Annual Report of Cardiovascular Surgery 2010 Nagasaki University ~

Transcription

1 Annual Report of Cardiovascular Surgery Nagasaki University.~.. Overall Page Ⅰ. Number of Operations and Surgical Mortality Ⅱ. Mode of Operation Ⅲ. Age Distribution. Summary of CardioVascular Division Ⅰ. Number of Operations and Surgical Mortality Ⅱ. Valvular Heart Disease 5 Ⅲ. Ischemic Heart Disease 7 Ⅳ. Congenital Heart Disease 9 Ⅴ. Others 9 Ⅵ. Maze operation 9 Ⅵ. Vascular Disease. Summary of Hospital Deaths

2 ~Overall~ Ⅰ. Number of Operations and Surgical mortality Division Cardiac Thoracic No. Cases No. OP. OP. mortality (%) Hosp. mortality (%) (.) (.) (.) (9.) Car. + Thoracic Total 7 8 (.) 5 (.) Abdominal aorta Periphearal artery (.) (.) Operations 5 Car+Thorac. Thoracic Cardiac

3 Ⅱ. Mode of Operation total Scheduled (%) Urgent (%) Emergent (%) Ischemic Valvular Congenital Others Thoracic oaccaota aorta Abdominal aorta Peripheral artery (8.) 9 (9.8) () (5.) (5.) 57 (8.) (.) 5 (9.) (.) (5.) (8.) (7.) (.) (5.) 9 (8.8) 9 (.) (.7) Total (7.%) 8 (5.7%) 5 (7.9%) Ⅲ. Age Distribution 8 Thoracic Ischemic Valve

4 ~Summary of Cardio-Vascular Division~ Ⅰ. Number of Operations and Surgical Mortality No. Cases No. OP. OP. mortality (%) Hosp. mortality (%) Cardiac Valvular (redo) Ischemic (redo) Congenital Others (9) 77 () 77 (.) (.) (.) (.) Vascular Thoracic aorta (redo) (Stent graft) Abdominal aorta (Stent graft) Peripheral artery 5 () () (7) Peripheral artery () (.) () (.) 5 (.7) (7.) Concomitant Procedure Valvular(only): 7 cases CABG(only): 5 cases Thoracic aorta(only): cases Valvular + CABG: 9 cases Valvular + Thoracic aorta: 7 cases Valvular + Congenital: cases Valvular + Others: cases CABG + Thoracic aorta: cases Vl Valvular l + CABG + Thoracic aorta: case

5 Ⅱ. Valvular Heart Disease No. Cases No. OP OP mortality (%) Hosp. mortality (%) Aortic * Mitral Tricuspid Pulmonary 9 Combined A+M M+T A+M+T (9.) (9.) Total (.) (.) a) )M-repair * Bentall ope cases Diagnosis MR MSr MsR MS MSR Total MVR (%) Repair (%) 7 7 (.%) (.7%) Etiology Congenital Infectious Degenerative Ischemic DCM 7 Post ope. follow up Jet area No. Ope Post ope. (discharge) non to trivial (-cm) mild (-cm) mild to moderate (-8cm) moderate to severe (8cm- ) Follow (~M) 7

6 b) Valve Substitutes implanted 79 Prostheses AVR MVR TVR PVR Mechanical Tissue Total 9 PVR Total

7 Ⅲ. Ischemic Heart Disease Total Isolated CABG OP. mortality(%) Hosp. mortality(%) SVD DVD TVD LMT 8 (5.) (5.) Total 77 5 (.) (.) Off pump CABG : 5 cases On pump beating CABG : cases a) Conduit 9 (.5 / patient ) Artery SVG Cases SVD DVD TVD LMT Total (5.8%) 9 (7.%) 77 b) Anastomoses (. patient ) b ) Anastomoses by OPCAB (. / patient ) No. Anastomoses No. Cases (%) 5 9 Total 77 Total anast. No. Anastomoses No. Cases (%) 5 5 Total 5 Total anast.

8 c) Anastomoses No. Anastomos es 5 No. OP SVD DVD TVD LMT Total 9 77 Total anast. 8 c) Graft patency Anastomoses Examined Patent Rate** Stenosis* Rate*** SVG Artery LITA RITA GEA Total 57(77.7%) (%) 9. (%) Intervention : case *Stenosis : 9% **patency rate (excl.stenosis) *** patency rate (incl.stenosis)

9 Ⅳ. Congenital Heart Disease ASD VSD PDA VSA(Valsalva) No. Cases No. OP. OP. mortality (%) Hosp. mortality (%) Total Ⅴ. Others No. Cases No. OP. OP. mortality (%) Hosp. mortality (%) Cardiac tumor Constrictive pericarditis VSP/LV aneurysm DCM VAS implantation Bleeding Others Total Ⅵ. Maze operation No. Cases Sinus recovery (%) Cryoablation 8.7% Total 8.7%

10 Ⅶ. Vascular Disease a) Replacement site Thoracic Ascending aorta Hemiarch Total arch Descending aorta (Stent graft) Thoracoabdominal Ao. No. Cases No. OP. OP. mortality (%) () () (7.7) (5) Hosp. mortality (%) (7.7) (.) (5.) (5) Total 5 5 (.7) (7.) No. Cases No. OP. OP. mortality (%) Hosp. mortality (%) Abdominal aorta (Stent graft) (7) (7) Peripheral artery () (.) () (.) Total 9 9 (.) (.)

11 b) Classification of Thoracic aorta No. Cases Hosp. mortality (%) Operation method Dissecting Acute Ⅰ Ⅱ Ⅲa Ⅲb 9 (5.) (7.) (.) Total arch replacement Hemiarch replacement (+CABG) Stent Graft 9 Chronic Ⅰ Ⅱ Ⅲa Ⅲb True Ascending Arch Descending Thoracoabdominal 7 (5.) ) (5.9) Hemiarch replacement (+AVR) Descending aorta replacement Thoracoabdominal Ao. replace. Stent graft Total arch replacement(+cabg) Total arch replacement(+bentall/avr) Bentall Hemiarch replacement(+avr) Descending aorta replacement Stent graft Thoracoabdominal Ao. replace. 7 5 c) Classification of Abdominal aorta, peripheral artery No. Hosp. mortality Cases (%) Operation method Abdominal aorta AAA Non-ruptured Ruptured 57 9 Graft replacement Stent Graft 9 7 Peripheral artery ASO Acute arterial occlusion Aneurysm Traumatic Others (.) (8.) Thrombectomy Bypass grafting Plasty Others 5 9

12 ~ 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 Cardiac case 下 子 F 75 U-AP OMI HD AS MR // 緊 9 CABG x AVR MP //9 無 MOF Thoracic aorta cases 代 雄 M 8 岡 子 F 78 道 紀 F 7 藤 則 M 58 弓部全置換術後仮性動脈瘤 /5/5 緊急 75 TEVAR(stent graft) /8/ 無 食道廔 AD(A) CD(B) DIC // 緊急 部分弓部置換術 //7 無 出血 CD(B) DIC TEVAR 後 // 待機 弓部全置換術 CABG // 無 出血 CD(B) /8/ 待機 5 遠位弓部胸部下行全置換術 // 無 NOMI MOF Peripheral artery cases 口 喜 M 7 AAO HD MNMS // 緊 血栓除去 // 無 MNMS

13 各種データの解釈 ) OP mortality: 術後 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 ) ) 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 ) 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 ) 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 ) Vascular Disease: Ascending aorta に対する手術は Bentall OP を含む