二尖瓣成形的技术要点(中英文).pptVIP

二尖瓣成形的技术要点JosephF.Sabik,M.D.TheClevelandClinic

手术技术一个系统工程

退行性二尖瓣疾病95%的瓣膜都是可成形的仅有5或6种技术三角形切除折叠成形人工腱索(或腱索转移)交界缝合瓣环成形

不同部位脱垂后叶脱垂前叶脱垂双叶脱垂交界脱垂

前叶脱垂成形技术腱索转移人工腱索其它双孔法有限切除

交界脱垂成形技术

瓣环成形

瓣环成形的指征矫正后瓣环扩大增加瓣叶贴合面增强版换缝线预防将来扩张

结果

病理解剖N=1072Post.ChordalRupture49%DilatedAnnulus16%ElongatedChordae24%Ant.Post.ChordalRupture5%Ant.ChordalRupture6%

生存10090807060500 2 4 6 8 10%99%93%81%Years

免予再次手术10095908580750 2 4 6 8 10%Years99%97%93%

结论二尖瓣成形95%瓣膜可成形6种技术生存率免予再次手术率

TechnicalTipsTricksforMitralValveRepairJosephF.Sabik,M.D.TheClevelandClinic

SurgicalTechniquesASystematicApproach

DegenerativeMitralValveDisease95%ofvalvesrepairableWithonly5or6techniquesTriangularresectionFoldingrepairArtificialchordae(orCh.Transfer)CommissureclosureAnnuloplasty

ProlapsingSegmentPosteriorLeafletProlapseAnteriorLeafletProlapseBileafletProlapseCommissuralProlapse

PosteriorProlapseRepairTechniquesQuadrangularresectionStandardtriangularresectionSlidingrepairfoldingrepairOthersEdge-to-edgerepairArtificialchordae

AnteriorProlapseRepairTechniquesChordaltransferArtificialchordaeOthersEdge-to-edgerepairLimitedresection

CommissuralProlapseRepairTechnique

Annuloplasty

IndicationsforAnnuloplastyCorrectposteriorannulardilatationIncreaseleafletcoaptationReinforceannularsuturelinesPreventfurtherdilatation

Results

PathoanatomyN=1072Post.ChordalRupture49%DilatedAnnulus16%ElongatedChordae24%Ant.Post.ChordalRupture5%Ant.ChordalRupture6%

Survival10090807060500 2 4 6 8 10%99%93%81%Years

FreedomfromReoperation10095908580750 2 4 6 8 10%Years99%97%93%

ConclusionsMVRepair95%ValveRepairable6TechniquesSurvivalFreedomfromReoperation