Coronary artery surgery results 2005 in Japan.

This report is focused on the status and outcome of coronary artery surgery performed in Japan, from January 1 to December 31, 2005. A total of 12,207 cases underwent coronary artery bypass grafting (CABG), as an isolated or concomitant procedure. Isolated CABG was performed in 9,827 patients. The operative mortality for patients who underwent isolated CABG was 1.91% in 2005. The mortality for initial elective CABG was 0.89%. These are the most improved results obtained since annual surveys started over 30 years ago. Since 1996 the number of off-pump CABG (OPCAB) cases increased year after year. This less-invasive procedure was performed on 4,936 patients in 2005, which is 61.0% the of total number of CABG cases. Mortality improved after complete OPCAB to 0.60%, which is the lowest rate since this procedure has been introduced. More than half (50.6%) of 4 and/or more grafting patients underwent OPCAB, which is higher rate than that (49.7%) in 2004. The percentage of elderly patients undergoing coronary artery bypass surgery is rising every year. In 2005, 46.5% of patients were aged 70 years or older and 7.8% were aged 80 years or older. The utilization rate of arterial grafts was 70%.

Successful surgical treatment of rupture of coronary arteriovenous fistula with unconsciousness after chest and back pain.

A 65 year-old woman was admitted to our hospital, because of unconsciousness after chest and back pain. Echocardiography showed pericardial effusion. She suffered from pre-shock due to cardiac tamponade. Although a cause of cardiac tamponade was unclear, we performed emergency surgical treatment without coronary angiography. In operation, we found a rupture of coronary arteriovenous fistula and repaired it. The patient recovered from the surgery uneventfully. Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major vessel. It is the most common congenital anomalies of the coronary arteries. Many patients with these anomalies remain asymptomatic, but some patients develop symptoms of congestive heart failure, infective endocarditis, myocardial ischemia, arrhythmia, or rupture of an aneurismal fistula. Usually, the dilatation of fistula is common, and although 19% of this may become aneurysmal, the rupture of the aneurysm is very rare. We report a case of ruptured coronary arteriovenous fistula who underwent successful emergent surgery.

Coronary artery surgery results 2002 in Japan.

Over the past 30 years, we have reported on status and outcome of coronary artery bypass surgery in Japan. This report is focused on surgery performed last year, from January 1 to December 31, 2002. A total of 13,474 cases underwent coronary artery bypass grafting (CABG) of these, 12,552 underwent CABG only. The operative mortality for patients who underwent CABG only was 2.04% in 2002. Mortality for initial elective CABG was 1.02%. These are the best results obtained since surveys were started. The percentage of elderly patients undergoing coronary artery bypass surgery is rising annually. In 2002, 44.4% of patients were aged 70 years or older and 6.9% were aged 80 years or older. Mortality in elderly patients undergoing initial elective surgery is decreasing, with a mortality of 1.3% for patients aged 70 years or older and 2.0% for patients aged 80 years or older. Since 1996, the number of off-pump CABG (OPCAB) cases remarkably increased annually. This less-invasive procedure was performed on 5,628 patients in 2002, which is 41.8% of the total number of CABG cases.

DeBakey IIIb aortic dissection originating in a distal aortic arch aneurysm.

This report presents a case of DeBakey IIIb aortic dissection originating in a distal aortic arch fusiform aneurysm. The atherosclerotic change of the aneurysm was mild and the letter "C"-shaped intimal flap was turned over to obstruct the true lumen blood flow. A four-branched woven Dacron vascular prosthesis was implanted in a double barrel fashion. Although this case was successfully managed, an emergent operation should have been conducted.

Coronary artery surgery results 2000.

We have reported on changes in the nature and outcome of coronary artery bypass surgery over the past 30 years, focusing on surgery performed last year, from January 1 to December 31, 2000. The operative mortality for patients who underwent only coronary artery bypass surgery was 2.75% in 2000. Mortality for initial elective surgery was 1.73%. These are the best results obtained since surveys were started. The percentage of elderly patients undergoing coronary artery bypass surgery is rising annually. In 2000, 40.8% of patients were aged 70 years or older and 5.3% were aged 80 years or older. Mortality in elderly patients undergoing initial elective surgery is decreasing, with a mortality of 2.5% for patients aged 70 years or older and 2.9% for patients aged 80 years or older. Off-pump coronary artery bypass grafting was performed on 3,356 patients in 2000. Median sternotomy was used in the majority of cases, with 2,988 patients undergoing surgery by this approach. Use of minimally invasive direct coronary artery bypass (MIDCAB) peaked in 1998 but is becoming less common, with only 280 patients undergoing this procedure in 2000.

Experiences of Postcardiotomy Assist: Pneumatic Ventricular Assist Device or Venoarterial Bypass with Percutaneous Cardiopulmonary Support.

From October 1982 to the present, 16 patients have been supported by a pneumatic ventricular assist device (VAD). Since April 1990, we have introduced a venoarterial bypass (VAB) with percutaneous cardiopulmonary support (PCPS) system. This PCPS system was used in 12 patients. The long-term survival rate of PCPS cases (41%) was much better than that of VAD cases (19%). The main cause of death in VAD cases was multiple organ failure (MOF). Although VAB was initiated more recently than VAD, the duration on support was longer in the VAD group than in the VAB group. Because of the longer support duration and the presence of many patients with MOF, coagulopathy deteriorated more readily in the VAD group than in the VAB group. In the case of postcardiotomy cardiopulmonary bypass weaning or low-output syndrome (LOS), the VAB with PCPS system should be applied first under intraaortic balloon pumping assist because of its simplicity and low cost. Thereafter, VAD should be applied in cases refractory to VAB support.