Hoashi Takaya, Miyata Hiroaki, Murakami Arata, Hirata Yasutaka, Hirose Keiichi, Matsumura Goki, Ichikawa Hajime, Sawa Yoshiki, Takamoto Shinichi
The Japan Cardiovascular Surgery Database Organization, Osaka, Japan
The Japan Cardiovascular Surgery Database Organization, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2015 Aug;21(2):151-6. doi: 10.1093/icvts/ivv109. Epub 2015 Apr 29.
Whereas surgical outcomes of congenital heart surgery have improved during the past two decades, there are still measurable postoperative mortalities in this field. This study is aimed at evaluating the current situation of mortality following congenital heart surgery.
Data on all registered 28 810 patients in The Japan Congenital Cardiovascular Surgery Database (JCCVSD) between 2008 and 2012 were analysed, except for patients with degenerative cardiomyopathy including dilated, restrictive and hypertrophic cardiomyopathy, and pathologically or histologically malignant cardiac tumours. The number of registered cases increased every year, and reached ∼9000 cases in 2012. The median age at surgery was 0.8 years (range, 0-82). More than half of the patients (54%) who underwent surgery were <1 year old, and 6.0% of all patients were over 18 years old (adults). In this study, all mortalities within 90 days after the operation and mortality at discharge beyond 90 days of hospitalization were defined as '90-day and in-hospital mortality'.
The 30-, 90-day and in-hospital mortality rates were 2.3, 3.5 and 4.5%, respectively. The mean and median durations from surgery to death were 61 ± 89 and 28 days (range, 0-717), respectively. Whereas 658 mortalities (51%) occurred within 30 days of surgery, 265 (21%) occurred later than 90 days after surgery. A total of 3630 patients (13%) were hospitalized for more than 90 days after the operation; of those, 3365 patients survived at discharge (93%). Cardiac problems were the most frequent causes of death after the surgery at any point in time, and 7.1 per 1000 patients died at over 30 days after the operation due to solely cardiac.
The investigation of JCCVSD revealed that about a half of mortalities occurred later than 30 days; hence 90-day and in-hospital mortality would be a good discriminator that accurately represented the current situation of mortality after congenital heart surgery. Mortalities long after the operation due to post-cardiotomy heart failure without any other lethal complications were still not rare.
尽管在过去二十年中先天性心脏病手术的治疗效果有所改善，但该领域术后仍存在可测量的死亡率。本研究旨在评估先天性心脏病手术后的死亡现状。
分析了日本先天性心血管手术数据库（JCCVSD）在2008年至2012年间登记的所有28810例患者的数据，但不包括患有退行性心肌病（包括扩张型、限制型和肥厚型心肌病）以及病理或组织学上为恶性心脏肿瘤的患者。登记病例数逐年增加，2012年达到约9000例。手术时的中位年龄为0.8岁（范围为0 - 82岁）。接受手术的患者中超过一半（54%）年龄小于1岁，所有患者的6.0%年龄超过18岁（成人）。在本研究中，术后90天内的所有死亡以及住院90天以上出院时的死亡被定义为“90天及院内死亡率”。
30天、90天和院内死亡率分别为2.3%、3.5%和4.5%。从手术到死亡的平均和中位持续时间分别为61±89天和28天（范围为0 - 717天）。658例死亡（51%）发生在手术后30天内，265例（21%）发生在手术后90天之后。共有3630例患者（13%）术后住院超过90天；其中，3365例患者出院时存活（93%）。心脏问题是手术后任何时间点最常见的死亡原因，每1000例患者中有7.1例在术后30天以上仅因心脏问题死亡。
对JCCVSD的调查显示，约一半的死亡发生在30天之后；因此，90天及院内死亡率是一个很好的区分指标，能准确反映先天性心脏病手术后的死亡现状。心脏切开术后心力衰竭导致的术后长时间死亡且无任何其他致命并发症的情况仍然并不罕见。
