Current status of cardiovascular surgery in Japan, 2013 and 2014: a report based on the Japan Cardiovascular Surgery Database 5. Thoracic aortic surgery.

BACKGROUND: Although open aortic repair (OAR) is still considered to be a standard treatment for thoracic aortic diseases, the indications for thoracic endovascular treatment (TEVAR)/hybrid aortic repair (HAR) have expanded in recent years. The purpose of this study was to review the current status of treatment of thoracic aortic diseases in Japan.

METHODS: Data for 2013 and 2014 concerning surgery for diseases of the thoracic/thoracoabdominal aorta were extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality were evaluated in terms of pathologic diagnosis (acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (JS; <5%, 5-10%, 10-15%, ≥15%), and their correlations.

RESULTS: There were 30,271 total cases in this study and the overall operative mortality was 5.9%. Among the three types of treatment, 73.2% of patients underwent OAR (root 98.3%; ascending 97.4%; root to arch 95.5%; arch 81.7%; descending 34.2%; thoracoabdominal 64.4%). While the rate of OAR was negatively correlated with JS for the treatment of the thoracoabdominal region (JS < 5, 80.4%; 5% ≤ JS < 10, 67.6%; 10% ≤ JS < 15, 58.8%; JS ≥ 15, 55.7%), a correlation was not observed in other anatomic regions. The operative mortality associated with OAR was well reflected by JS (JS < 5, 2.1%; 5% ≤ JS < 10, 5.5%; 10% ≤ JS < 15, 10.2%; JS ≥ 15, 20.3%); however, the operative mortality associated with TEVAR/HAR was less than that with JS.

CONCLUSIONS: The distribution of treatment differs depending on the site of disease and is not markedly influenced by JS. It is clear that JS is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than the JS in TEVAR/HAR, and a new risk score for TEVAR/HAR should be established.