主动脉疾病的治疗进展与挑战刘永民

1、会计学1主动脉疾病的治疗进展与挑战刘永民主动脉疾病的治疗进展与挑战刘永民第1页/共64页第2页/共64页第3页/共64页传统分型第4页/共64页第5页/共64页6第6页/共64页第7页/共64页第8页/共64页第9页/共64页第10页/共64页11第11页/共64页12全弓替换术第12页/共64页13升主动脉替换升主动脉替换第13页/共64页第14页/共64页第15页/共64页第16页/共64页 第17页/共64页CPBCPB手术难度手术难度手术方法手术方法B1SB1S常温阻断常温阻断+ +血泵法血泵法血液回收血液回收动脉输入动脉输入技术技术一般一般介入治疗介入治疗部分胸主动脉替换部分胸主动脉

2、替换B2SB2S一般一般全胸主动脉替换全胸主动脉替换B3B3常温股常温股股转流或股转流或深低温停深低温停循环循环大大全胸主动脉替换全胸主动脉替换+ +腹主动腹主动脉替换脉替换BCBC大大根据病变远端位置根据病变远端位置第18页/共64页-杂交技术弓部分支间搭桥升主动脉弓部分支搭桥+带膜支架植入第19页/共64页介入材料开发-开孔和分支带膜支架可用于有重要分支部位 操作复杂 成功率低 推广受限第20页/共64页 基础研究方面-脏器保护和血液保护 外科手术-手术时机的选择 适应证扩展 手术方式的改进 介入治疗-适应证扩展 材料研制第21页/共64页22第22页/共64页(Jan.1994Dec.2

3、008) 刘永民Center of Aortic Surgery 第23页/共64页 the UK cardiac surgical register reported mortality rates in 2000 14.6% for aortic root operation 28% for aortic arch replacement 31.5% for descending aorta repairNational adult cardiac surgical database report 2000001. /sections/audit/Car

4、diac/index.html. Accessed June 1, 2006.第24页/共64页第25页/共64页第26页/共64页(10/48)(29/581)(8/29)(9/376)Type AType B第27页/共64页(12/76)(6/392)(4/43)(2/136)(8/45)(8/216)ARAADA第28页/共64页Center of Aortic Surgery Half of this year: 240 aortic operations The total number: 2,000 (since 1994) Total mortality: about 3%第2

5、9页/共64页survivorsdeathFalse aneurysm （2/64 3.02%）True aneurysm （15/741 2.02%）dissection（38/977 3.89%）54% %939384% %42% %72615622第30页/共64页977 patients (38/977 3.89%)survivorsdeath38% %62% %572293679(29/581 4.83%)Stanford type BStanford type A(9/376 2.39%)第31页/共64页第32页/共64页Total aortic replacement第33页/

6、共64页第34页/共64页Descending aortic replacement + mini stented elephant trunk第35页/共64页Partial descending aortic replacement combined with stented ETPrePrePost第36页/共64页IT ComplicationPatientsAscending aortic dissection10Endoleak3Arch pseudoaneurysm 1Brachiocephalic occlusion1Stent-graft removed1Total16End

7、ovascular treatment for Stanford type B1S dissection Using proper stent-graft；Soft hand and preventing endoleak第37页/共64页Root and extensive aneurysm, most see in Marfan syndromeascending aneurysm, most see in aortic valve diseaseArch aneurysm, most see in congenital disease and valve diseaseDescendin

8、g and abdominal aneurysm , most see in hypertension and arteriosclerosis disease第38页/共64页 Results 5-year survival (unoperated pts) 54% Aneurysms 6 cm, yearly rupture/dissection 6.4% yearly mortality 10.8% Elective/preemptive surgery restored life-expectancy to normalYearly Rupture/Dissection Rates f

9、orThoracic Aortic AneurysmsDavies et al, Presented at 2001 STS第39页/共64页Non-MarfanMarfan (familial) (AVR)Ascending 5.5 cm 5.0 cm (4.55.0cm)Descending 6.5 cm 6.0 cmElefteriades ATS 2002第40页/共64页第41页/共64页第42页/共64页TAAR：total aortic arch replacement; TH-AR: Thoracoabdominal aortic replacement；STT：stented

10、 technique;AAR: ascending aortic replacement; TAR: total aortic replacement; IT：interventional therapy; STAAR：subtotal aortic arch replacement; DAR: descending aortic replacement Total BentallCabrolAAR+STTSTAARTAARDAR AARTHARITothersTotal64 314381371168survivor62 314281361168death2 0001001000Death r

11、ate3.02% 03.02% 00 00 033% %00 014% %0 00 00 0第43页/共64页16 patients, no death , two minor endoleakless invasive, effective, and safetyPseudo-aneurysmclosure using 10/7mm Plug device第44页/共64页第45页/共64页第46页/共64页Stanford type A dissectionAortic root change: A1、A2、A3Aortic arch: type C、 SStanford type B d

12、issectionDilated range: B1、B2、B3Aortic arch: type C、type S第47页/共64页Nearly half of aortic operations in china were done 第48页/共64页49第49页/共64页50第50页/共64页51第51页/共64页52第52页/共64页53第53页/共64页54第54页/共64页55第55页/共64页谢谢第56页/共64页第57页/共64页传统分型第58页/共64页59第59页/共64页第60页/共64页第61页/共64页 Results 5-year survival (unoperated pts) 54% Aneurysms 6 cm, yearly rupture/dissection 6.4% yearly mortali