Current Status of Cardiovascular Surgery in Japan:A Report Based on the Japan Cardiovascular Surgery Database in 2017, 2018. 3. Valvular Heart Surgery

Tomonobu Abe＊1	Hiraku Kumamaru2	Kiyoharu Nakano3
Noboru Motomura4	Hiroaki Miyata5	Shinichi Takamoto5

（Division of Cardiovascular Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University1, Maebashi, Japan, Healthcare Quality Assessment, The University of Tokyo2, Tokyo, Japan, Harajuku Rehabilitation Hospital3, Tokyo, Japan, Department of Cardiovascular Surgery, Toho University Sakura Medical Center4, Sakura, Japan, and Department of Health Policy and Management, School of Medicine, Keio University5, Tokyo, Japan）

Objectives:We sought to present data relative to valvular heart surgeries from the Japan Cardiovascular Surgery Database in 2017 and 2018 to show current status and trend in Japan. Methods:We extracted data relative to cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We obtained total number of aortic valve replacement procedures and showed trend for these 6 years from 2013 to 2018. The operative mortality rates were shown for representative valve procedures stratified by age group with the aim of showing a bench mark of Japan. Data regarding minimally invasive procedures and transcatheter aortic valve implantation which the Japan Cardiovascular Surgery Database can provide were also presented. Results:Despite dramatic increase of number of transcatheter aortic valve implantation in 2017 and 2018 compared to in 2015 and 2016, surgical aortic valve replacement also increased from 26,054 to 28,202. Regarding the operative mortality of first time valve procedures, it was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, 8.2% in mitral valve replacement with biological prostheses, and 4.6% with mechanical prostheses. For first time valve procedures with concomitant coronary artery bypass, the operative mortality was 5.2% in aortic valve replacement, 4.9% in mitral valve repair. Regarding prosthetic valve selection, 72.6% of patients had biological prosthesis for aortic valve replacement procedures in their 60’s, showing trend of increasing percentages of biological valve choice. Regarding minimally invasive procedure, 31.8% of first time isolated mitral valve plasty were performed via right thoracotomy. Though patients who underwent surgery via right thoracotomy had better clinical outcomes, it was also apparent that the patients who underwent surgery via right thoracotomy had lower operative risk profile. Aortic clamp time and cardiopulmonary bypass time were longer in the right thoracotomy patients. 6.3% of the patients who had isolated aortic valve replacement underwent surgery via right thoracotomy. The right thoracotomy aortic valve replacement patients had better clinical outcomes and had more percentage of lower risk profile. The overall mortality of transcatheter aortic valve implantation and surgical aortic valve replacement were 1.5% and 1.8%, respectively. Conclusion:We reported data related to heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.

 

Jpn. J. Cardiovasc. Surg. 49:160-168（2020）

Keywords：valvular heart disease;surgery;Japan;transcatheter aortic valve implantation;minimally invasive cardiac surgery