Updates on JAYCS activities and

Idiosyncrasies of Japanese cardiac surgery

13th Annual Scientific Meeting for ISMICS, 16 – 19 June , 2010, Berlin, Germany

International Fellows Session

Mitsuhiro Kawata, MD, PhD, Shin Takabayashi, MD, PhD, Hiroo Takayama, MD,

Yasutaka Hirata, MD, PhD, Kazuma Okamoto, MD, Hiroyuki Tsukui, MD, PhD,

Naoto Miyagi, MD, PhD,

Updates on JAYCS activities

Objectives of JAYCS

Easy to understand,Our policy is…

JAYCS of the young cardiac surgeon, by the young cardiac surgeon, for the young cardiac surgeon.

Gettysburg Address by U.S. President Abraham Lincoln

1. Improve the skills and knowledge of young cardiac surgeons

2. Improve the communication and exchange of information among young cardiac surgeons

3. Enhance the communication between young cardiac surgeons and established surgeons through lectures and teachings

4. Establish mutual respect between young cardiac surgeons and established surgeons

5. Contribute to the improvement of cardiac surgery patient care

6. Obtain global perspective of our specialty

The goals of JAYCS

Regulations of JAYCS; Oct. 28, 2008

Executives of JAYCS

1

2345

1. One Representative Director Shin Takabayashi

2. Two Accounting Auditors Hiroo Takayama Naoto Miyagi

3. Up to 15 Directors from nationwide (5 regions) 4. Two Consultants Shinichi Takamoto: President of the JSCVS Shunji Sano: Professor of Okayama University

1. Cardiac surgeons (Individual Member)

2. Cardiac surgery programs (Institutional Member)

3. Medical companies that endorse the objectives of JAYCS (Supporting Member)

4. Others, such as med. students/nurses… (Homepage Member)

Membership

Individual Member : young cardiac surgeons ≦ postgraduate year 15 advisors > postgraduate year 16

Total number of JAYCS members

222Members

Start:Oct 282008

Structure of JAYCS

Total: 222 members

Work in 136 hospitals including 25 abroad Graduated from 56 medical schools Belong to 43 programs

Individual: 180 not belong to programs:31(17%) Adviser: 26 Homepage: 13 Institutional: 3

Associate professor Lecturer Lecturer

Assistant professor

Assistant professor

Assistant professor

Assistant professor

Staff Staff Staff Staff Staff

graduate student

graduate student

graduate student

graduate student

Dept. of Cardiac surgery

“A” University program “B” Medical school program

resident resident resident resident

medical student

Chief professorAssociate professor Lecturer Lecturer

Assistant professor

Assistant professor

Assistant professor

Assistant professor

Staff Staff Staff Staff Staff

graduate student

graduate student

graduate student

graduate student

Dept. of Cardiac surgery

resident resident resident resident

medical student

Programs

director

director

director

director

Associate professor

Chief professor

practice, research, education

Postgraduate year

Years

Members Specialty

99

33

48

JAYCS individual members ( 15yrs)≦

JAYCS activities

1. Annual Seminar

2. Biannual symposium

3. Frequent informal meetings

Routine Activities of JAYCS

• JAYCS homepage: 33000 hits

Provide information about International fellowship Meetings and seminars Review of textbooks 2009 Chief surgeon questionnaire

• Ongoing Projects

1. JAYCS textbook of the cardiac surgery 2. Discussion Forum in JAYCS homepage 3. Cannulation technique hands-on seminar 4. Globalization of cardiac surgery 5. 2010 Young surgeon questionnaire

JAYCS Search

Click!

• We have waited for a suitable opportunity. Now, our main interest is to improve Japanese training system for young cardiac surgeons.

• To create better future of cardiac surgery, we have to

“Reconstruct the training system in Japan”.

• At first, to make many people pay attention to the issue, JAYCS will pull a trigger on the meetings in this summer and winter.

Comments

How to create a nationwide program regulation system?

Cardiac surgery in Japan

1. Adult cardiac surgery

2. Congenital cardiac surgery

3. For all Japanese cardiac surgeons

1. Adult cardiac surgery

2. Congenital cardiac surgery

3. For all Japanese cardiac surgeons

Japan Adult Cardiovascular Surgery Database

Risk-adjusted Mortality, Items equivalent to STS Database

Since 1999

・ Good outcome of Aortic surgery

4707 records were analyzed from 97 hospitals (between January 1, 2000, and December 31, 2005).Raw 30-day and 30-day operative mortality rates were 6.7% and 8.6%, respectively.Conclusion: ,,,,,,,,the result of this series was excellent. (Circulation. 2008;118[suppl 1]:S153–S159.)

European Journal of Cardio-thoracic Surgery 36 (2009) 517—523

・ Good outcome of Off-pump CABG

Gen Thorac Cardiovasc Surg (2009) 57:488–513

OPCAB (10,979 cases): •63.4% of the total isolated CABG(17,295 cases) •Primary elective, 30-day mortality 0.7%•Primary emergency, 30-day mortality 4.1%•Redo, emergency, 30-day mortality 4.8%

J Thorac Cardiovasc Surg 2004;127:1151-7

Ann Thorac Surg 2004;78:1304 –11

・ A new device must be introduced over a long time

It takes much time to be approved by The Ministry of Health, Labor and Welfare

For example,

Commercially available Stent –Graft

1998 Europe

2000 USA

2007 Japan

TAG: Gore & Associates, Inc.

1. Adult cardiac surgery

2. Congenital cardiac surgery

3. For all Japanese cardiac surgeons

・ Good outcome of RVOT reconstruction / repair 　 with ePTFE conduit　 with monocuspid patch

Gen Thorac Cardiovasc Surg (2009) 57:488–513

30-day mortality 0.2%

RVOTR (337 cases, Neonate 5, Infant 105, 1-17 years 227):

Ann Thorac Surg 2000;70:1511– 4

no perioperative death

good motion of all cusps

no or trivial pulmonary regurgitation

J Thorac Cardiovasc Surg 2007;134:327-32*no mortality, no morbidity *no patients required reoperation during follow-up.

*Valve motion was fully maintained in all patients.

1. Adult cardiac surgery

2. Congenital cardiac surgery

3. For all Japanese cardiac surgeons

Homograft is difficult to obtain.

Japanese Society of Tissue Transplantation since 2001.10.27

West Japan Tissue Transplant NetworkWJTTN

East Japan Tissue Transplant NetworkEJTTN

Cardiac valve and vascular bank

Cardiac valve and vascular bank

Pancreatic islet bank Pancreatic islet bank

Bone bank Bone bank

Skin bank

Japanese Society of Tissue Transplantation since 2001.10.27

West Japan Tissue Transplant NetworkWJTTN

East Japan Tissue Transplant NetworkEJTTN

Cardiac valve and vascular bank

Cardiac valve and vascular bank

Pancreatic islet bank Pancreatic islet bank

Bone bank Bone bank

Skin bank

donor recipient

donor

recipient

Postoperative care in ICU or CCU is mainly the task of cardiac surgeons.

Intensivists for post cardiac surgery are definitely rare.

Advantage?

Disadvantage?

Let’s do our Best for our Patients.Let’s do our Best for our Patients.

Let’s Challenge Together !!!Let’s Challenge Together !!!

Thank you for your attention!

Danke schon!..