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ManagementofComplexAorticStenosis-RoleoftheApex-to-AorticConduit.JohnW.Brown,etal.IndianaUniversity
1主动脉瓣置换术严重主动脉瓣钙化高龄升主动脉严重钙化（EggShell）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
2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FreestyleStentless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
3结果左室压差≤10mmHgMRI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（一次成功，不用CPB）
4SutureBicuspidizationoftheTricupidValveVersusRingAnnuloplastyforRepairofFunctionalTricupidRegurgitation:Mid-TermResultsof237ConsecutivePatients.RaviK.Ghanta,etal.MA
51999~2003年，237例，年龄67±14yrsBicuspidization：157例Ring：80例（Cosgrove75％，Carpentier16％）86％获出院随访（平均2.6年）TR分级：1＝Trace，2＝Mild3＝Moderate，4＝Severe
6结果BicuspidizationRing中－重度TR平均TR中－重度TR平均TRPreop95%3.4±0.698%3.5±0.52yrsPostop25%2.0±1.031%2.1±1/1P<0.5结论：中期效果相似
7SurgeryforAtrialFibrillationinMitralPatientswithandwithoutAdditionalProcedures.Resultsat5yearsfromanInternationalRegistry.JoalQ.Melo,etal.UK
81476例二尖瓣手术（美国和欧洲10个心脏中心）同期手术：TVP436例，AV手术234例，CABG86例768例随访>1yr，734例消融，34例切割方法481例仅做左房手术，其它做双房手术随访1～8.5yrs，平均2.5±1.7yrs
9手术死亡率3.9%（不影响手术死亡率）术后一年：71％＝sSR，23％＝sAF，6％＝IR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
10Analysisof92MitralPulmonary-AutograftReplacement(RossⅡ)Operations.SamiS.Kabbani,etal.SyrianArabRepublic
11目的：一些病人无法长期应用抗凝药物时间：1997.7~2004.8，92例二尖瓣病变年龄：2～64yrs，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
12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
13TheImpactofPatient-ProsthesisMismatchonLateOutcomesafterMitralValveReplacement.B-KhanhLam,etal.Canada
14Between1985and2005,884patientsMVRMeanage63±12yrsFollowtime5.1±4.1yrsPPMwasdefinedasIEOA≤1.22cm2/m2
15TheincidenceofPPMwas13.8%PPMwasindependentlyassociatedwithdecreasedlatesurvival,recurrenceofCHFandresidualpulmonaryhypertension
16ProspectiveRandomisedComparisonofCarbomedicsandSt.JudeMedicalBileafletMechanicalHeartValveProstheses:10yearFollow-up.AlanJ.Bryan,etal.UnitedKingdom
17Between1992and1996485PatientsCarboValve234patientsSJMValve251patientsTherewerenostatisticallysignificantdifferenceinclinicalperformanceandclinicaloutcome
18LongTermClinicalofMitralValvuloplastyusingFlexibleandRigidRing:ProspectiveandRandomizedStudy.Byung-ChulChang,etal.RepublicofKorea
19Between1995and2005,411patientshadMVPCarpentierRing:222patientsDuranRing:189patientsOperativemortality:1.7%Survivalat10yrsCarpentierRing:85.2±4.6%DuranRing:76.3±8.4%
20SignificantMRCarpentier8casesDuran17casesFreedomfromsignificantMRat10yrsCarpentierRing:88.5±4.6%DuranRing:68.1±9.6%Conclusion:Nosignificantdifference
21RecurrentMitralRegurgitationFollowingRepair:ShouldtheMitralValvebeRe-Repaired?RakeshM.Suri,etal.Rochester,MN
22Upto10%ofptmayrequirereoperationforregurgitationfollowingMVP148pthadreoperationforrecurrentMRfollowingMVPbetween1970and2005Themediandurationfromrepairtoreoperationwas1.8yr(range0~25yr)AllpthadisolateddegenerativemitralvalvediseaseAtreoperation,47%ofpthadclassⅢ~Ⅳsymptomsand93%ofpthadmoderate-to-severeMR
23Theindicationsforreoperationregurgitationalone75%,hemolysis18%,systolicanteriormotion3%,endocarditis2%Thepathologyofreoperationnewvalvepathology51%,failureoftheinitialrepair39%anteriorleaflet45%,posteriorleaflet43%,annuloplasty29%ReoperationMitralvalvere-repairin45%Mitralvalvereplacementin55%
24Thirty-daysurvivalValvere-repair100%Valvereplacement96%Five-yearsurvivalRe-MVP81%MVR61%Ofpthavingre-repair,6hadathirdmitraloperationatamedianof2.3yrafterreoperation
25SurgicalStrategyfortheBicuspidAorticValve:TricuspidizationwithLeafletExtensionVersusPulmonaryAutograft.DavidMichaelMcMullan,etal.Australia
26Thesurgicalinterventionofthecongenitallybicuspidaorticvalve(BAV)involvesvalverepairorvalvereplacementinpediatricpatientsBetween1999and2005of46BAVpts(1~20yrs)Tricuspidizationwithleafletextension(TLE)in21casesRossin25casesPriorballoonvalvuloplasty5intheTLEgroup16intheRossgroup
27Amedianfollow-upof3yrs(range1monthto5.5yrs)3TLEpatientsrequiredreoperation1RosspatientrequiredreoperationTherewerenodeathsandallpatientsremaininNYHAclassⅠConclusionsReinterventionratesinpatientsundergoingTLEorprimaryRossaresimilarTLEvalveperformanceisverysatisfactoryatmid-termfollow-upbuttheRossappearstoprovidegreaterstabilityofvalvefunction
28谢谢
