1. Updates on JAYCS activities and Idiosyncrasies of Japanese cardiac surgery 13 th Annual Scientific Meeting for ISMICS, 16 – 19 June, 2010, Berlin, Germany International Fellows Session Mitsuhiro Kawata, MD, PhD,Shin Takabayashi, MD, PhD,Hiroo Takayama, MD, Yasutaka Hirata, MD, PhD,Kazuma Okamoto, MD,Hiroyuki Tsukui, MD, PhD, Naoto Miyagi, MD, PhD,

2. Updates on JAYCS activities

3. Objectives of JAYCS Easy to understand, Our policy is… JAYCS of the young cardiac surgeon, by the young cardiac surgeon, for the young cardiac surgeon. Gettysburg Address by U.S. President Abraham Lincoln

4. 1. Improve the skills and knowledge of young cardiac surgeons 2. Improve the communication and exchange of information among young cardiac surgeons 3. Enhance the communication between young cardiac surgeons and established surgeons through lectures and teachings 4. Establish mutual respect between young cardiac surgeons and established surgeons 5. Contribute to the improvement of cardiac surgery patient care 6. Obtain global perspective of our specialty The goals of JAYCS Regulations of JAYCS; Oct. 28, 2008

5. Executives of JAYCS 1 2 3 4 5 1. One Representative Director Shin Takabayashi 2. Two Accounting Auditors Hiroo Takayama Naoto Miyagi 3. Up to 15 Directors from nationwide (5 regions) 4. Two Consultants Shinichi Takamoto: President of the JSCVS Shunji Sano: Professor of Okayama University

6. 1. Cardiac surgeons (Individual Member) 2. Cardiac surgery programs (Institutional Member) 3. Medical companies that endorse the objectives of JAYCS (Supporting Member) 4. Others, such as med. students/nurses… (Homepage Member) Membership Individual Member : young cardiac surgeons ≦ postgraduate year 15 advisors > postgraduate year 16

7. Total number of JAYCS members 222 Members Start: Oct 28 2008

8. Structure of JAYCS Total: 222 members Work in 136 hospitals including 25 abroad Graduated from 56 medical schools Belong to 43 programs Individual: 180 not belong to programs:31(17%) Adviser: 26 Homepage: 13 Institutional: 3

9. Associate professor Lecturer Assistant professor Assistant professor Assistant professor Assistant professor Staff graduate student graduate student graduate student graduate student Dept. of Cardiac surgery “A” University program“B” Medical school program resident medical student Chief professor Associate professor Lecturer Assistant professor Assistant professor Assistant professor Assistant professor Staff graduate student graduate student graduate student graduate student Dept. of Cardiac surgery resident medical student Programs director Associate professor Chief professor practice, research, education

10. Postgraduate year Years Members Specialty 99 33 48 JAYCS individual members ( ≦ 15yrs)

11. JAYCS activities

12. 1. Annual Seminar 2. Biannual symposium 3. Frequent informal meetings Routine Activities of JAYCS

13. JAYCS homepage: 33000 hits Provide information about International fellowship Meetings and seminars Review of textbooks 2009 Chief surgeon questionnaire Ongoing Projects 1. JAYCS textbook of the cardiac surgery 2. Discussion Forum in JAYCS homepage 3. Cannulation technique hands-on seminar 4. Globalization of cardiac surgery 5. 2010 Young surgeon questionnaire JAYCSSearch Click!

14. We have waited for a suitable opportunity. Now, our main interest is to improve Japanese training system for young cardiac surgeons. To create better future of cardiac surgery, we have to “Reconstruct the training system in Japan”. At first, to make many people pay attention to the issue, JAYCS will pull a trigger on the meetings in this summer and winter. Comments How to create a nationwide program regulation system?

15. Cardiac surgery in Japan

16. 1. Adult cardiac surgery 2. Congenital cardiac surgery 3. For all Japanese cardiac surgeons

17. 1. Adult cardiac surgery 2. Congenital cardiac surgery 3. For all Japanese cardiac surgeons

18. Japan Adult Cardiovascular Surgery Database Risk-adjusted Mortality, Items equivalent to STS Database Since 1999

19. ・ Good outcome of Aortic surgery 4707 records were analyzed from 97 hospitals (between January 1, 2000, and December 31, 2005). Raw 30-day and 30-day operative mortality rates were 6.7% and 8.6%, respectively. Conclusion:,,,,,,,,the result of this series was excellent. (Circulation. 2008;118[suppl 1]:S153–S159.)

20. European Journal of Cardio-thoracic Surgery 36 (2009) 517—523

21. ・ Good outcome of Off-pump CABG Gen Thorac Cardiovasc Surg (2009) 57:488–513 OPCAB (10,979 cases): 63.4% of the total isolated CABG(17,295 cases) Primary elective, 30-day mortality 0.7% Primary emergency, 30-day mortality 4.1% Redo, emergency, 30-day mortality 4.8%

22. J Thorac Cardiovasc Surg 2004;127:1151-7 Ann Thorac Surg 2004;78:1304 –11

23. ・ A new device must be introduced over a long time It takes much time to be approved by The Ministry of Health, Labor and Welfare For example, Commercially available Stent –Graft 1998 Europe 2000 USA 2007 Japan TAG: Gore & Associates, Inc.

24. 1. Adult cardiac surgery 2. Congenital cardiac surgery 3. For all Japanese cardiac surgeons

25. ・ Good outcome of RVOT reconstruction / repair with ePTFE conduit with monocuspid patch Gen Thorac Cardiovasc Surg (2009) 57:488–513 30-day mortality 0.2% RVOTR (337 cases, Neonate 5, Infant 105, 1-17 years 227 ):

26. Ann Thorac Surg 2000;70:1511– 4 no perioperative death good motion of all cusps no or trivial pulmonary regurgitation

27. J Thorac Cardiovasc Surg 2007;134:327-32 *no mortality, no morbidity*no patients required reoperation during follow-up. *Valve motion was fully maintained in all patients.

28. 1. Adult cardiac surgery 2. Congenital cardiac surgery 3. For all Japanese cardiac surgeons

29. Homograft is difficult to obtain.

30. Japanese Society of Tissue Transplantation since 2001.10.27 West Japan Tissue Transplant Network WJTTN East Japan Tissue Transplant Network EJTTN Cardiac valve and vascular bank Cardiac valve and vascular bank Pancreatic islet bank Bone bank Skin bank

31. Japanese Society of Tissue Transplantation since 2001.10.27 West Japan Tissue Transplant Network WJTTN East Japan Tissue Transplant Network EJTTN Cardiac valve and vascular bank Cardiac valve and vascular bank Pancreatic islet bank Bone bank Skin bank

32. donorrecipient donor recipient

33. Postoperative care in ICU or CCU is mainly the task of cardiac surgeons. Intensivists for post cardiac surgery are definitely rare. Advantage? Disadvantage?

34. Let’s do our Best for our Patients. Let’s Challenge Together !!!

35. Thank you for your attention! Danke schon!..