Current Status of Cardiovascular Surgery in Japan:Analysis of Data from Japan Cardiovascular Surgery Database in 2015, 2016. 4. Thoracic Aortic Surgery

Hideyuki Shimizu＊1	Norimichi Hirahara2	Noboru Motomura3
Hiroaki Miyata2	Shinichi Takamoto2

（Department of Cardiovascular Surgery, School of Medicine, Keio University1, Tokyo, Japan, Department of Health Policy and Management, School of Medicine, Keio University2, Tokyo, Japan, and Department of Cardiovascular Surgery, Toho University Sakura Medical Center3, Sakura, Japan）

Background:Thoracic and thoracoabdominal aortic diseases are treated using operative procedures like open aortic repair（OAR), thoracic endovascular aortic repair（TEVAR）or even hybrid aortic repair（HAR), a combination of OAR and TEVAR. The surgical approach to aortic repair is evolving over the decades. The purpose of this study was to examine the current trends in treatment. Methods:We extracted the nationwide data of aortic repair procedures performed between 2015 and 2016 from the Japan Cardiovascular Surgery Database（JCVSD). In addition to estimating the number of cases, we also classified the cases based on various criteria such as operative mortality, associated major morbidities（e.g. stroke, spinal cord insufficiency, renal failure), disease pathology（e.g. acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), site of operative repair（e.g. aortic root, ascending aorta, aortic root to arch, aortic arch, descending aorta, thoracoabdominal aorta）and the preferred surgical approach（i.e. OAR, HAR or TEVAR). Results:The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. In comparison to the data in our previous report（also derived from the JCVSD in 2013 and 2014), the total number of cases and numbers of OAR, HAR, and TEVAR have increased by 17.0%, 2.4%, 126.1% and 34.9%, respectively. While the overall stroke rates following aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3% respectively. OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9% and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. Conclusions The number of operated thoracic and thoracoabdominal aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting aortic arch aneurysms.

 

Jpn. J. Cardiovasc. Surg. 48:18-24（2019）

Keywords：the Japan Cardiovascular Surgery Database（JCVSD）;aortic aneurysm;aortic dissection;stroke;paraplegia;renal failure