支架和無支架主動(dòng)脈瓣植入的技術(shù)要點(diǎn)和技巧

1、michael mack, m.d.dallas, tx shanghai 1993支架和無支架主動(dòng)脈瓣膜植入的技術(shù)要點(diǎn)和技巧成人人工主動(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)管主動(dòng)脈瓣置換nanjing road 199310個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈

2、根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。微創(chuàng)主動(dòng)脈瓣置換10個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣

3、膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。10個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。21.2 mm20 m

4、m10個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 查閱有效瓣膜口面積表，避免出現(xiàn)人工瓣患者不匹配8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。nanjing road 199310個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤

5、其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。10個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較

6、有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。supra-annular implantation10個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(dòng)脈脆弱患者（老年患者)采用自

7、體或牛心包加固血管縫合處4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。無需 墊片 !outside peace hotel 199310個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 尤其是合并 主動(dòng)脈瓣二瓣化2.支架和無支架瓣膜裝置無差異，主動(dòng)脈根部較小患者行主動(dòng)脈弓根部置換時(shí)例外3.主動(dòng)脈脆弱患者（老年患者)采用自體或牛心包加固主動(dòng)脈切口縫合處4.無需使用墊片(可使流出道狹窄

8、)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。10個(gè)主要技術(shù)要點(diǎn)和技巧1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的

9、人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主動(dòng)脈手術(shù)可以通過經(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1.升主動(dòng)脈直徑大于等于 4 cm 時(shí)，尤其是合并 主動(dòng)脈瓣二瓣化時(shí)，需行升主動(dòng)脈置換2.除了主動(dòng)脈根部細(xì)小患者需行主動(dòng)脈根部置換外，無支架瓣較有支架瓣無優(yōu)勢3.主動(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4.無需使用墊片(可使流出道狹窄)5.瓣環(huán)上置瓣6.若出現(xiàn)患者-人工瓣不匹配, 需行主動(dòng)脈根部擴(kuò)大或用無支架瓣7. 避免使用錯(cuò)誤型號(hào)的人工瓣膜 (患者假體不匹配)8.提前知道瓣膜大小9.充分暴露并打開主動(dòng)脈10. 大部分主

10、動(dòng)脈手術(shù)可以通過經(jīng)胸骨小切口完成。主動(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 adultsmechanicaltissueheterograftstentedstentlesshomograftautograft (ross)transcatheteraortic valve replacementnanjing ro

11、ad 1993top ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile

12、aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replacement7. use sizing charts to avoid patient-prosthesis mismatch (ppm)8. know the valve size ahead of time9. open aorta wi

13、dely10.most aortic valve procedures can be done through a mini sternotomyminimally invasive avrtop ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinfor

14、ce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replacement7. use sizing charts to avo

15、id patient-prosthesis mismatch (ppm)8. know the valve size ahead of time9. open aorta widely10.most aortic valve procedures can be done through a mini sternotomytop ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves ex

16、cept as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargeme

17、nt or stentless aortic root replacement7. use sizing charts to avoid patient-prosthesis mismatch (ppm)8. know the annulus size ahead of time (also stj and lvot)9. open aorta widely10.most aortic valve procedures can be done through a mini sternotomy21.2 mm20 mmtop ten tips and tricks1. replace ascen

18、ding aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necess

19、ary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replacement7. use effective orifice area charts to avoid patient-prosthesis mismatch (ppm)8. know the valve size ahead of time9. open aorta widely10.most aortic valve proce

20、dures can be done through a mini sternotomynanjing road 1993top ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autol

21、ogous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replacement7. use sizing charts to avoid patient-prosthesis mismatch (ppm

22、)8. know the valve size ahead of time9. open aorta widely10.most aortic valve procedures can be done through a mini sternotomytop ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small

23、 aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replace

24、ment7. use sizing charts to avoid patient-prosthesis mismatch (ppm)8. know the valve size ahead of time9. open aorta widely10.most aortic valve procedures can be done through a mini sternotomysupra-annular implantationtop ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid

25、 valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-

26、annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replacement7. use sizing charts to avoid patient-prosthesis mismatch (ppm)8. know the valve size ahead of time9. open aorta widely10.most aortic valve procedures can be done through a mini sternotomyno pledgets nece

27、ssary !outside peace hotel 1993top ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium i

28、n patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular implantation6. if ppm, then aortic root enlargement or stentless aortic root replacement7. use sizing charts to avoid patient-prosthesis mismatch (ppm)8. know the valve size ahead

29、 of time9. open aorta widely10.most aortic valve procedures can be done through a mini sternotomytop ten tips and tricks1. replace ascending aorta if 4 cm especially with bicuspid valve2. no advantage of stentless over stented valves except as a root replacement in small aortic root patients3. reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females)4. pledgets not necessary (and can narrow outflow tract)5. supra-annular impla