小主动脉根部的主动脉瓣置换临床经验(英文）演示文稿.pptVIP

Supravalvular Aortic Stenosis Supravalvular Aortic Stenosis Apico-Des. Aorta-Conduit Porcelain aorta Repeatedly pre-cardiac surgery Following Konno-Procedure Transthoracic Approach to Implant Apico-Aortic Conduits Cooley et al. Ann Thorac Surg 2000;69:1511-14 Early mortality 6% to 11% 5-years survival 70% Problems Conduit valve failure Conduit thrombosis High reoperation rate Congenital Valvular Aortic StenosisLeft Ventricular Hypertrophy 15-year-old boydied after open aortic comissurotomy Konno-Rastan Aortoventriculoplasty (11Pts, 16Ops) Mean age 7.9yrs. (3 – 38) Early mortality 0% 20-years survival (8)72.7% Complications 5-years Re-Stenosis (2) 18.1% 15-years Re-Stenosis (6) 54.5% High reoperation rate inclu. re-re-op. (1 re-re-re-op) Re-op: Apico-Aortic Conduits 3 (died 1) Re-op: Transapical AVR 2 (died 1) Re-op: VAD-HTX 1 Re-op: TAH 1 (survival 1yr.) Konno-Rastan Aortoventriculoplasty Transcatheter AVR (Hybrid/Intenvention) CE Mark Approval Main Inclusion Criteria Logistic EuroSCORE of 20% /or STS Risk Calculator score of 10 Patient has senile degenerative aortic valve stenosis with a mean gradient 40 mmHg and/or jet velocity greater than 4.0 m/s or documented initial aortic valve area (AVA) of 0.8cm2 Patient is symptomatic from his/her aortic valve stenosis ( NYHA Functional Class II or greater) Contraindications for THV Absence of symptoms Not high risk for surgery Too high risk for any intervention Life expectancy 1year Unsuitable anatomy Aortic annulus 18mm or 25mm Heavy calcification in front of LM Approach specific contraindication Transcatheter AVR Demographcs (April 08-Feb. 09, n = 78) Euro Score (9) 30% ( early mortality) Age 79.1 yrs(39-91 yrs) M/F 29/49 NYHA III 62 NYHA IV 16 AS (n =77) 0.71 cm2 AV (n = 1, AS II, AI III) Pre-Cardiac Surgery(CABG 4, Konno 2) 2 Follow-up 45-334 d. (100%) Cerebral event 2(?) Hospitalization 7 d. Clinical Outcomes 30 Days 30