心脏瓣膜外科PPT参考幻灯片.ppt

心脏瓣膜外科-AmericanAssociationforThoracicSurgery86thAnnualMeetingApril29May3,2006Philadelphia,Pennsylvania,第二军医大学长海医院胸心外科上海市成人心血管临床医学中心中国人民解放军心胸外科研究所徐志云,ManagementofComplexAorticStenosis-RoleoftheApex-to-AorticConduit.,JohnW.Brown,etal.IndianaUniversity,主动脉瓣置换术严重主动脉瓣钙化高龄升主动脉严重钙化（EggShell）既往心脏手术后胸骨感染CABG术后多根桥血管仍然通畅无法行球囊扩张或介入性主动脉瓣置换外科手术行AVR风险性极高,心尖降主动脉带瓣管道旁路,45例高龄严重主动脉瓣狭窄且有上述高危因素左胸后外侧切口，显露心尖和降主动脉带瓣管道：27例Hancock，18例FreestyleStentless近心尖部管道：人造血管内衬硬质支架8例应用短暂CPB，38例直接插入连接降主动脉端应用侧壁钳吻合,结果,左室压差10mmHgMRI显示左室血量1/3经主动脉瓣左室血量2/3经带瓣管道临床症状显著改善术后无需抗凝今后工作：心尖吻合器（一次成功，不用CPB）,SutureBicuspidizationoftheTricupidValveVersusRingAnnuloplastyforRepairofFunctionalTricupidRegurgitation:Mid-TermResultsof237ConsecutivePatients.,RaviK.Ghanta,etal.MA,19992003年，237例，年龄6714yrsBicuspidization：157例Ring：80例（Cosgrove75，Carpentier16）86获出院随访（平均2.6年）TR分级：1Trace，2Mild3Moderate，4Severe,结果,P1yr，734例消融，34例切割方法481例仅做左房手术，其它做双房手术随访18.5yrs，平均2.51.7yrs,手术死亡率3.9%（不影响手术死亡率）术后一年：71sSR，23sAF，6IR此后四年：每年有2.6%的病例转为AF左房大小是sSR的独立影响因子，5.8cm为分界线,Analysisof92MitralPulmonary-AutograftReplacement(Ross)Operations.,SamiS.Kabbani,etal.SyrianArabRepublic,目的：一些病人无法长期应用抗凝药物时间：1997.72004.8，92例二尖瓣病变年龄：264yrs，平均39yrs病变：86例风湿性，2例先天性方法：用肺动脉瓣置换二尖瓣其中4例失败，手术置换共88例随访：平均47个月，失访9例,结果,术中超声：压差3.9mmHg，瓣口2.8cm2，无明显MR手术死亡率4.6%，晚期死亡7.9%（与手术相关）3例再手术，5例有进行性瓣膜狭窄（随访中）4例有肺动脉瓣狭窄存活患者有63不接受抗凝治疗,TheImpactofPatient-ProsthesisMismatchonLateOutcomesafterMitralValveReplacement.,B-KhanhLam,etal.Canada,Between1985and2005,884patientsMVRMeanage6312yrsFollowtime5.14.1yrsPPMwasdefinedasIEOA1.22cm2/m2,TheincidenceofPPMwas13.8%PPMwasindependentlyassociatedwithdecreasedlatesurvival,recurrenceofCHFandresidualpulmonaryhypertension,ProspectiveRandomisedComparisonofCarbomedicsandSt.JudeMedicalBileafletMechanicalHeartValveProstheses:10yearFollow-up.,AlanJ.Bryan,etal.UnitedKingdom,Between1992and1996485PatientsCarboValve234patientsSJMValve251patientsTherewerenostatisticallysignificantdifferenceinclinicalperformanceandclinicaloutcome,LongTermClinicalofMitralValvuloplastyusingFlexibleandRigidRing:ProspectiveandRandomizedStudy.,Byung-ChulChang,etal.RepublicofKorea,Between1995and2005,411patientshadMVPCarpentierRing:222patientsDuranRing:189patientsOperativemortality:1.7%Survivalat10yrsCarpentierRing:85.24.6%DuranRing:76.38.4%,SignificantMRCarpentier8casesDuran17casesFreedomfromsignificantMRat10yrsCarpentierRing:88.54.6%DuranRing:68.19.6%Conclusion:Nosignificantdifference,RecurrentMitralRegurgitationFollowingRepair:ShouldtheMitralValvebeRe-Repaired?,RakeshM.Suri,etal.Rochester,MN,Upto10%ofptmayrequirereoperationforregurgitationfollowingMVP148pthadreoperationforrecurrentMRfollowingMVPbetween1970and2005Themediandurationfromrepairtoreoperationwas1.8yr(range025yr)AllpthadisolateddegenerativemitralvalvediseaseAtreoperation,47%ofpthadclasssymptomsand93%ofpthadmoderate-to-severeMR,Theindicationsforreoperationregurgitationalone75%,hemolysis18%,systolicanteriormotion3%,endocarditis2%Thepathologyofreoperationnewvalvepathology51%,failureoftheinitialrepair39%anteriorleaflet45%,posteriorleaflet43%,annuloplasty29%ReoperationMitralvalvere-repairin45%Mitralvalvereplacementin55%,Thirty-daysurvivalValvere-repair100%Valvereplacement96%Five-yearsurvivalRe-MVP81%MVR61%Ofpthavingre-repair,6hadathirdmitraloperationatamedianof2.3yrafterreoperation,SurgicalStrategyfortheBicuspidAorticValve:TricuspidizationwithLeafletExtensionVersusPulmonaryAutograft.,DavidMichaelMcMullan,etal.Australia,Thesurgicalinterventionofthecongenitallybicuspidaorticvalve(BAV)involvesvalverepairorvalvereplacementinpediatricpatientsBetween1999and2005of46BAVpts(120yrs)Tricuspidizationwithleafletextension(TLE)in21casesRossin25casesPriorballoonvalvuloplasty5intheTLEgroup16intheRossgroup,Amedianfollow-upof3yrs(range1monthto5.5yrs)3TLEpatientsrequiredreoperation1RosspatientrequiredreoperationTherewerenodeathsandallpatientsremaininN