Abstract 2674: The Risk Model of Thoracic Aortic Surgery in 4707 Cases from Single Race Nationwide Population, via Web-based Data Entry System: a First Report of 30-day and Operative Outcome Risk Model on Thoracic Aortic Surgery.
Objective: Thoracic aortic surgery is still one of the most challenging area in cardiovascular surgery field. Objective of this study is to collect the integrated data from nationwide hospitals using web-based national database and to build up our own risk model for thoracic aortic surgery.
Methods: Japan Adult Cardiovascular Surgery Database (JACVSD) was used in this study. JACVSD captures data from 151 units throughout Japan via web-based data entry system. Variables and definition are almost identical to the STS National Database. A part of thoracic aorta (Dissection or not, Acute or Chronic, Stanford type A or B, Range of replacement) was added to the STS National Database. We examined all thoracic aortic surgery procedures between 2000/1/1 and 2005/12/31. Following the data clean-up, 4707 records from 97 hospitals were analyzed.
Results: Mean age was 66.5 and 67.5% was male. Preoperatively, percentage of chronic lung disease was 11.0%, renal failure was 9.2%, reoperation was 7.9%, and rapture or malperfusion was 9.7%. In terms of a range of replacement (including overlapped area), 10.1% was aortic root, 46.6% was ascending aorta, 44.4% was aortic arch, 20.6% was distal arch, 26.9% was descending aorta, and 8.1% was thoracoabdominal aorta. There was 25.5% that required an emergent or salvage procedure and 7.5% required an urgent procedure. Raw 30-day and operative mortality of all 4707 cases was 6.71% and 8.58%, respectively. Percentage of permanent stroke was 6.14%, renal failure with dialysis was 6.69%, and cardiac reoperation was 9.11%. Odds ratio of preoperative variables for operative mortality was as follows; Emergent or Salvage was 3.67, Creatinine>3.0 was 2.97, unexpected CABG was 2.58, left main disease was 2.38, and Rapture or Malperfusion was 2.10. As a performance metric of the risk model, C-index of 30-day and operative mortality was 0.79 and 0.78, respectively.
Conclusion: This is a first report of risk stratification on thoracic aortic surgery using a nationwide multicenter surgical database. While condition of these patients undergoing thoracic aortic surgery was much more serious than other type of procedure like CABG or valve surgery, the result of this series was excellent.