日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: Re-interventions must be avoided after surgical correction of the right ventricular outflow tract (RVOT) and/or pulmonary artery (PA). This study aimed to examine the status focusing the surgical material used and to estimate the economic impact of re-interventions.

Methods: The Japanese Society of Pediatric Cardiology and Cardiac Surgery (JSPCC) performed a web-based survey. This study calculated the actual medical costs of the re-interventions performed at Osaka Medical and Pharmaceutical University Hospital.

Results: Responses were collected from 31/49 (63.3％) core hospitals in Japan. This study revealed 2,520 relevant RVOT/PA surgeries and 500 re-interventions, 238 (47.6％) re-operations, and 262 (52.4％) catheter interventions in the last 3 years. Surgical materials included autologous pericardium (n＝272, 54.5％), polytetrafluoroethylene (n＝179, 35.8％), and glutaraldehyde-treated bovine pericardium (n＝49, 9.8％). Most re-interventions for a failed autologous pericardium were performed relatively early postoperatively. Those for the other two materials occurred throughout the postoperative period, but especially after five years. Degradation, excess intimal proliferation, and inextensibility are the adverse changes in materials. The average medical cost of re-interventions was 6 million yen per case. This yield estimated annual expenses for re-interventions of approximately 900 million yen at the 31 hospitals and approximately 2.7 billion yen at 90 centers nationwide.

Conclusion: The JSPCC questionnaire helped understand the status of re-interventions after RVOT/PA repair using existing surgical materials. The total medical costs for the re-interventions should not be overlooked in the national healthcare system.