心脏外科的现状.pptVIP

心脏外科的现状What The Cardiac Surgeon Do 天津武警医学院附属医院心胸外科 于洪泉主任，教授 心脏内、外科 = 1＋12 心脏病 ↙ ↘ 心脏内科医师 ＋ 心脏外科医师 ↘ ↙ 治疗心脏病患者 ‖ 痊愈、健康、长寿 心脏外科医师 冠状动脉外科， 冠心病的并发症 瓣膜疾病 先天性心脏病 大血管疾病 AF “It was the best of times, it was the worst of times” CABG Mortality What we do, as cardiac surgeons, can offer the patients with CAD better in the era of drug eluting stents? 2100 Publications on Off-Pump CABG over the last 5 years….. …so what do we know about the benefits of avoiding CPB ? Reduced post-op transfusion? Reduced atrial fibrillation? Reduced length of stay? Reduced cost? Reduced mortality? Reduced CVA? Reduced neurocognitive deficit? OPCAB Surgery: Conclusions to Date Coronary surgery off-pump is performed in hundreds of centers across the world. The evidence is structured in 1200 peer-reviewed articles. The selection of the patients is related to the experience of the center. Complete and arterial revascularization are possible without patient selection. Coronary surgery off-pump reduces, after adjustment for variability in risk, early mortality and some major morbidity events: neurocognitive dysfunction, stroke and renal failure. Off-pump coronary surgery allows and mandates a rigorous re-engineering RE-DO After Stent Angina Re-Stent or Operation After operation angina Re-Stent or Operation Severe or Complex CAD Three vessel diseases Left main 男性，66岁， OMI＝2 AMI＋acute HF EF=30% CABG x 3,post 7 days EF=56% Comparison of survival following coronary artery bypass grafting vs. percutaneous coronary intervention in diabetic and non-diabetic patients: retrospective cohort study of 6320 procedures.Pell JP, Pell AC, Jeffrey RR Diabet Med. 2004 Jul;21(7):790-2.,  6320 eligible procedures, 5042 (80%) CABG and 1278 (20%)PCI 831 (13%) patients had diabetes with no significant difference by procedure (13% vs. 12%). Results: A total of 382 deaths occurred over a mean follow-up of 2.3 years. Diabetic patie