National Clinical Database (NCD) is a multidisciplinary clinical registry platform collecting patient case information throughout Japan in close linkage with the board certification systems for various Japanese professional medical societies. Since its initiation of data collection in 2011, NCD has grown in its size as more national level professional societies joined its activity. Its current case registration volume is above 150 million cases per year. In this commentary, we will introduce four patterns of utilization examples of NCD: 1) data use for the assessment and improvement of healthcare quality in Japan, 2) data use for conducting observational studies to answer physician generated clinical questions, 3) data use for health services research, and 4) Use of the registry platform for industry-government-academia collaboration. We will also go over some of the data quality management and improvement activities at NCD, which they regard as one of the top priority issues in the operation of the institution. These include: defining and designing of the data elements, administrative support from the office staffs, data error checking using the web based registration system, and data audit and validation.

Data on isolated coronary artery bypass grafting (CABG) performed in 2017 and 2018, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 54.6% (n＝14,684) of all CABG cases (n＝26,913), and graft material for the LAD was left internal thoracic artery in 76.4% and right internal thoracic artery in 19.0%. Operative mortality was 1.5% in elective cases (On-pump CABG : ONCAB 1.9%, off-pump CABG : OPCAB 1.2%, p＜0.001), 7.4% in emergency cases (ONCAB 10.2%, OPCAB 4.3%, p＜0.001), and 2.5% overall. Postoperative morbidity was low in almost all aspects in OPCAB, and average JapanSCORE II is elevating every year. Overall short-term operative results for isolated CABG is stable, and operative candidates are shifting to higher-risk patients.

Objectives : We sought to present data relative to valvular heart surgeries from the Japan Cardiovascular Surgery Database in 2017 and 2018 to show current status and trend in Japan. Methods : We extracted data relative to cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We obtained total number of aortic valve replacement procedures and showed trend for these 6 years from 2013 to 2018. The operative mortality rates were shown for representative valve procedures stratified by age group with the aim of showing a bench mark of Japan. Data regarding minimally invasive procedures and transcatheter aortic valve implantation which the Japan Cardiovascular Surgery Database can provide were also presented. Results : Despite dramatic increase of number of transcatheter aortic valve implantation in 2017 and 2018 compared to in 2015 and 2016, surgical aortic valve replacement also increased from 26,054 to 28,202. Regarding the operative mortality of first time valve procedures, it was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, 8.2% in mitral valve replacement with biological prostheses, and 4.6% with mechanical prostheses. For first time valve procedures with concomitant coronary artery bypass, the operative mortality was 5.2% in aortic valve replacement, 4.9% in mitral valve repair. Regarding prosthetic valve selection, 72.6% of patients had biological prosthesis for aortic valve replacement procedures in their 60's, showing trend of increasing percentages of biological valve choice. Regarding minimally invasive procedure, 31.8% of first time isolated mitral valve plasty were performed via right thoracotomy. Though patients who underwent surgery via right thoracotomy had better clinical outcomes, it was also apparent that the patients who underwent surgery via right thoracotomy had lower operative risk profile. Aortic clamp time and cardiopulmonary bypass time were longer in the right thoracotomy patients. 6.3% of the patients who had isolated aortic valve replacement underwent surgery via right thoracotomy. The right thoracotomy aortic valve replacement patients had better clinical outcomes and had more percentage of lower risk profile. The overall mortality of transcatheter aortic valve implantation and surgical aortic valve replacement were 1.5% and 1.8%, respectively. Conclusion : We reported data related to heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.