冠心病外科的进展up-to-datecoronarysurgery阮新民培训课件.pptVIP

冠心病外科的进展(up-to-date coronary surgery)阮新民;前 言;冠心病的治疗; 冠状动脉搭桥术; 自体 内乳动脉：10年通畅90% 桡动脉、胃网膜右动脉、腹壁下动脉 大(小)隐静脉：10年后50%狭窄 异体 同种静脉移植 1年内闭塞50% 人造血管 ;搭桥病人远期存活率;搭桥的适应证;搭桥的禁忌证;搭桥的相对禁忌证;手术方法;常规体外循环下搭桥（CCABG);体外循环下冠脉搭桥术;微创大隐静脉取出术;微创大隐静脉取出术;微创大隐静脉取出术;内窥镜下内乳动脉取出术;微创冠脉搭桥(MIDCAB);微创冠脉搭桥(MIDCAB);窗口手术 (port-access);不停跳冠脉搭桥(OPABG);ROBOTIC-ASSISTED CARDIAC SURGERY: HYBRID CORONARY BYPASS PROJECT;‘Fly by Wire’ Technology;冠脉搭桥的质量控制;冠脉搭桥的质量控制;冠脉搭桥的质量控制;冠脉搭桥的质量控制;激光心肌打孔术（TMR）;激光心肌打孔术（TMR）;;生物搭桥;Randomized Trial;Randomized Trial;SoS Trial;MASS II Trial;ERACI II Trial;ARTS Trial;a meta-analysis of 13 randomized trials;5)DM patients-- CABG provided a significant survival advantage over PTCA at 4 years but not at 6.5 years. CONCLUSIONS: CABG is associated with a lower five-year mortality, less angina, and fewer revascularization procedures. For patients with multivessel disease, CABG provided a survival advantage at five to eight years, and for diabetics, a survival advantage at four years. The addition of stents reduced the need for repeat revascularization by about half. Hoffman SN, J Am Coll Cardiol. 2003;41 ;Left Main;DES;DES A meta-analysis of randomized controlled trials ;2) Restenosis was highly reduced from 30.6% with bare stents to 8.7% with DES (p0.001) with a similar heterogeneity between sub-groups. 3) Mortality was not significantly different between DES and control group: 4) Conclusion: -- confirms the overall benefit of DES on restenosis and MACE --with significant heterogeneity between drugs suggesting higher efficacy of sirolimus-eluting stents. Roiron C, Heart 2005. Oct,10;DES;Conclusion;Conclusion