Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Coronary Artery Surgery Results2003

Coronary Artery Surgery Results2003

The Japanese Association for Coronary Artery Surgery

Yukiyasu Sezai

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

00 2020 100%100%4040 6060 8080

Initial SurgeryInitial Surgery Re-do SurgeryRe-do Surgeryelective1.20%elective1.20%

emergency7.36%emergency7.36%

elective3.82%elective3.82%emergency13.85%emergency13.85%

1010

MortalityMortality%%

00

Outcome according to urgency and times of surgery(Isolated CABG in 2003 : 14,947 cases)

Operative mortality : 2.14%

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

%%

-'80-'80 '81-'85'81-'85 '86-'90'86-'90 '91-'95'91-'9500

2020

4040

6060

8080

100100

'96-'00'96-'00singlesingle

doubledouble

tripletriple

≥quad-ruple

≥quad-ruple

'01'01 '02'02 '03'03

Changes in number of grafts in CABG(mean number of grafts : 2.72)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

00 2020 100%100%4040 6060 8080

22

MortalityMortality

%%

00

11 1VD(0.52%)

1VD(0.52%)

2VD(0.82%)

2VD(0.82%)

3VD(1.32%)

3VD(1.32%)

LMT+1VD(1.43%)

LMT+1VD(1.43%)

LMT+2VD(1.22%)

LMT+2VD(1.22%)

LMT+3VD(1.90%)

LMT+3VD(1.90%)

LMT only(0.89%)

LMT only(0.89%)

Outcome according to number of diseased vessels(12,505 initial elective surgery : 1.20%)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

00 2020 100%100%4040 6060 8080

1010

MortalityMortality

%%

00

55

1VD(6.43%)

1VD(6.43%) 2VD

(7.64%)

2VD(7.64%)

3VD(7.31%)

3VD(7.31%)

LMT+1VD(7.87%)

LMT+1VD(7.87%) LMT+2VD

(7.66%)

LMT+2VD(7.66%) LMT+3VD

(7.28%)

LMT+3VD(7.28%)

LMT only(7.14%)

LMT only(7.14%)

Outcome according to number of diseased vessels(1,984 initial emergency surgery : 7.36%)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

4040 6060 80805050 7070 yearsyears

%%

2020

1010

3030

4040

00

'97 - '00'97 - '00

'01'01

'02'02

'03'03

3030

Age distribution (total number)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Age distribution according to gender (total number)

male : 75.6% female : 24.4%

50

60

70

80

40

0 1,0001,0002,0003,000 04,000

mortality : 1.72% motality : 2.79%

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

male : 76.4% female : 23.6%

50

60

70

80

40

0 1,0001,0002,0003,000 04,000

mortality : 0.88% motality : 1.58%

Age distribution according to gender (initial elective surgery)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

'97 - '00'97 - '00

'01 '01

'02 '02

55

MortalityMortality

00

%%

4040 6060 80805050 7070 yearsyears3030

'03 '03

Mortality according to age (initial elective surgery)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

'97 - '00'97 - '00

'01 '01

'02 '02

55

MortalityMortality

00

%%

4040 6060 80805050 7070 yearsyears3030

'03 '03

Mortality according to age (total number)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

'96'96 '98'98 '00'00 '01'0100

33

MortalityMortality%%

initial elective CABGinitial elective CABG

total CABGtotal CABG

'02'02'97'97 '99'99

11

22

44

'03'03

Changes in mortality of CABG

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

'96'96

'97'97

'98'98

'99'99

'00'00

'01'01

'02'02

'03'03

50%50%Off-pumpOff-pump On-pumpOn-pump

Off-pump CABG

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

00

01-20

21-40

41-60

61-80

81-100

101-

The number of OPCAB in respective institutions (2003)

159159159159

19191919

66666666

27272727

19191919

3333 9999The number of OPCAB

(case)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

1VD1VD

2VD2VD

3VD3VD

LMT onlyLMT only

LMT+1VDLMT+1VD

LMT+2VDLMT+2VD

LMT+3VDLMT+3VD

50%50%Off-pumpOff-pump On-pumpOn-pump

TotalTotal

Off-pump CABG according to number of diseased vessels(7,030 initial elective OPCAB)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

singlesingle

doubledouble

tripletriple

≥quadruple≥quadruple

00 1,0001,000500500 2,0002,0001,5001,500

The number of grafts (initial elective surgery)

meanmean off pump : 2.55off pump : 2.55 on pump : 3.02on pump : 3.02

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

1VD1VD 2VD2VD LMTonly

LMTonly

3VD3VD LMT+ 1VDLMT+ 1VD

LMT+ 2VDLMT+ 2VD

LMT+ 3VDLMT+ 3VD

33

00

%%MortalityMortality

22

11

TotalTotal

Operative mortality by number of diseased vessels(initial elective surgery)

Off pump (0.81%)

On pump (1.70%)

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Relationship between (pre)operative factors and mortality(initial elective surgery)

(Pre)operative factors mortality(%) p

LMT(-) vs LMT(+) 1.08 vs 1.54 0.037

male vs female 0.88 vs 1.58 0.0012

<70yovs ≥70yo 0.79 vs 1.37 0.0014

off pump vs on pump 0.81 vs 1.70 0.000006

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

-'80-'80 '81-'85'81-'85 '86-'90'86-'90 '91-'95'91-'9500

55

1010

1515

2020%%

'96-'00'96-'00

MortalityMortality

'03'03

Survival 239Survival 239Survival 239Survival 239

Death 9Death 9

Changes in mortality for left ventricular aneurysm

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Changes in mortality for ventricular septal perforation

-'80-'80 '81-'85'81-'85 '86-'90'86-'90 '91-'95'91-'9500

1010

2020

%%

'96-'00'96-'00

MortalityMortality

3030

4040

5050

'03'03

Survival 128Survival 128Survival 128Survival 128

Death 35Death 35

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

-'80-'80 '81-'85'81-'85 '86-'90'86-'90 '91-'95'91-'9500

1010

2020

%%

'96-'00'96-'00

MortalityMortality

3030

4040

5050

'03'03

Changes in mortality for left ventricular papillary muscle rupture

Survival 34Survival 34Survival 34Survival 34

Death 12Death 12

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Changes in mortality for cardiac rupture

-'80-'80 '81-'85'81-'85 '86-'90'86-'90 '91-'95'91-'9500

2020

4040

%%

'96-'00'96-'00

MortalityMortality

6060

8080

100100

'03'03

Survival 73Survival 73Survival 73Survival 73

Death 35Death 35

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Total CABG : 14,947

Isolated CABG : 12,505

Off Pump CABG : 7,853

Off Pump : On Pump = 52.5 : 47.5

Conclusions 1

Coronary Artery Surgery 2003Coronary Artery Surgery 2003

Mortality of initial elective surgery : 1.20%

Off pump CABG(56.2%)mortality:0.57%

On pump CABG (43.8%)mortality: 1.70%

Conclusions 2

Coronary Artery Surgery 2003Coronary Artery Surgery 2003