心脏外科现况和进展课件
67页1、心脏外科现况和进展 广东省中医院心脏中心 阮新民,心脏外科的现况,中国: 冠脉搭桥 5000 0-60% 瓣膜外科 10000 20-30% 先天心 20000 60-65% 其它 1000,The Future of Cardiac Intervention (National Health Council),Stent and intravascular intervention expected to double over next 3 years CABG volume to decline about 10% with cardiac surgery primarily expanding in EPS and CHF such as ablative surgery, biventricular pacing, LV remodeling, and cardiac muscle augmentation. Valvular volume to increase about 20% by 2005,Vascular Intervention PTCA PDA ASD VSA
2、 AA AAA,Cardiac Surgery Need Refinement. WHY?,Challenges of aging population. Recurrent diseases. Increasing competent edge of PTCA/STENTS. Cost of surgery. Morbidity associated ,Most of The Morbidity is Associated With what?,CPBAortic Manipulation. Midline sternotomy. Hypothermia. Heart Arrest .,WHAT DO YOU THINK IS THE FUTURE OF CARDIAC SURGER?,Minimal invasive,MIDCAB OPCAB PA(PORT-EXCESS) ENDO-CABG,Minimal invasive CABG,OPCAB The New Standard of Care!,Video-assistant Thoracoscopy Surgery,PDA
3、Pericardial CABG AF,Endoscopic IMA Mobilization,HEARTSTRINGTM Proximal Seal System,OPCAB,Due Diligence,A process of evaluation of two robotic systems,Fly by Wire Technology,HEART VALVE SURGERY,ATS Mechanical,Evolution-Improvements Over Time,Hancock II Design Overview,Flexible, reduced-profile Supra-annular stent T6 surfactant treatment Minimized porcine muscle shelf,Implantability,Assembled from 3 noncoronary aortic leaflets taken from 3 porcine valves,No Dacron or artificial annular support,Sup
4、ra - annular implantation,Cryo Life - OBrien,Personal Predictions 2004,Biological Ross autograft Allograft Xenograft - “Perimount” pericardial - Stentless valve Mechanical valve Swing back to some popularity Change in model usage,Conclusions,Mechanical valves may become a more common choice Easy technical implantation A/C complications accepted as inevitable Some recent studies reducing A/C levels ? future new anticoagulant medication regime Xenografts for the elderly Both autografts and allogra
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