cases

SVD

91220DVD

211014TVD

56

7039

LMT

422Total

9094

184 / 75 casesb) Anastomoses (Distal site)
No. Anastomoses

2.5 / patient
No. Cases (%)

118 (24.0)

214(18.7)

332 (42.7)

410 (13.3)

51 (1.3)

Total Cases

75

Total anast.

1877b’) Anastomoses by OPCAB
No. Anastomoses

1.5 / patient
No. Cases (%)

14 (50.0)

24 (50.0)

30 (0)

Total Cases

8Total anast.

12c) Anastomoses
No. Anastomoses

12345No. OP.

SVD

18200020

DVD01220014TVD

00299139

LMT001102Total cases

181432

10175

Total anast.

182896405187d) Graft patency
No. of grafts

Examined

PatentPatency Rate (%)

Artery90878496.6

LITA

60575596.5RITA

30302996.7

SVG

94939197.8

184

180

175

97.2

Total

8

Ⅳ. Congenital heart disease
No. Cases

No. OP.

OP. mortality

Hosp. mortality

ASD/PFO

8800VSD

1100

PDA

0000

Total

9900

Ⅴ. Others
No. OP.

No. Cases

OP. mortality

Hosp. mortality

Cardiac tumor

6600

Thrombus/ CAT

4400

Surgical ventricular repair (VSP)

3

31

1#1

VAS implantation

2200

Bleeding (LV rupture)

3

300

Pericardiectomy

1101#2Morrow / Myectomy

7700LAAP

151500Atrial Fibrillation Surgery

151500Pulmonary endarterectomy

1100Other

3300Total

606000Ⅵ. Maze operationDevice

SR recover / Total cases

Full Maze*, n = 1

cryo-ICE

1 / 1 (100)LA Maze**, n = 14

cryo-ICE

10 / 14 (71.4)-0 / 0 (0)PV isolation only, n = 0Total, n = 1511 / 15 (73.3)* PVI + mitral isthmus ablation + RA Maze, ** PVI + mitral isthmus ablation

9Ⅶ. VAD
No. OP.

No. Cases

OP. mortality

Hosp. mortality

HeartMate Ⅲ2200Total

220010

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

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Root

101000Ascending aorta

202000Hemiarch

5500

Total arch

42

42

2 #3,52 #3,5

Descending aorta

222200(Stent graft)

(18)

(18)

(0)

(0)

551#4

1#4(0)

(0)

(0)

(0)

104

104

3 (2.9)3 (2.9)Thoracoabdominal aorta(Stent graft)
Totalb) Classification of Thoracic aorta
No. Cases

Hosp. mortality

Acute442Ⅰ

36

1 #5Ⅱ

51 #3

Ⅲa00Ⅲb30

Chronic

160

Ⅲa00Ⅲb160

True

490Root

80Ascending

100Arch190Descending

170

Thoracoabdominal

51#4Dissection

11

Operation method
Root replacement

16Bentall

7Isolated

3+ Ascending

2+ TAR

1+ TAR + OSG

1Reimplantation (David)

8

Isolated

6+ Ascending

2Total Root Remodeling (Sleeve)

1+ TAR

1Ascending aorta replacement

22Hemiarch replacement

6Total arch replacement (TAR)

23+ Descending

1+ OSG

14Descending aorta replacement5Thoracoabdominal aorta replacement

5TEVAR

15

Debranch TEVAR

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

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Abdominal aorta

454500(Stent graft)

(24)

(24)

00

Peripheral artery

41

41

00

Total

86

86

00

No. Cases

Hosp. mortality

Operation method

450450

Graft replacement

21

Impending rupture

10EVAR

24

Ruptured60

ASO

00Others

00

Abdominal aorta
AAAPeripheral artery

0ASO

80Thrombectomy

12Acute arterial occlusion

140Bypass grafting

12Aneurysm

100Plasty

10

Traumatic

00

Others6Others8013

~ Summary of hospital death ~No

AgeGender

DxOperation procedures

POD (days)

VSP
174

10

Constrictive pericarditis
67

36

AADA, TAA
86

31

TAAA
74

0

AADA, AMI (LMT)56

Urgency

Cardiogenic shock, IABP, Intubation

Not done

HF

Elective

CRF on HD, Pneumonia

Not done

MOF

Emergency

Cardiac tamponade, CPA

Not done

UTI, Sepsis

Electivep/o TEVAR, AAA grafting

Not done

Bleeding

Emergency

Cardiogenic shock, ECMO

Not done

Cerebral ischemia

MGrafting5Cause of death

FTAR (long EF), TEVAR

4Autopsy

MPericardiotomy

3Risk factors

MVSP closure

2Emergency

MTAR, CABG-1

2＊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）
Japan Score Ver.4 から算出。

各種データの解釈
1) OP mortality: 術後 30 日以内全死亡。Hospital mortality:術後院内全死亡。
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。

14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～）

15