机械及生物主动脉瓣 病人选择及手术方式实施.ppt

Advantage Disadvantage Advantage and disadvantage of artificial valve ? Life-long anticoagulation ? Related complications ? Few structural deterioration ? Free from re- operation ? Good haemodynamics ? Free from anticoagulation ? Calcification ? Deterioration ? Re-operation MPV BPV 9143 982 Distribution of 10125 artificial valves used in 8206 patients in Xijing Hospital from May, 1988 to May, 2008 Results Follow-up rate was 91.2% Accumulated follow-up time is 49232 patients ? year Complications Mechanical (Patients ? year) Bioprosthetics (Patients ? year) Thromboembolisis 1.8 ％ 0.21 ％ Bleeding 2.1 ％ 0.48 ％ 90.1% 86.4% 69.1% Kaplan-Mier Survival Curve of bioprosthesis during 15 years follow-up 89.2% 84.5% 68.6% Kaplan-Mier Survival Curve of mechanical valve during 15 years follow-up ? 60 years old ? Comorbided with atrial fibrillation ? Risk factor for thromboembolism ? Infective endocarditis (For the first time) Principle for selection of mechanical or bioprosthetic valves in Xijing Hospital Mechanical valve preferred ? 60 years old ? Comorbided without atrial fibrillation ? No risk factor for thromboembolism ? Tricuspid valve replacement ? Female patients with fertility require Principle for selection of mechanical or bioprosthetic valves in Xijing Hospital Bioprosthetic valve preferred ? Indexed effective orifice area （ IEOA ） =0.85 ? 2 mm smaller than the radius of the aortic annulus ? 19mm in patients with small aortic root ? Our sizes were smaller than that of western countries Selection of the size for artificial valves 14% 26% 41% 15% 4% 19 21 23 25 25+ Aortic valve Distribution of the size of 1422 aortic valve replaced in our hospital 机械及生物主动脉瓣 -- 病人选择及手术方式实施 第四军医大学西京医院心血管外科 易定华，俞世强，刘金成，金振晓等 2008 年 12 月 上海 cases 1990 － 2007 西京医院心血管外科手术量情况 0 500 1000 1500 2000 2500 3000 3500 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999