二尖瓣成形的技术要点中.ppt

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,后叶脱垂成形技术,长方形切除标准成形三角形切除滑行成形折叠成形其它双孔法成形人工腱索,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=1072,Post.ChordalRupture49%,DilatedAnnulus16%,ElongatedChordae24%,Ant.&Post.ChordalRupture5%,Ant.ChordalRupture6%,生存,1009080706050,0246810,%,99%,93%,81%,Years,免予再次手术,1009590858075,0246810,%,Years,99%,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,TechnicalTips&TricksforMitralValveRepair,JosephF.Sabik,M.D.TheClevelandClinic,SurgicalTechniquesASystematicApproach,DegenerativeMitralValveDisease,95%ofvalvesrepairableWithonly5or6techniquesTriangularresectionFoldingrepairArtificialchordae(orCh.Transfer)CommissureclosureAnnuloplasty,ProlapsingSegment,PosteriorLeafletProlapseAnteriorLeafletProlapseBileafletProlapseCommissuralProlapse,PosteriorProlapseRepairTechniques,QuadrangularresectionStandardtriangularresectionSlidingrepairfoldingrepairOthersEdge-to-edgerepairArtificialchordae,AnteriorProlapseRepairTechniques,ChordaltransferArtificialchordaeOthersEdge-to-edgerepairLimitedresection,CommissuralProlapseRepairTechnique,Annuloplasty,IndicationsforAnnuloplasty,CorrectposteriorannulardilatationIncreaseleafletcoaptationReinforceannularsuturelinesPreventfurtherdilatation,Results,Pathoanatomy,N=1072,Post.ChordalRupture49%,DilatedAnnulus16%,ElongatedChordae24%,Ant.&Post.ChordalRupture5%,Ant.ChordalRupture6%,Survival,1009080706050,0246810,%,99%,93%,81%,Years,FreedomfromReoperation,1009590858075,0246810,%,Years,99%,97%,9