coronary artery surgery results in 2016

The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)

Coronary artery surgery results

In 2016

Coronary artery bypass grafting (CABG), 2016 Total cases : 12,729 Isolated CABG : 8,492 (67%)(previous year:70%)

Concomitant CABG : 4,237 (33%)(previous year:30%) Isolated CABG Initial elective : 7,142 Except initial elective :1,350

Off-pump : 4,424 Off-pump : 695 On-pump : 2,718 On-pump : 655 (Off-pump rate : 62%) (Off-pump rate : 51%) (previous year : 63%) (previous year : 51%)

Changes of off-pump CABG rate（Initial elective CABG）

62%

0

10

20

30

40

50

60

70

80

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

%

year

Initial elective CABG :7,142(100%) On-pump (arrest) :1,706(23.9%) On-pump (beating) :1,012(14.2%) Off-pump (total) :4,424(61.9%) Off-pump (complete) :4,322 On-pump (conversion) : 102 Off-pump complete rate :97.7%

Off to on-pump conversion rate :2.3% (previous year:1.8%)

Mortality of isolated CABG :1.66% (previous year:1.72%) Mortality of initial elective CABG:1.09% (previous year:0.83%) On-pump (arrest) :1.29% On-pump (beating) :1.28% Off-pump (total) :0.97% Off-pump (complete):0.86% (previous year:0.54%) On-pump (conversion):5.88% (previous year:4.40%)

Changes of mortality （Isolated and initial elective CABG）

1.66%

1.09%

0

0.5

1

1.5

2

2.5

3

3.5

4

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

mo

rtal

ity

(%)

year

Isolated CABG

Initial elective CABG

Changes of mortality for procedures（Initial elective CABG）

0

1

2

3

4

5

6

7

8

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

mo

rtal

ity

(%)

year

Off-pump（complete）

On-pump（beating）

On-pump（arrest）

Off to on-pump(conversion)

Mortality according to number of diseased vessels (Initial elective CABG：7,142, mortality:1.09%)

mortality

(%)

1.0

0 25 50 75 100 (%)

1VD

(0%)

2VD

(0.65%)

3VD

(1.20%)

LMT

(0%)

LMT＋2VD

(0.78%)

LMT＋1VD

(0.62%)

LMT＋3VD

(1.56%)

2.0

Mortality according to number of diseased vessels (Except initial elective CABG：1,350, mortality:4.67%)

mortality

(%)

10

5

0 25 50 75 100 (%)

1VD

(7.50%)

2VD

(4.49%) 3VD

(4.17%)

LMT

(5.00%)

LMT＋1VD

(0.00%)

LMT＋2VD

(5.20%)

LMT＋3VD

(5.08%)

mortality

(%)

10

5

0 25 50 75 100 (%)

Off-pump (total)

2.59%

On-pump

(beating)

7.46% On-pump

(arrest)

6.14%

Mortality according to surgical procedures (Except initial elective CABG：1.350, mortality:4.67%)

Graft number according to procedures（Initial elective CABG）

Total

On-pump

(arrest)

On-pump

(beating)

Off to on

(conversion)

Off-pump (complete)

0 25 50 75 100%

average No. (previous year）

3.05

(2.99)

3.17

(3.17)

3.10

(3.01)

3.25

(3.08)

2.99

(2.74)

１２３４≦

４≦

４≦

４≦

４≦

３

３

３

３

２

２

２

２１

１

１

１

graft number

１

２

３

４≦

0 25 50 75 100%

Off-pump

Off to on-pump (conversion) On-pump (beating)

On-pump

(arrest)

Off-pump

Off-pump

Off-pump

On-pump

(arrest)

On-pump

(arrest)

On-pump

(arrest)

57.2%

Procedure according to graft number（Initial elective CABG）

graft number

On-pump (arrest） vs. off-pump (Initial elective CABG）

0 25 50 75 100%

On-pump (arrest)

On-pump (arrest)

On-pump (arrest)

Off-pump

Off-pump

Off-pump

68%

68%

88%

91%

78%

76%

bypass＋

bypass −

RCA

LAD

LCX

Off-pump vs. off to on-pump conversion (Initial elective CABG）

0 25 50 75 100%

RCA(＋) 3,003

LAD(＋) 4,497

LCX(＋) 3,367

RCA(−) 1,421

LAD(−) 93

LCX(−) 1,057

Off-pump

Off to on-pump conversion

2.3%

2.0%

2.5%

2.1%

10.7%

1.6%

Off-pump

Off-pump

Off-pump

Off-pump

Off-pump

Bypass No. conversion

rate

Age distribution according to gender （Initial elective CABG）

2000 1000 1000 0 0

313

780

2094

2212

709

60

123

420

677

330

49≧

60−69

50−59

70−79

≧80

（Age） Male：79.1% Female：20.9%

3000

（case）（case）

Changes of elderly cases（Initial elective CABG）

50.9%

13.5%

0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013 2014 2015 2016

%

year

70 y.o. ≦

80 y.o. ≦

Changes of mortality according age（Initial elective CABG）

0

0.5

1

1.5

2

2.5

3

3.5

2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013 2014 2015 2016

mo

rtal

ity

(%)

year

49 y.o. ≧

50-59 y.o.

60-69 y.o.

70-79 y.o.

80 y.o. ≦

Graft selection （Total graft number of isolated CABG：22,938）

GEA

(3.2%)

RA

(3.8%)

LITA

(35.3%)

RITA

(15.6%)

SVG

(42.1%)

Changes of graft selection

0

5

10

15

20

25

30

35

40

45

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

%

year

LITA

RITA

GEA

RA

SVG

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Off-pump (complete) On-pump（arrest） On-pump（beating） Off to on-pump (coversion)

%

Stroke rate according to procedures（Isolated CABG）

Stroke cases：108

Stroke rate：108/8492(isolated CABG）＝1.27%

1.10% 1.05%

1.96%

3.96%

p:0.0072

p:0.0332

p:0.0071

Results of emergency CABG after PCI complications

Emergency CABG; operation after PCI complications (coronary

occlusion and/or bleeding), within 24 hours

Cases：78

Rate：78／8492(isolated CABG）；0.92%

Death cases：8

Mortality:10.2%

Results

cases death cases mortality(%)

CABG① 21 1 4.76

CABG② 27 3 11.11

CABG③ 16 3 18.75

CABG④ 6 0 0

Other procedures 8 1 12.5

Changes in results of ventricular septal perforation

Total No.：174, death：37 (mortality：21.2%)

0

10

20

30

40

50

60

mo

rtal

ity

(%)

year

Results of ventricular septal perforation (1)

alive

0 50 100 150

Total cases

Bypass（＋）

Bypass（−）

death

37

174(mortality;21.2%)

72 13

102 24

137

78

(mortality;18.0%)

(mortality;23.5%)

(case）

200

59

Results of ventricular septal perforation (2)

0 50 100 150

Patch closure

alive

death

(mortality;22.0%)

18

19

(mortality;22.2%)

(mortality;21.0%)

(case）

Infarction exclusion

50

76

39 11

93 (mortality;18.4%)

Anterior infarction(mortality;19.5%)

Post-inferior infarction(mortality;26.8%)

52 14

Others 7 (mortality;14.2%)

14

15

Others 4 (mortality;75%)

4

1 3

6 1

Patch closure

Infarction exclusion

4

0

10

20

30

40

50

60

70

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

mo

rtal

ity

(%)

Anterior VSP

Post-inferior VSP

Changes in results of ventricular septal perforation

according to region

year

Changes in results of papillary muscle rupture


0

5

10

15

20

25

30

35

40

45

50

mo

rtal

ity

(%)

year

0 10 20 30

Total cases

Bypass（＋）

Bypass（−）

alive

death

32 (mortality:12.5%)

12

20 17

(mortality;8.33%)

(mortality;15.0%)

(case）

4 28

11

3

1

Results of papillary muscle rupture


0

20

40

60

80

100

120

mo

rtal

ity

(%)

year

Changes in results of LV free wall rupture

0 50 100 150

Total cases

Bypass（＋）

Bypass（−）

alive

death


(mortality;54.2%)

(mortality;9.5%)

(case）

38 106

Blowout type 60 (mortality;50.0%) 30 30

12 (mortality;33.3%) 8

48 26 22

Oozing type

Bypass（＋）

Bypass（−）

84 8 76

22 (mortality;9.1%)

6 56 62 (mortality;9.7%)

20

4

2

Results of LV free wall rupture

0

10

20

30

40

50

60

70

80

2009 2010 2011 2012 2013 2014 2015 2016

mo

rtal

ity

(%)

Blowout type

Oozing type

Changes in results of LV free wall rupture

according to rupture type

year

Changes in results of left ventricular aneurysm (LVA)


0

2

4

6

8

10

12

14

16

18

mo

rtal

ity

(%)

year

0 100 200 300

Total cases

Bypass（＋）

Bypass（−）

alive

death

8 (mortality;4.87%)

114

156


(mortality;5.88%)

(case）

51 48

164

Results of left ventriculoplasty and/or aneurysmectomy

5

3

0 100 200

Total cases

death


(case）

12 300

Total

Bypass（＋）

Bypass（＋）

Bypass（−）

Bypass（−）

Total

226（mortality;1.76%) 4 222

200（mortality;2.00%) 271

26（mortality;0%)

26

86（mortlity;9.30%)

78

59（mortality;11.86%)

8

52


26

alive

Mitral valve

plasty

Mitral valve

replacement

50 150 250

7

300

196 4

1

Results of MVR or MVP for ischemic MR

0 50 100 150

Total cases

death


(case）

4

Total

Bypass（＋）

Bypass（＋）

Bypass（−）

Bypass（−）

Total

55（mortality;5.45%) 52

38（mortality;7.89%) 35

17（mortality;0%)

8（mortality;0%)

8

12(mortality;8.33%)


alive

Left ventriculoptasty

＋ Mitral valve plasty

17

11

63

3

1

3

3

1

Results of ischemic MR＋LVA or ischemic cardiomyopathy

Left ventriculoptasty

＋ Mitral valve

replacement

Conclusions (1)

1. The mortality of isolated CABG was 1.66%, that of initial

elective CABG was 1.09%, indicating almost same excellent

results than those of previous year.

2. Of initial elective CABGs, 62% cases underwent off-pump

procedure, showing still high rate. The mortality of off-pump

was 0.86%, which was slightly higher than that of previous

year, indicating still good results.

3. Off to on-pump conversion rate was 2.3%, and the mortality

of those cases was 5.88%, resulting getting worse.

4. The more bypass number, the lower the off-pump rate.

However, of all 4 and/more bypass procedures, 57.2% cases

were done by off-pump CABG.

5. CABG cases is getting older year by year, more than 70

years old patients rate was 50.9%, more than 80 was 13.5%,

showing high rate.

Conclusions (2)

6. Arterial grafts were used in 57.9%n of all grafts, while vein

grafts were used in 42.1%. The frequency of vein graft

usage increased in recent years.

7. The complication rate of central nerve system stroke of all

isolated CABG was 1.27%. This rate of off-pump CABG

showed significantly lower than those of on-pump (beating)

and off to on-pump conversion procedures, resulting

OPCAG can avoid this complication.

8. After PCI complications, emergency operation underwent in

0.92% of all isolated CABG within 24 hours. The mortality of

those cases was 10.2%, showing still high rate.

9. The results of complications for acute and old myocardial

infarction improved than those of previous year. However,

the mortality of post-inferior VSP and blowout type free wall

rupture, were high rate, indicating worse prognosis.

Special survey of intra-operative graft flow measurement for CABG

The Survey Committee of Japanese Association for Coronary Artery Surgery (JACAS)

Question 1 ；Do you know that an intra-operative graft flow measurement fee can

charge as payment for medical services ?

Question 2 ；Do you charge this fee, actually ?

Yes(90.2%)

No(9.8%)

Yes(78.6%)

No(21.4%)

Question 3 ;What kind of equipment do you use for intra-operative graft flow

measurement ?

0

50

100

150

200

250

TTFM TTFM+Echo Echo others

215

26

6 6

Question 4 ；What kind of parameters do you measure for intra-operative graft

flow measurement ?

0

50

100

150

200

250

mean flow PI DF flow waveform

others

236

196

108

202

3

Question 5 ；What kind of parameters do you emphasize for intra-operative

graft flow measurement ?

0

20

40

60

80

100

120

140

160

180

200

mean flow PI DF flow waveform

others

174

140

10

81

3

Question 6 :Do you use any diagnostic image equipment except graft flow

measurement ?

Yes(16.5%)

No(83.5%)

Question 7 :What kind of diagnostic image equipment do you use ?

0

5

10

15

20

25

30

SPY PDE Echo Others

11

26

10

6

Question 8 :How many grafts did you revise to perform CABG due to

abnormal graft flow measurement, in last year ?

Answer; 347

Question 9 :How many grafts did you perform CABG, in last year ?

Answer; 29,008

Revision rate;1.2%

Question 10 :What were the reasons for revision to perform CABG ?

0

20

40

60

80

100

120

Technical error Graft dissection Coronary arterydissection

Bleeding and/orhematoma

Unknouw Others

108

36

14 13

23 15

Question 11(1) :Do you have any standard to revise to perform CABG ?

83

33

23

14

7

0

10

20

30

40

50

60

70

80

90

Graft flow measuement(flow, PI, DF)

Flow wave form Anastomosis shape Diagnostic imaging Doppler flow meter

Question 11(2) :Do you have any standard to revise to perform to CABG ?

(detail of graft flow measurement standard)

0

1

2

3

4

5

6

7

8

9

10

0 < 10 <15 < 20

0

2

4

6

8

10

12

> 4 > 5 > 10

mean flow PI

DF < 60% : 2

(ml/min)

Question 12 :Do you think that an intra-operative flow measurement is useful

to prevent graft failure for CABG?

No(3.6%)

Yes(96.4%)

coronary artery surgery results in 2016

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