支架和无支架主动脉瓣膜植入的技术要点和技巧.ppt

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1、,Michael Mack,M.D.Dallas,TX,Shanghai 1993,支架和无支架主动脉瓣膜植入的技术要点和技巧,成人人工主动脉瓣膜,机械瓣生物瓣异种移植物带支架不带支架同种移植物自体移植物t(Ross)经导管,主动脉瓣置换,Nanjing Road 1993,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支

2、架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,微创主动脉瓣置换,微创主动脉瓣置换,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过

3、经胸骨小切口完成。,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,21.2 mm,20 mm,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升

4、主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 查阅有效瓣膜口面积表，避免出现人工瓣患者不匹配提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,Nanjing Road 1993,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用

5、自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工

6、瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,Supra-annular Implantation,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切

7、口完成。,无需 垫片!,Outside Peace Hotel 1993,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 尤其是合并 主动脉瓣二瓣化支架和无支架瓣膜装置无差异，主动脉根部较小患者行主动脉弓根部置换时例外主动脉脆弱患者（老年患者)采用自体或牛心包加固主动脉切口缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化

8、时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,无支架生物瓣膜,10个主要技术要点和技巧,升主动脉直径大于等于 4 cm 时，尤其是合并 主动脉瓣二瓣化时，需行升主动脉置换除了主动脉根部细小患者需行主动脉根部置换外，无支架瓣较有支架瓣无优势主动脉脆弱患者（老年患者)采用自体或牛心包

9、加固血管缝合处无需使用垫片(可使流出道狭窄)瓣环上置瓣若出现患者-人工瓣不匹配,需行主动脉根部扩大或用无支架瓣 避免使用错误型号的人工瓣膜(患者假体不匹配)提前知道瓣膜大小充分暴露并打开主动脉大部分主动脉手术可以通过经胸骨小切口完成。,主动脉二瓣化,Shanghai 1993,Technical Tips and Tricks for Stented and Stentless Aortic Valves,Michael Mack,M.D.Dallas,TX,Shanghai 1993,Prosthetic Aortic Valve Options For Adults,MechanicalT

10、issueHeterograftStentedStentlessHomograftAutograft(Ross)Transcatheter,Aortic Valve Replacement,Nanjing Road 1993,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patie

11、ntsReinforce 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 to avoid

12、patient-prosthesis mismatch(PPM)Know the valve size ahead of timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,Minimally Invasive AVR,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented val

13、ves except as a root replacement in small aortic root patientsReinforce 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 st

14、entless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch(PPM)Know the valve size ahead of timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo adv

15、antage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce 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 PP

16、M,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 widelyMost aortic valve procedures can be done through a mini sternotomy,21.2 mm,20 mm,Top Ten Tips and Tric

17、ks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas(elderly females)Pledgets not

18、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 timeOpen aorta widelyMost aortic valve procedures can be

19、done through a mini sternotomy,Nanjing Road 1993,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce aortotomy suture line with autologous or bovine per

20、icardium 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 the valve size ahead of tim

21、eOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce aortotomy sutur

22、e 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-prosthesis mismatch(

23、PPM)Know the valve size ahead of timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,Supra-annular Implantation,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root rep

24、lacement in small aortic root patientsReinforce 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 repl

25、acement Use sizing charts to avoid patient-prosthesis mismatch(PPM)Know the valve size ahead of timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,No Pledgets Necessary!,Outside Peace Hotel 1993,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially w

26、ith bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas(elderly females)Pledgets not necessary(and can narrow outflow tract)Supra-an

27、nular 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 timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,Top Ten Tips and Tricks,Replace

28、ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas(elderly females)Pledgets not necessary(a

29、nd 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 timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternot

30、omy,Stentless Tissue Valves,Top Ten Tips and Tricks,Replace ascending aorta if 4 cm especially with bicuspid valveNo advantage of stentless over stented valves except as a root replacement in small aortic root patientsReinforce aortotomy suture line with autologous or bovine pericardium in patients

31、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 the valve size ahead of timeOpen aorta widelyMost aortic valve procedures can be done through a mini sternotomy,Bicuspid Valves,Shanghai 1993,