Coronary artery surgery results In 2016
48
The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS) Coronary artery surgery results In 2016
Transcript of Coronary artery surgery results In 2016
The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)
Coronary artery surgery results
In 2016
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%)
Changes of off-pump CABG rate（Initial elective CABG）
62%
0
10
20
30
40
50
60
70
80
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
%
year
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%)
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%)
Changes of mortality （Isolated and initial elective CABG）
1.66%
1.09%
0
0.5
1
1.5
2
2.5
3
3.5
4
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
mo
rtal
ity
(%)
year
Isolated CABG
Initial elective CABG
Changes of mortality for procedures（Initial elective CABG）
0
1
2
3
4
5
6
7
8
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
mo
rtal
ity
(%)
year
Off-pump（complete）
On-pump（beating）
On-pump（arrest）
Off to on-pump(conversion)
Mortality according to number of diseased vessels (Initial elective CABG：7,142, mortality:1.09%)
mortality
(%)
1.0
0 25 50 75 100 (%)
1VD
(0%)
2VD
(0.65%)
3VD
(1.20%)
LMT
(0%)
LMT＋2VD
(0.78%)
LMT＋1VD
(0.62%)
LMT＋3VD
(1.56%)
2.0
Mortality according to number of diseased vessels (Except initial elective CABG：1,350, mortality:4.67%)
mortality
(%)
10
5
0 25 50 75 100 (%)
1VD
(7.50%)
2VD
(4.49%) 3VD
(4.17%)
LMT
(5.00%)
LMT＋1VD
(0.00%)
LMT＋2VD
(5.20%)
LMT＋3VD
(5.08%)
mortality
(%)
10
5
0 25 50 75 100 (%)
Off-pump (total)
2.59%
On-pump
(beating)
7.46% On-pump
(arrest)
6.14%
Mortality according to surgical procedures (Except initial elective CABG：1.350, mortality:4.67%)
Graft number according to procedures（Initial elective CABG）
Total
On-pump
(arrest)
On-pump
(beating)
Off to on
(conversion)
Off-pump (complete)
0 25 50 75 100%
average No. (previous year）
3.05
(2.99)
3.17
(3.17)
3.10
(3.01)
3.25
(3.08)
2.99
(2.74)
１ ２ ３ ４≦
４≦
４≦
４≦
４≦
３
３
３
３
２
２
２
２ １
１
１
１
graft number
１
２
３
４≦
0 25 50 75 100%
Off-pump
Off to on-pump (conversion) On-pump (beating)
On-pump
(arrest)
Off-pump
Off-pump
Off-pump
On-pump
(arrest)
On-pump
(arrest)
On-pump
(arrest)
57.2%
Procedure according to graft number（Initial elective CABG）
graft number
On-pump (arrest） vs. off-pump (Initial elective CABG）
0 25 50 75 100%
On-pump (arrest)
On-pump (arrest)
On-pump (arrest)
Off-pump
Off-pump
Off-pump
68%
68%
88%
91%
78%
76%
bypass＋
bypass −
RCA
LAD
LCX
Off-pump vs. off to on-pump conversion (Initial elective CABG）
0 25 50 75 100%
RCA(＋) 3,003
LAD(＋) 4,497
LCX(＋) 3,367
RCA(−) 1,421
LAD(−) 93
LCX(−) 1,057
Off-pump
Off to on-pump conversion
2.3%
2.0%
2.5%
2.1%
10.7%
1.6%
Off-pump
Off-pump
Off-pump
Off-pump
Off-pump
Bypass No. conversion
rate
Age distribution according to gender （Initial elective CABG）
2000 1000 1000 0 0
313
780
2094
2212
709
60
123
420
677
330
49≧
60−69
50−59
70−79
≧80
（Age） Male：79.1% Female：20.9%
3000
（case） （case）
Changes of elderly cases（Initial elective CABG）
50.9%
13.5%
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013 2014 2015 2016
%
year
70 y.o. ≦
80 y.o. ≦
Changes of mortality according age（Initial elective CABG）
0
0.5
1
1.5
2
2.5
3
3.5
2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013 2014 2015 2016
mo
rtal
ity
(%)
year
49 y.o. ≧
50-59 y.o.
60-69 y.o.
70-79 y.o.
80 y.o. ≦
Graft selection （Total graft number of isolated CABG：22,938）
GEA
(3.2%)
RA
(3.8%)
LITA
(35.3%)
RITA
(15.6%)
SVG
(42.1%)
Changes of graft selection
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
%
year
LITA
RITA
GEA
RA
SVG
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Off-pump (complete) On-pump（arrest） On-pump（beating） Off to on-pump (coversion)
%
Stroke rate according to procedures（Isolated CABG）
Stroke cases：108
Stroke rate：108/8492(isolated CABG）＝1.27%
1.10% 1.05%
1.96%
3.96%
p:0.0072
p:0.0332
p:0.0071
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(%)
CABG① 21 1 4.76
CABG② 27 3 11.11
CABG③ 16 3 18.75
CABG④ 6 0 0
Other procedures 8 1 12.5
Changes in results of ventricular septal perforation
Total No.：174, death：37 (mortality：21.2%)
0
10
20
30
40
50
60
mo
rtal
ity
(%)
year
Results of ventricular septal perforation (1)
alive
0 50 100 150
Total cases
Bypass（＋）
Bypass（−）
death
37
174(mortality;21.2%)
72 13
102 24
137
78
(mortality;18.0%)
(mortality;23.5%)
(case）
200
59
Results of ventricular septal perforation (2)
0 50 100 150
Patch closure
alive
death
(mortality;22.0%)
18
19
(mortality;22.2%)
(mortality;21.0%)
(case）
Infarction exclusion
50
76
39 11
93 (mortality;18.4%)
Anterior infarction(mortality;19.5%)
Post-inferior infarction(mortality;26.8%)
52 14
Others 7 (mortality;14.2%)
14
15
Others 4 (mortality;75%)
4
1 3
6 1
Patch closure
Infarction exclusion
4
0
10
20
30
40
50
60
70
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
mo
rtal
ity
(%)
Anterior VSP
Post-inferior VSP
Changes in results of ventricular septal perforation
according to region
year
Changes in results of papillary muscle rupture
Total No.：32, death：4 (mortality：12.5%)
0
5
10
15
20
25
30
35
40
45
50
mo
rtal
ity
(%)
year
0 10 20 30
Total cases
Bypass（＋）
Bypass（−）
alive
death
32 (mortality:12.5%)
12
20 17
(mortality;8.33%)
(mortality;15.0%)
(case）
4 28
11
3
1
Results of papillary muscle rupture
Total No.：144, death：38 (mortality：26.4%)
0
20
40
60
80
100
120
mo
rtal
ity
(%)
year
Changes in results of LV free wall rupture
0 50 100 150
Total cases
Bypass（＋）
Bypass（−）
alive
death
144 (mortality;26.4%)
(mortality;54.2%)
(mortality;9.5%)
(case）
38 106
Blowout type 60 (mortality;50.0%) 30 30
12 (mortality;33.3%) 8
48 26 22
Oozing type
Bypass（＋）
Bypass（−）
84 8 76
22 (mortality;9.1%)
6 56 62 (mortality;9.7%)
20
4
2
Results of LV free wall rupture
0
10
20
30
40
50
60
70
80
2009 2010 2011 2012 2013 2014 2015 2016
mo
rtal
ity
(%)
Blowout type
Oozing type
Changes in results of LV free wall rupture
according to rupture type
year
Changes in results of left ventricular aneurysm (LVA)
Total No.：164, death：8 (mortality：4.87%)
0
2
4
6
8
10
12
14
16
18
mo
rtal
ity
(%)
year
0 100 200 300
Total cases
Bypass（＋）
Bypass（−）
alive
death
8 (mortality;4.87%)
114
156
109 (mortality;4.38%)
(mortality;5.88%)
(case）
51 48
164
Results of left ventriculoplasty and/or aneurysmectomy
5
3
0 100 200
Total cases
death
312 (mortality;3.84%)
(case）
12 300
Total
Bypass（＋）
Bypass（＋）
Bypass（−）
Bypass（−）
Total
226（mortality;1.76%) 4 222
200（mortality;2.00%) 271
26（mortality;0%)
26
86（mortlity;9.30%)
78
59（mortality;11.86%)
8
52
27（mortality;3.70%)
26
alive
Mitral valve
plasty
Mitral valve
replacement
50 150 250
7
300
196 4
1
Results of MVR or MVP for ischemic MR
0 50 100 150
Total cases
death
67 (mortality;5.97%)
(case）
4
Total
Bypass（＋）
Bypass（＋）
Bypass（−）
Bypass（−）
Total
55（mortality;5.45%) 52
38（mortality;7.89%) 35
17（mortality;0%)
8（mortality;0%)
8
12(mortality;8.33%)
4（mortality;25.0%)
alive
Left ventriculoptasty
＋ Mitral valve plasty
17
11
63
3
1
3
3
1
Results of ischemic MR＋LVA or ischemic cardiomyopathy
Left ventriculoptasty
＋ Mitral valve
replacement
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.
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.
Special survey of intra-operative graft flow measurement for CABG
The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)
Question 1 ；Do you know that an intra-operative graft flow measurement fee can
charge as payment for medical services ?
Question 2 ；Do you charge this fee, actually ?
Yes(90.2%)
No(9.8%)
Yes(78.6%)
No(21.4%)
Question 3 ;What kind of equipment do you use for intra-operative graft flow
measurement ?
0
50
100
150
200
250
TTFM TTFM+Echo Echo others
215
26
6 6
Question 4 ；What kind of parameters do you measure for intra-operative graft
flow measurement ?
0
50
100
150
200
250
mean flow PI DF flow waveform
others
236
196
108
202
3
Question 5 ；What kind of parameters do you emphasize for intra-operative
graft flow measurement ?
0
20
40
60
80
100
120
140
160
180
200
mean flow PI DF flow waveform
others
174
140
10
81
3
Question 6 :Do you use any diagnostic image equipment except graft flow
measurement ?
Yes(16.5%)
No(83.5%)
Question 7 :What kind of diagnostic image equipment do you use ?
0
5
10
15
20
25
30
SPY PDE Echo Others
11
26
10
6
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%
Question 10 :What were the reasons for revision to perform CABG ?
0
20
40
60
80
100
120
Technical error Graft dissection Coronary arterydissection
Bleeding and/orhematoma
Unknouw Others
108
36
14 13
23 15
Question 11(1) :Do you have any standard to revise to perform CABG ?
83
33
23
14
7
0
10
20
30
40
50
60
70
80
90
Graft flow measuement(flow, PI, DF)
Flow wave form Anastomosis shape Diagnostic imaging Doppler flow meter
Question 11(2) :Do you have any standard to revise to perform to CABG ?
(detail of graft flow measurement standard)
0
1
2
3
4
5
6
7
8
9
10
0 < 10 <15 < 20
0
2
4
6
8
10
12
> 4 > 5 > 10
mean flow PI
DF < 60% : 2
(ml/min)
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%)
