1、心脏瓣膜外科 -American Association for Thoracic Surgery 86th Annual Meeting April 29May 3, 2006 Philadelphia, 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,Management of Complex Aortic Stenosis-Role of the Apex-to-Aortic Conduit.,John W. Brown, et al. Indiana University,主动脉瓣置换术 严重主动脉瓣钙化 高龄
2、 升主动脉严重钙化（Egg Shell） 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Freestyle Stentless 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10mmHg MRI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
3、功，不用CPB）,Suture Bicuspidization of the Tricupid Valve Versus Ring Annuloplasty for Repair of Functional Tricupid Regurgitation: Mid-Term Results of 237 Consecutive Patients.,Ravi K. Ghanta, et al. MA,19992003年，237例，年龄6714 yrs Bicuspidization：157例 Ring：80例（Cosgrove 75，Carpentier 16） 86获出院随访（平均2.6年） T
4、R分级： 1Trace，2Mild 3Moderate，4Severe,结果,P0.5 结论：中期效果相似,Surgery for Atrial Fibrillation in Mitral Patients with and without Additional Procedures. Results at 5 years from an International Registry.,Joal Q. Melo, et al. UK,1476例二尖瓣手术（美国和欧洲10个心脏中心） 同期手术：TVP 436例，AV手术234例，CABG 86例 768例随访1yr，734例消融，34例切割方
5、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,Analysis of 92 Mitral Pulmonary-Autograft Replacement (Ross ) Operations.,Sami S. Kabbani, et al. Syrian Arab Republic,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：264yr
6、s，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,The Impact of Patient-Prosthesis Mismatch on Late Outcomes after Mitral Valve Replacement.,B-Khanh Lam, et al. Canada,Betwee
7、n 1985 and 2005, 884 patients MVR Mean age 6312yrs Follow time 5.14.1yrs PPM was defined as IEOA1.22cm2/m2,The incidence of PPM was 13.8% PPM was independently associated with decreased late survival, recurrence of CHF and residual pulmonary hypertension,Prospective Randomised Comparison of Carbomed
8、ics and St. Jude Medical Bileaflet Mechanical Heart Valve Prostheses:10 year Follow-up.,Alan J. Bryan, et al. United Kingdom,Between 1992 and 1996 485 Patients Carbo Valve 234 patients SJM Valve 251 patients There were no statistically significant difference in clinical performance and clinical outc
9、ome,Long Term Clinical of Mitral Valvuloplasty using Flexible and Rigid Ring: Prospective and Randomized Study.,Byung-Chul Chang, et al. Republic of Korea,Between 1995 and 2005, 411 patients had MVP Carpentier Ring: 222 patients Duran Ring: 189 patients Operative mortality: 1.7% Survival at 10 yrs C
10、arpentier Ring: 85.24.6% Duran Ring: 76.38.4%,Significant MR Carpentier 8 cases Duran 17 cases Freedom from significant MR at 10yrs Carpentier Ring: 88.54.6% Duran Ring: 68.19.6% Conclusion: No significant difference,Recurrent Mitral Regurgitation Following Repair: Should the Mitral Valve be Re-Repa
11、ired?,Rakesh M. Suri, et al. Rochester, MN,Up to 10% of pt may require reoperation for regurgitation following MVP 148 pt had reoperation for recurrent MR following MVP between 1970 and 2005 The median duration from repair to reoperation was 1.8 yr (range 025 yr) All pt had isolated degenerative mit
12、ral valve disease At reoperation, 47% of pt had class symptoms and 93% of pt had moderate-to-severe MR,The indications for reoperation regurgitation alone 75%, hemolysis 18%, systolic anterior motion 3%, endocarditis 2% The pathology of reoperation new valve pathology 51%, failure of the initial rep
13、air 39% anterior leaflet 45%, posterior leaflet 43%, annuloplasty 29% Reoperation Mitral valve re-repair in 45% Mitral valve replacement in 55%,Thirty-day survival Valve re-repair 100% Valve replacement 96% Five-year survival Re-MVP 81% MVR 61% Of pt having re-repair, 6 had a third mitral operation
14、at a median of 2.3 yr after reoperation,Surgical Strategy for the Bicuspid Aortic Valve: Tricuspidization with Leaflet Extension Versus Pulmonary Autograft.,David Michael McMullan, et al. Australia,The surgical intervention of the congenitally bicuspid aortic valve (BAV) involves valve repair or val
15、ve replacement in pediatric patients Between 1999 and 2005 of 46 BAV pts (120yrs) Tricuspidization with leaflet extension(TLE) in 21 cases Ross in 25 cases Prior balloon valvuloplasty 5 in the TLE group 16 in the Ross group,A median follow-up of 3 yrs (range 1 month to 5.5 yrs) 3 TLE patients requir
16、ed reoperation 1 Ross patient required reoperation There were no deaths and all patients remain in NYHA class Conclusions Reintervention rates in patients undergoing TLE or primary Ross are similar TLE valve performance is very satisfactory at mid-term follow-up but the Ross appears to provide greater stability of valve function,谢谢,
