心脏瓣膜病再次手术地治疗策略.ppt

Strategies of Re-operation in Heart Valve Disease Cong Lu, MD Guangdong General Hospital Guangdong Provincial Cardiovascular Institute Guangzhou, China Guangdong General Hospital Guangdong Provincial Cardiovascular Institute Relevant Historic Milestones in China 1954 Closed mitral commissurotomy 1958 The first application of CPB 1958 Open mitral commissurotomy by CPB 1965 Mitral valve replacement Eminent Pioneers and Institutions of China Cai Yongzhi Changhai Hospital Shanghai Zhang Baoren Changhai Hospital Shanghai Guo Jiaqiang Fuwai Cardiovascular Hospital Beijing Luo Zhengxiang Guangdong General Hospital Guangzhou Operations and Re-operations By the late 1990s, 6000 heart valve operations performed each year In recent years, the number of valve operations per year is more than 20 000 With the number of heart valve surgeries increasing, re-operation of heart valve disease becomes an unavoidable problem The Experience of Our Hospital Heart valve surgeries in Guangdong General Hospital from 1997 to 2007 The Experience of Our Hospital The total operations from 1997 to 2007： 6703 cases Re-operations：499 cases ( 7.4%) Perioperative mortality of re-operations ：8.8% Causes of Re-operation The leading cause： Re-stenosis after closed mitral commissurotomy（64.5%） Causes of re-operation of other hospital Hospital Re-operation causes Fuwai Hospital 333 a,b,c,d,e,f Xinqiao Hospital 187 f,a,d,g Renji Hospital 203 f,a,g, Fujian Provincial Hospital 104 f,e,g,d,a,h Baotou Central Hospital 165 f,a,g,c,d,b,e a: bioprosthetic failure， b: perivalvular leakage， c: lesion of natural valve， d: dysfunction of mechanical valve， e: endocarditis， f: closed mitral commissurotomy， g: open mitral commissurotomy， h: others Risks and Strategies Risks are higher of re-operation than initial operation ◆ pro-longed history ◆ poor cardiac function ◆ a