Annual Report of Cardiovascular Surgery 2022

Nagasaki University

2022.1.1～2022.12.31

1. Overall

Page

Ⅰ. Number of Operations and Surgical Mortality

2-3

Ⅱ. Mode of Operation

4

Ⅲ. Age Distribution

4

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

5

Ⅱ. Valvular Heart Disease

6- 7

Ⅲ. Ischemic Heart Disease

8-9

Ⅳ. Congenital Heart Disease10

Ⅴ. Others

10

Ⅵ. Maze operation

10

Ⅶ. VAD

10

Ⅷ. Vascular Disease

11-13

3. Summary of Hospital Deaths

14

4. Annotations

15

~ Overall~Ⅰ-1. Number of Operations and Surgical mortality

Division

No. OP.

No. CasesOP. mortality (%)

Hosp. mortality (%)

Cardiac181 (1*)179 (1*)00

Car. + Thoracic

161611Thoracic

60

580

1257 (1*)

253 (1*)1 (0.4)2 (0.8)Abdominal aorta

41

4100Peripheral

26

26

00

Total

324

320

1 (0.3)2 (0.6)Total*TAVI (performed by Cardio-vascular department)

400
CardiacThoracic

Car+Thorac

350

81224 58 135051
62300
8250
200
150

3154 6 933 19 20

981146 43
2 7 47
4 19332247 5258

136 148

160 159 177

142 151 139 150 157

111562 35 24 3042421660

270
221 22410050102459164 165

202 207184 174247275

240
181

2000
2001
20022003
20042005
2006
2007
2008
2009201020112012201320142015201620
17201820192020202120
2202Ⅰ-2. Number of Operations and Surgical mortality including all TAVIDivision

No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Cardiac222 (42*)220 (42*)00Car. + Thoracic

1616

11Thoracic

605801298 (42*)

294 (42*)1 (0.3)2 (0.7)

Abdominal aorta

414100Peripheral

26

26

00

Total

365

361

1 (0.3)2 (0.6)Total*TAVI, all cases

400
CardiacThoracic

Car+Thorac

350
12300
8250

47 52

200150315

4 6 9
33 19 20

1024

98

115

43 58
7 47 4624
22 19 33

136 148

160 159177

142 151 139 150 157

164 165

62

24 58 13
51

1162

15
24 30
35
4242
270

221 224

100
50

950

8202 207 184

247

275

240

1660

222

174

2000
2001
2002
2003
20
04
2005
2006
2007
2008
2009
20
1020
1120
1220
1320
1420
1520
1620
1720
1820
19
20
202021202203Ⅱ. Mode of Operation

Total

Scheduled (%)

Urgent (%)

Emergent (%)

Ischemic

64

51 (79.7)

6 (9.4)7 (10.9)

Valvular98

89 (90.8)

5 (5.1)4 (4.1)

Congenital

1010 (100)00

Others15

11 (73.3)

1 (6.7)

3 (20.0)

Thoracic aorta

70

34 (48.6)

3 (4.3)33 (47.1)

Abdominal aorta

41

35 (85.4)

1 (2.4)5 (12.2)

Peripheral artery26

8 (30.8)2 (7.7)16 (61.5)

Total

324

238 (73.5)

18 (5.6)

68 (21.0)

Ⅲ. Age Distribution

9080
257060145010154019302010101542

811214201770-49

50-59
Valve60-69
Ischemic

470-79Thoracic80-

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

No. Cases

OP. mortality

Hosp. mortality

Valvular109

109

00(redo)

(14)

(14)

00

Ischemic75

7400(redo)

(4)

(4)

00

Congenital

111100

Others47

4600

Thoracic aorta

76

74

1 #1

2 #1,2(redo)

(10)

(8)

0

1 #2

(Stent graft)

(17)

(17)

00

Abdominal aorta

41

4100

(Stent graft)(13)(13)00

Peripheral artery

282800

Cardiac

VascularConcomitant Procedure
Valvular (only): 59 cases

Valvular + Congenital: 2 cases

CABG (only): 58 cases

Valvular + Others: 26 cases

Congenital (only): 9 cases

CABG + Thoracic aorta: 2 cases

Others (only): 14 cases

CABG + Others: 4 cases

Thoracic aorta (only): 59 cases

Thoracic + Extra: 2 cases

Valvular + CABG: 9 cases

Congenital + Others: 1 case

Valvular + Thoracic aorta: 12 cases
Valvular + Thoracic aorta + CABG: 1 case
Valvular + CABG + Others: 1 case5Ⅱ. Valvular Heart Disease
No. OP.

No. Cases

OP mortality

Hosp. mortality

Aortic *646400Mitral

303000Tricuspid

0000Pulmonary

1100

A+M *

1100

M+T

111100

A+M+T *

3300

A+T *

2200Total

112

112

00Combined*: AVR 49, Bentall 3, Reimplantation only 5, Total Root Remodeling +AVP 6, TAVI-TF 1a) Mitral valve disease
DiagnosisMRMSMSRTotal

MVR (%)

Repair (%)

35524218 (42.9)

24 (57.1)b) Mitral valve repair
Etiology
Congenital

Infectious

Degenerative

Rheumatic

Ischemic

DCM

Others02180104

Post ope. follow up
Intra. Op. n = 24

Follow(〜12M), n = 24

non to trivial (0-2cm2)

2020

Mild (2-4cm2)

44

mild to moderate, (4-8cm2)00moderate to severe, (8cm2- )00

Jet area6c) Valve substitutes implanted
MechanicalTissue

Total

AVR

1345*

58*

MVR

41418TVR

000PVR011Total

176077*(TAVI: 1 case)d) Minimally invasive cardiac surgery
Procedures

No. Op.

MP*13 (0)MVR**

3 (0)

AVR

3ASD/PFO

6TP, only0LA mass/ thrombus

4Total (case)28() redo*) MP isolated (±Maze, LAAP) 11
MP+TAP (±Maze, LAAP)

2**) MVR isolated (±Maze, LAAP) 3

LAAP: LA Appendage plication

7Ⅲ. Ischemic heart disease
Total

Isolated CABG

Op. Mortality

Hosp. Mortality

SVD

14800DVD

151100TVD

282500LMT

1100Total

584500Conventional CABG: 38 cases
Off pump CABG: 1 caseOn pump beating CABG: 19 casesa) Conduit

2.3 / patientITASVGCases

SVD7814DVD

181315TVD

424528LMT

111Total

6867135 / 58 casesb) Anastomoses
No. Anastomoses

2.6 / patient
No. Cases (%)

113 (22.4)

212 (20.7)

318 (31.0)

414 (24.1)

51 (1.7)

Total Cases

58

Total anast.

1528c) Anastomoses
No. Anastomoses

12345No. OP.

SVD

130

10014DVD01041015TVD011313128LMT010001Total cases

13121714158

Total anast.

132451565149d) Graft patencyNo. of grafts

Examined

PatentPatency Rate (%)

Artery68656497.0

LITA

444242100

RITA

24232295.7

SVG

70686798.5

Total

138

133

131

98.5

9

Ⅳ. Congenital heart disease
No. Cases

No. OP.

OP. mortality

Hosp. mortality

ASD/PFO

9900

VSD

1

100

PDA

1100Total

111100Ⅴ. Others
No. OP.

No. Cases

OP. mortality

Hosp. mortality

Cardiac tumor

4400

Thrombus/ CAT

1100

Surgical ventricular repair

2100VAS implantation

2200Bleeding (LV rupture)

2200Morrow / Myectomy

5500LAAP

212100Atrial Fibrillation Surgery

171700Pulmonary endarterectomy

1100

Other4400Total

585700Ⅵ. Maze operation

LA Maze, n = 17Device

SR recover / Total cases

cryo-ICE

14 / 17 (82.4)

Ⅶ. VAD
No. OP.

No. Cases

OP. mortality

Hosp. mortality

HeartMate Ⅲ

2*200Total

2200* HM-2→HM-3 conversion

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

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Root

11900

Ascending aorta

13130

1#2

Hemiarch

3300

Total arch232300Descending aorta

191900(Stent graft)

(17)

(17)

(0)

(0)

5500(0)(0)00747201 (1.4)

Thoracoabdominal aorta(Stent graft)
Totalb) Classification of Thoracic aorta
Dissection

No. Cases

Hosp. mortality

Ⅰ29

2 #1,2

Ⅱ

70

Ⅲa00

Ⅲb10

Ⅰ

10

Ⅱ

10

Ⅲa70Ⅲb50

Acute

Chronic

11

True

No. Cases

Hosp. mortality

Root

40

Ascending20Arch70

Descending

80Thoracoabdominal

50Operation method
Root replacement
Bentall3

Reimplantation

5Total Root Remodeling

6Bentall + Ascending

1

Reimplantation + Ascending

0Bentall + TAR

1

Reimplantation + TAR

3Ascending aorta replacement

17

Hemiarch replacement

3Total arch replacement (TAR)

14TAR + OSG

10Descending aorta replacement

3

Thoracoabdominal aorta replacement

5TEVAR

1712c) Classification of Abdominal aorta, peripheral artery
No. OP.

No. Cases

OP. mortality (%)

Hosp. mortality (%)

Abdominal aorta

414100(Stent graft)

(13)

(13)

00

Peripheral artery

282800Total

696900No. Cases

Hosp. mortality

Operation method

410390

Graft replacement

26

Impending rupture

00EVAR

13

Ruptured

50others

2ASO00

Others

20

280

ASO

70

Thrombectomy

8

Acute arterial occlusion

100

Bypass grafting

8Aneurysm

10Plasty

10

Traumatic

60Others

40

Abdominal aorta
AAA

Peripheral artery13

~ Summary of hospital death ~NoAgeGender

DxOpe dateEmergency

Risk factors*1

Operation procedures

POD (days)

Autopsy

Cause of death*2

Cardiac 0 caseCar. + Thoracic 0 caseThoracic 2 case127956

AADA, p/o AVR

4/29

Emergency

p/o AVR, redo

7.6

上⾏置換

214

Not done

MOF

38.6

AADA, AMI,

3/25

Emergency

AMI, Cardiogenic shock, IMPELLA

5.3

上⾏置換, CABG

16

Not done

Cardiogenic shock, MOF

30.7

M

M

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）
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。
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 として全症例をカウント.
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〜）

15