Current Status of Cardiovascular Surgery in Japan, 2013 and 2014:A Report based on the Japan Cardiovascular Surgery Database（JCVSD）　

5. Thoracic Aortic Surgery

Hideyuki Shimizu＊1,2	Norimichi Hirahara1,3	Noboru Motomura1,4
Hiroaki Miyata1,3	Shinichi Takamoto1,5

（the Japan Cardiovascular Surgery Database, the Japanese Society for Cardiovascular Surgery1, Tokyo, Japan, Department of Cardiovascular Surgery, Keio University2, Tokyo, Japan, Department of Health Policy and Management, Keio University3, Tokyo, Japan, Department of Cardiovascular Surgery, Toho University Sakura Medical Center4, Chiba, Japan, and Mitsui Memorial Hospital5, Tokyo, Japan）

Background:Although open aortic repair（OAR）is still considered to be a standard treatment for thoracic aortic diseases, recently the indication of thoracic endovascular treatment（TEVAR）/hybrid aortic repair（HAR）is expanding. The purpose of this study is to review the current status of treatment of thoracic aortic diseases. Methods:The data concerning surgery for diseases in thoracic/thoracoabdominal aorta in 2013 and 2014 are extracted from the Japan Cardiovascular Surgery Database（JCVSD). The number of cases and operative mortality are evaluated for pathology（acute dissection, chronic dissection, ruptured aneurysm, un-ruptured aneurysm), treatment modality（OAR, HAR, TEVAR), JapanSCORE（＜5%, 5 to 10%, 10 to 15%, 15%≦）and their combination. Results:The total number of cases included in this study was 30,271 and the overall operative mortality was 5.9%. Among 3 types of treatment, 73.2% of patients underwent OAR（root, 98.3%;ascending, 97.4%;root to arch, 95.5%;arch, 81.7%;descending, 34.2%;thoracoabdominal, 64.4%). Although the rate of OAR was in negative correlation with JapanSCORE（JS）in treatment for thoracoabdominal region（JS＜5%, 80.4%;5%≦JS＜10%, 67.6%;10%≦JS＜15%, 58.8%;15%≦JS, 55.7%), such relation was not observed in other regions. The operative mortality of OAR was well reflected by JS（JS＜5%, 2.1%;5%≦JS＜10%, 5.5%;10%≦JS＜15%, 10.2%;15%≦JS, 20.3%), however, those of TEVAR/HAR was less than the range of JS. Conclusions:The distribution of treatment differs depending on site of diseases and is not much influenced by JS. It has become clear that JapanSCORE is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than JS in TEVAR/HAR and a new risk score for TEVAR/HAR should be established.

 

Jpn. J. Cardiovasc. Surg. 46:205-211（2017）

Keywords：the Japan Cardiovascular Surgery Database（JCVSD）;JapanSCORE;aortic aneurysm;aortic dissection