机械及生物主动脉瓣--病人选择及手术方式实施知识讲稿.pptVIP

52% 23% 8% 7% 10% Distribution of different types of 3225 cardiac operations in the Department of Cardiovascular Surgery Xijing Hospital in 2007 Advantage Disadvantage Advantage and disadvantage of artificial valve Life-long anticoagulation Related complications Few structural deterioration Free from re-operation Good haemodynamics Free from anticoagulation Calcification Deterioration Re-operation 9143 982 Distribution of 10125 artificial valves used in 8206 patients in Xijing Hospital from May, 1988 to May, 2008 Results Follow-up rate was 91.2% Accumulated follow-up time is 49232 patients?year Complications Mechanical (Patients?year) Bioprosthetics (Patients?year) Thromboembolisis 1.8％ 0.21％ Bleeding 2.1％ 0.48％ 90.1% 86.4% 69.1% Kaplan-Mier Survival Curve of bioprosthesis during 15 years’ follow-up 89.2% 84.5% 68.6% Kaplan-Mier Survival Curve of mechanical valve during 15 years’ follow-up 60 years old Comorbided with atrial fibrillation Risk factor for thromboembolism Infective endocarditis (For the first time) Principle for selection of mechanical or bioprosthetic valves in Xijing Hospital Mechanical valve preferred 60 years old Comorbided without atrial fibrillation No risk factor for thromboembolism Tricuspid valve replacement Female patients with fertility require Principle for selection of mechanical or bioprosthetic valves in Xijing Hospital Bioprosthetic valve preferred Indexed effective orifice area（IEOA）=0.85 2 mm smaller than the radius of the aortic annulus 19mm in patients with small aortic root Our sizes were smaller than that of western countries Selection of the size for artificial valves Aortic valve Distribution of the size of 1422 aortic valve replaced in our hospital Most selected mitral valve in adults is 27mm Smaller valve preferred in patients with small left ventricle or heart insufficiency 22 cases of valve replacement in patients under 45kg 3 cases of 19mm valve replacement in 3-12 months’ old infants Dis