1、Michael Mack, M.D.Dallas, TX Shanghai 1993支架和無支架自動(dòng)脈瓣膜植入的技術(shù)要點(diǎn)和技巧成人人工自動(dòng)脈瓣膜機(jī)械瓣生物瓣異種移植物帶支架不帶支架同種移植物自體移植物t (Ross)經(jīng)導(dǎo)管自動(dòng)脈瓣置換Nanjing Road 199310個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防

2、止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。微創(chuàng)自動(dòng)脈瓣置換微創(chuàng)自動(dòng)脈瓣置換10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切

3、口完成。10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。21.2 mm20 mm10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)

4、脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 查閱有效瓣膜口面積表，防止出現(xiàn)人工瓣患者不匹配提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。Nanjing Road 199310個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合

5、處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹

6、配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。Supra-annular Implantation10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。無需 墊片

7、!Outside Peace Hotel 199310個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 尤其是合并 自動(dòng)脈瓣二瓣化支架和無支架瓣膜安裝無差別，自動(dòng)脈根部較小患者行自動(dòng)脈弓根部置換時(shí)例外自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固自動(dòng)脈切口縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自

8、動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。無支架生物瓣膜10個(gè)主要技術(shù)要點(diǎn)和技巧升自動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 自動(dòng)脈瓣二瓣化時(shí)，需行升自動(dòng)脈置換除了自動(dòng)脈根部細(xì)小患者需行自動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢(shì)自動(dòng)脈脆弱患者老年患者)采用自體或牛心包加固血管縫合處無需運(yùn)用墊片(可

9、使流出道狹窄)瓣環(huán)上置瓣假設(shè)出現(xiàn)患者-人工瓣不匹配, 需行自動(dòng)脈根部擴(kuò)展或用無支架瓣 防止運(yùn)用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)提早知道瓣膜大小充分暴露并翻開自動(dòng)脈大部分自動(dòng)脈手術(shù)可以經(jīng)過經(jīng)胸骨小切口完成。自動(dòng)脈二瓣化Shanghai 1993Technical Tips and Tricks for Stented and Stentless Aortic ValvesMichael Mack, M.D.Dallas, TX Shanghai 1993Prosthetic Aortic Valve Options For AdultsMechanicalTissueHeterograft

10、StentedStentlessHomograftAutograft (Ross)TranscatheterAortic Valve ReplacementNanjing Road 1993Top Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aor

11、totomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-pro

12、sthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini sternotomyMinimally Invasive AVRTop Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves exce

13、pt as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or sten

14、tless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini sternotomyTop Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No a

15、dvantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantatio

16、n If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the annulus size ahead of time (also STJ and LVOT) Open aorta widely Most aortic valve procedures can be done through a mini sternotomy21.2 mm20 mmTop Ten Tip

17、s and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)

18、 Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use Effective Orifice Area charts to avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic val

19、ve procedures can be done through a mini sternotomyNanjing Road 1993Top Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with aut

20、ologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know

21、 the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini sternotomyTop Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root pat

22、ients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts t

23、o avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini sternotomySupra-annular ImplantationTop Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless o

24、ver stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic r

25、oot enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini sternotomyNo Pledgets Necessary !Outside Peace Hotel 1993Top Ten Tips and Tric

26、ks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets

27、not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done

28、through a mini sternotomyTop Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If P