心胸麻醉进展.pptVIP

心胸麻醉进展The advancement of cardiothoracic anesthesia 2012 VAT房颤射频消融术 瓣膜病治疗进展 Transcatheter transseptal double-orifice repair,　短、中期明显缓解MVR. Minimally Invasive Valve Surgery 创伤小； 相对长的主A阻断时间和CPB时间； 相同死亡率和CNS损伤； 股A灌注可能使老年病患术后中风风险高. 麻醉体会 OLV，体外除颤，放置右侧CVP（左颈内16~18F辅助静脉引流），TEE引导静脉导管置入，CPB中持续CVP测量。 示经股静脉插入的静脉引流管，需使其开口位于上腔静脉入口。 Transcatheter Aortic Valve Implantation 适用于不能耐受常规瓣膜手术的重度主动脉瓣狭窄病人，经股动、静脉，或经心尖。 30d死亡率12~14%，而经心尖为6~10% 麻醉挑战，心功差，高龄且合并症多 全麻，或局麻结合深度镇静 ADVANCES IN CORONARY ARTERY DISEASE Coronary Artery Surgery in Heart Failure An assessment of myocardial viability did not correlate with enhanced survival after CABG surgery as compared with medical therapy. In patients with triple-vessel coronary artery disease, CABG surgery offers better relief from angina than PCI with drugeluting stents. Patients with significant ischemic but viable myocardium in the distribution of a coronary artery with severe proximal disease should be revascularized whether by PCI or CABG surgery. ADVANCES IN HEMATOLOGY The Oral Factor Xa Inhibitors Rivaroxaban 利伐沙班, Apixaban 阿哌沙班 拮抗药物尚处于研究阶段，prothrombin complex Thrombin Inhibitors Dabigatran 达比加群，快速起效，无需监测，但没有拮抗剂。其导致的严重出血需要recombinant activated factor VII治疗 Blood Conservation Preoperative Interventions for Blood Conservation Erythropoeitin Antifibrinolytic Therapy Fresh Frozen Plasma, Recombinant factor VIIa, Factor XIII, Factor IX Leukoreduction, platelet plasmapharesis, and blood salvage are all components of a multimodal approach to optimize perioperative transfusion practice. * 术后6m有效率90% TEE排除左心耳血栓 胸外除颤电极 无需肝素化 OLV 麻醉体会 较侧卧易低氧症；阻断肺静脉时低血压。 Hemodynamic Outcome of a Double MitraClip Implant (A) Bidimensional echocardiography at 60° to show the intercommissural view. Two clips are implanted in the middle of the valve. (B) The diastolic flow shows no turbulence. (C) A residual minimal jet is found laterally to the second implanted clip. *