Coronary artery surgery results In The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)

Transcription

1 Coronary artery surgery results In 2016 The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)

2 Coronary artery bypass grafting (CABG), 2016 Total cases : 12,729 Isolated CABG : 8,492 (67%)(previous year:70%) Concomitant CABG : 4,237 (33%)(previous year:30%) Isolated CABG Initial elective : 7,142 Except initial elective :1,350 Off-pump : 4,424 Off-pump : 695 On-pump : 2,718 On-pump : 655 (Off-pump rate : 62%) (Off-pump rate : 51%) (previous year : 63%) (previous year : 51%)

3 Changes of off-pump CABG rate(initial elective CABG) % % year

4 Initial elective CABG :7,142(100%) On-pump (arrest) :1,706(23.9%) On-pump (beating) :1,012(14.2%) Off-pump (total) :4,424(61.9%) Off-pump (complete) :4,322 On-pump (conversion) : 102 Off-pump complete rate :97.7% Off to on-pump conversion rate :2.3% (previous year:1.8%)

5 Mortality of isolated CABG :1.66% (previous year:1.72%) Mortality of initial elective CABG:1.09% (previous year:0.83%) On-pump (arrest) :1.29% On-pump (beating) :1.28% Off-pump (total) :0.97% Off-pump (complete):0.86% (previous year:0.54%) On-pump (conversion):5.88% (previous year:4.40%)

6 mortality (%) Changes of mortality (Isolated and initial elective CABG) Isolated CABG Initial elective CABG % % year

7 mortality (%) Changes of mortality for procedures(initial elective CABG) 8 7 Off-pump(complete) On-pump(beating) On-pump(arrest) 6 Off to on-pump(conversion) year

8 Mortality according to number of diseased vessels (Initial elective CABG:7,142, mortality:1.09%) mortality (%) 2.0 1VD (0%) LMT+1VD (0.62%) LMT+2VD LMT (0.78%) (0%) VD (0.65%) LMT+3VD 3VD (1.56%) (1.20%) (%)

9 Mortality according to number of diseased vessels (Except initial elective CABG:1,350, mortality:4.67%) mortality 10 (%) 1VD (7.50%) LMT (5.00%) LMT+1VD (0.00%) 5 2VD (4.49%) 3VD (4.17%) LMT+2VD (5.20%) LMT+3VD (5.08%) (%)

10 Mortality according to surgical procedures (Except initial elective CABG:1.350, mortality:4.67%) mortality (%) Off-pump (total) 2.59% On-pump (beating) 7.46% On-pump (arrest) 6.14% (%)

11 Graft number according to procedures(initial elective CABG) graft number average No. (previous year) Total (2.99) On-pump (arrest) (3.17) On-pump (beating) (3.01) Off to on (conversion) (3.08) Off-pump (complete) (2.74) %

12 Procedure according to graft number(initial elective CABG) graft number 1 Off to on-pump (conversion) Off-pump On-pump (beating) On-pump (arrest) 2 Off-pump On-pump (arrest) 3 Off-pump On-pump (arrest) 4 Off-pump On-pump (arrest) 57.2% %

13 On-pump (arrest) vs. off-pump (Initial elective CABG) bypass+ bypass On-pump (arrest) Off-pump RCA 68% 68% On-pump (arrest) Off-pump LAD 88% 91% On-pump (arrest) Off-pump LCX 78% 76% %

14 Off-pump vs. off to on-pump conversion (Initial elective CABG) Bypass No. Off to on-pump conversion conversion rate RCA(+) 3,003 LAD(+) 4,497 LCX(+) 3,367 Off-pump Off-pump Off-pump 2.3% 2.0% 2.5% RCA( ) 1,421 LAD( ) 93 LCX( ) 1,057 Off-pump Off-pump Off-pump 2.1% 10.7% 1.6% %

15 Age distribution according to gender (Initial elective CABG) Male:79.1% 709 (Age) 80 Female:20.9% (case) (case)

16 Changes of elderly cases(initial elective CABG) % % y.o. 80 y.o % year

17 mortality (%) Changes of mortality according age(initial elective CABG) y.o y.o y.o y.o. 80 y.o year

18 Graft selection (Total graft number of isolated CABG:22,938) SVG (42.1%) RITA (15.6%) LITA (35.3%) RA (3.8%) GEA (3.2%)

19 Changes of graft selection % LITA RITA GEA RA SVG year

20 Stroke rate according to procedures(isolated CABG) Stroke cases:108 Stroke rate:108/8492(isolated CABG)=1.27% p: p: % 3 % p: % % 1.05% Off-pump (complete) On-pump(arrest) On-pump(beating) Off to on-pump (coversion)

21 Results of emergency CABG after PCI complications Emergency CABG; operation after PCI complications (coronary occlusion and/or bleeding), within 24 hours Cases:78 Rate:78/8492(isolated CABG);0.92% Death cases:8 Mortality:10.2% Results cases death cases mortality(%) CABG CABG CABG CABG Other procedures

22 mortality (%) Changes in results of ventricular septal perforation year Total No.:174, death:37 (mortality:21.2%)

23 Results of ventricular septal perforation (1) alive death Total cases (mortality;21.2%) Bypass(+) (mortality;18.0%) Bypass( ) (mortality;23.5%) (case)

24 Results of ventricular septal perforation (2) Anterior infarction(mortality;19.5%) Patch closure (mortality;22.0%) alive death Infarction exclusion Others (mortality;18.4%) 7 (mortality;14.2%) Post-inferior infarction(mortality;26.8%) Patch closure (mortality;22.2%) Infarction exclusion (mortality;21.0%) Others (mortality;75%) (case)

25 mortality (%) Changes in results of ventricular septal perforation according to region Anterior VSP Post-inferior VSP year

26 mortality (%) Changes in results of papillary muscle rupture year Total No.:32, death:4 (mortality:12.5%)

27 Results of papillary muscle rupture alive death Total cases (mortality:12.5%) Bypass(+) (mortality;8.33%) Bypass( ) (mortality;15.0%) (case)

28 mortality (%) Changes in results of LV free wall rupture year Total No.:144, death:38 (mortality:26.4%)

29 Results of LV free wall rupture alive death Total cases Blowout type (mortality;50.0%) 144 (mortality;26.4%) Bypass(+) (mortality;33.3%) Bypass( ) (mortality;54.2%) Oozing type (mortality;9.5%) Bypass(+) Bypass( ) (mortality;9.1%) (mortality;9.7%) (case)

30 mortality (%) 80 Changes in results of LV free wall rupture according to rupture type Blowout type Oozing type year

31 mortality (%) Changes in results of left ventricular aneurysm (LVA) year Total No.:164, death:8 (mortality:4.87%)

32 Results of left ventriculoplasty and/or aneurysmectomy alive Total cases death (mortality;4.87%) Bypass(+) (mortality;4.38%) Bypass( ) (mortality;5.88%) (case)

33 Results of MVR or MVP for ischemic MR alive death Total cases (mortality;3.84%) Mitral valve plasty Total Bypass(+) (mortality;1.76%) 200(mortality;2.00%) Bypass( ) 26 26(mortality;0%) Mitral valve replacement Total Bypass(+) Bypass( ) (mortlity;9.30%) 59(mortality;11.86%) 27(mortality;3.70%) (case)

34 Results of ischemic MR+LVA or ischemic cardiomyopathy alive death Total cases (mortality;5.97%) Left ventriculoptasty + Mitral valve plasty Total Bypass(+) (mortality;5.45%) 38(mortality;7.89%) Left ventriculoptasty + Mitral valve replacement Bypass( ) Total Bypass(+) Bypass( ) (mortality;0%) 1 12(mortality;8.33%) 8(mortality;0%) 1 4(mortality;25.0%) (case)

35 Conclusions (1) 1. The mortality of isolated CABG was 1.66%, that of initial elective CABG was 1.09%, indicating almost same excellent results than those of previous year. 2. Of initial elective CABGs, 62% cases underwent off-pump procedure, showing still high rate. The mortality of off-pump was 0.86%, which was slightly higher than that of previous year, indicating still good results. 3. Off to on-pump conversion rate was 2.3%, and the mortality of those cases was 5.88%, resulting getting worse. 4. The more bypass number, the lower the off-pump rate. However, of all 4 and/more bypass procedures, 57.2% cases were done by off-pump CABG. 5. CABG cases is getting older year by year, more than 70 years old patients rate was 50.9%, more than 80 was 13.5%, showing high rate.

36 Conclusions (2) 6. Arterial grafts were used in 57.9%n of all grafts, while vein grafts were used in 42.1%. The frequency of vein graft usage increased in recent years. 7. The complication rate of central nerve system stroke of all isolated CABG was 1.27%. This rate of off-pump CABG showed significantly lower than those of on-pump (beating) and off to on-pump conversion procedures, resulting OPCAG can avoid this complication. 8. After PCI complications, emergency operation underwent in 0.92% of all isolated CABG within 24 hours. The mortality of those cases was 10.2%, showing still high rate. 9. The results of complications for acute and old myocardial infarction improved than those of previous year. However, the mortality of post-inferior VSP and blowout type free wall rupture, were high rate, indicating worse prognosis.

37 Special survey of intra-operative graft flow measurement for CABG The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)

38 Question 1 ;Do you know that an intra-operative graft flow measurement fee can charge as payment for medical services? No(9.8%) Yes(90.2%) Question 2 ;Do you charge this fee, actually? No(21.4%) Yes(78.6%)

39 Question 3 ;What kind of equipment do you use for intra-operative graft flow measurement? TTFM TTFM+Echo Echo others

40 Question 4 ;What kind of parameters do you measure for intra-operative graft flow measurement? mean flow PI DF flow wave form 3 others

41 Question 5 ;What kind of parameters do you emphasize for intra-operative graft flow measurement? mean flow PI DF flow wave form 10 3 others

42 Question 6 :Do you use any diagnostic image equipment except graft flow measurement? Yes(16.5%) No(83.5%)

43 Question 7 :What kind of diagnostic image equipment do you use? SPY PDE Echo Others

44 Question 8 :How many grafts did you revise to perform CABG due to abnormal graft flow measurement, in last year? Answer; 347 Question 9 :How many grafts did you perform CABG, in last year? Answer; 29,008 Revision rate;1.2%

45 Question 10 :What were the reasons for revision to perform CABG? Technical error Graft dissection Coronary artery dissection Bleeding and/or hematoma Unknouw Others

46 Question 11(1) :Do you have any standard to revise to perform CABG? Graft flow measuement (flow, PI, DF) Flow wave form Anastomosis shape Diagnostic imaging Doppler flow meter

47 Question 11(2) :Do you have any standard to revise to perform to CABG? (detail of graft flow measurement standard) 10 mean flow 12 PI < 10 <15 < 20 DF < 60% : 2 (ml/min) 0 > 4 > 5 > 10

48 Question 12 :Do you think that an intra-operative flow measurement is useful to prevent graft failure for CABG? No(3.6%) Yes(96.4%)