Thoracic and cardiovascular surgery in Japan during 2004 Annual report by the Japanese Association for Thoracic Surgery
Thoracic and cardiovascular surgery in Japan during 2004 Annual report by the Japanese Association for Thoracic Surgery
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DOI：
10.1007/s11748-006-0008-x
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发表时间：
2006-08-01
影响因子：
1.2
通讯作者：
Fujita, Hiromasa
中科院分区：
文献类型：
--
作者：
Kazui, Teruhisa;Osada, Hiroaki;Fujita, Hiromasa
图1显示了过去19年日本心血管外科的发展情况。动脉瘤手术只包括胸腹主动脉瘤的手术。起搏器及辅助装置植入手术次数不计入手术总次数。仅2004年，539家机构共实施心血管手术52434例，其中2002年开始实施的心脏移植手术5例。与2003年相比，瓣膜性心脏病的手术数量增加了6.7%，胸主动脉瘤的手术数量增加了14.3%。先天性心脏病手术增加了4.1%。相比之下，缺血性心脏病的手术减少了6.5%。表1-7总结了各个类别的数据。在为先天性心脏病进行的7,380例心脏直视手术中，医院死亡率为3.9%，与2003年（3.7%）相似。2 165例姑息手术的住院死亡率为3.2%，比2003年的3.6%有所下降。孤立二尖瓣修复占所有瓣膜性心脏病手术的30.6%（12,626例），与2003年的31.3%相似。瓣膜性心脏病初次手术的住院死亡率为4.1%，而二次手术的住院死亡率为9.3%，虽然略低于2003年11.4%的死亡率，但仍然很高。在19,930例中进行了孤立冠状动脉旁路移植术，总体住院死亡率为2.6%。择期手术的住院死亡率为1.6%。急诊手术的住院死亡率为9.1%，虽然比2003年的12.1%有所下降，但仍然很高。非体外循环冠状动脉旁路移植术（OPCAB）共12018例，占离体冠状动脉旁路移植术总数的60.3%。与2003年相比，OPCAB在孤立冠状动脉搭桥术中所占的比例从55.2%上升到60.3%。共有823例患者因心肌梗死并发症进行了手术，其中450例为左心室动脉瘤或梗死手术。3858例患者接受了夹层动脉瘤手术，住院总死亡率为13.1%。4,299例患者接受了非夹层性动脉瘤手术，住院总死亡率为9.2%。未破裂动脉瘤的住院死亡率为6.2%，破裂动脉瘤的住院死亡率为29.8%，两者仍然较高。然而，与2003年相比，解剖性和非解剖性动脉瘤的手术死亡率有了小幅改善。支架移植手术的数量逐年增加。166例夹层主动脉瘤行支架置入术（血管内支架置入117例，开放式支架置入49例）。医院死亡率为4.2%。440例非夹层性主动脉瘤行支架置入术（血管内支架置入术332例，开放式支架置入术108例）。医院死亡率为7.7%。
Figure 1 shows the development of cardiovascular surgery in Japan over the last 19 years. Aneurysm surgery includes only operations for thoracic or thoracoabdominal aortic aneurysms. The number of pacemaker and assist device implantation operations is not included in the total number of surgical operations. A total of 52,434 cardiovascular operations were performed at 539 institutions during 2004 alone and included 5 cardiac transplantation operations, which were started in 2002. In comparison with 2003, the number of operations for valvular heart disease increased by 6.7%, and that for thoracic aortic aneurysms increased by 14.3%. Surgery for congenital heart disease increased by 4.1%. In contrast, operations for ischemic heart disease decreased by 6.5%. Data for individual categories are summarized in Tables 1–7. For the 7,380 open-heart operations performed for congenital heart disease, the hospital mortality was 3.9%, similar to that in 2003 (3.7%). The hospital mortality for 2,165 palliative operations was 3.2%, decreasing from the 3.6% hospital mortality for this category in 2003. Isolated mitral valve repair constituted 30.6% of all valvular heart disease operations (12,626), similar to that in 2003 (31.3%). The hospital mortality for primary operations for valvular heart disease was 4.1%, whereas the hospital mortality for redo operations was 9.3%, which although somewhat lower than the 11.4% mortality in 2003 was still high. Isolated coronary artery bypass grafting was performed in 19,930 cases, with an overall hospital mortality of 2.6%. The hospital mortality associated with elective surgery was1.6%. The hospital mortality of emergency operations was 9.1%, which had decreased from the 12.1% mortality in 2003 but was still high. Off-pump coronary bypass grafting (OPCAB) was performed in 12,018 cases, which constituted 60.3% of the total number of isolated coronary bypass grafts. In comparison with 2003, the percentage of OPCAB among the total isolated coronary bypass graft cases increased from 55.2% to 60.3%. A total of 823 patients had surgery for complications of myocardial infarction, including 450 operations for a left ventricular aneurysm or infarction. Operations for a dissecting aneurysm were performed in 3,858 patients with an overall hospital mortality of 13.1%. Operations for nondissecting aneurysm were carried out in 4,299 patients, with an overall hospital mortality of 9.2%. The hospital mortality for unruptured aneurysms was 6.2%, and that for ruptured aneurysms was 29.8%, which remained high. A small improvement, however, was noted in the operative mortality for dissecting and nondissecting aneurysms compared to that in 2003. The number of stent-graft procedures has increased year by year. A total of 166 patients with dissecting aortic aneurysms underwent stent-graft placement (endovascular stent-rafting 117 cases; open stent-grafting 49 cases). The hospital mortality rate was 4.2%. A total of 440 patients with nondissecting aortic aneurysms underwent stent-graft placement (endovascular stent-grafting 332 cases; open stent-grafting 108 cases). The hospital mortality rate was 7.7%.