中國(guó)心外科發(fā)展現(xiàn)狀的幻燈課件

CardiacSurgeryinChina

Currentstatusand

SomeCharacteristicsZhuXiaodongFuwaiCardiovascularInstitute2004.101CHINA:

Adevelopingcountrywithahuge

populationof1.3billions*Eventhegrowingpaceofthepopulationhasgraduallysloweddown

Increasingrate:stillashighas0.7%peryear

Outof16.6millionsofnewborns>100,000babieswithCHD(6.7‰)areaddedeachyear*ReportoftheMinistryofPublicHealth.20012PotentialPatients

whomayneedcardiacsurgery:Myocardialinfarction2.967millions*Rheumaticvalvulardisease2.235millionsCongenitalheartdisease1.80-1.95millions

（6.7‰innewborns)Idiopathiccardiomyopathy1.60millions**Others

Total>8millions*GuDongfeng.PrevalenceofcardiovasculardiseasesinChina42ndconferenceoncardiovasculardiseaseepidemiologyandprevention2002.04Hawaii**YubaoZouetal.AmJMedicine2004,116:14-83CABGhasgradually

surpassedvalveoperationsFu-WaiHospital5LimitedMedicalresources

ThecapacityofcardiacsurgeryThereareabout900cardiothoracicunits(includingabout500heartunits)Nearly80,000heartoperationsin200313bigheartcenters(>1000openhearts/year)

(阜外,安貞,新華,上海中山,長(zhǎng)海,武漢協(xié)和,亞心,霍英東,湘雅,沈軍區(qū),華西,四醫(yī)大,三醫(yī)大…)

6Ourmission:

Millionsofheartoperations/yAnotherhundredofheartcentersasbigasFu-waihearthospitalorasgoodasTHIshouldbebuiltupinChina.Awholenetworkofserviceandareliableinsurancesystemnationwidealsoshouldbeestablished.71.Increasingnumberofbaby-patients蘇肇伉：心血管病國(guó)際論壇2004.09北京characteristic349operationsofcomplicatedcongenitalheartdiseases.

57％under6monthsofage

徐志偉)*：

*晚期心臟病外科治療研討會(huì)，上海2004Surgeryof

CongenitalHeartDisease8ImprovementofCoronarySurgeryFirstCABG1974GuoJiaqiang10Off-pumpCoronarybypassNumberofOPCABhasbeenincreasingOutoftotalnumberofCABG,20%-30%areoff-pumpingeneral.Aseriesof1198cases(79.5%oftotalCABG)Mortality

1.2%EarlyresultsweresatisfactoryItwas46%atFWH200312EtiologyofValveDisease

ThemajorityofheartvalvediseasewasrheumaticCongenitaldegenerative(FuWaiHospital1997~2003)HeartValveSurgery:14TechnicallypopularizedMVR>AVRValveprosthesis:

Mechanical>90%:G-K,Lanzhou,St.Jude,MAFW97-03ValveReplacementFirstcase--1965CaiYongzhi,Tissuevalves:muchless(becauseofyoungerageandre-operation..)HomemadePericardialSince1976,Thelongest:AVR-21y;MVR-21y15ValveRepairAmongthemitralvalveoperations

Onlyaround10%----repairAvarietyofplasticringsareused

Alfieriedgetoedgetechnique:forischemicmitralregurgitationTV：Exclusively

---reconstructiontechniqueDeVegaorRingAVrepair:Onlylimitedindications

AS,Prolapseofleaflets,AV-ringdilatation16MinimallyInvasiveProcedures

forheartvalvesurgeryRightthoracotomyPartialsternotomyBeatingheartwithECCEndoscopyassisted

11%FuWaiHospitalData:1997~2000)17SurgeryofAorticAneurysmTheaorticarchreplacementwasstarted----1960th

Theoperativemortalityofdissectinganeurysmhascomedownto6.8%-10.1%recently.Surgery+Intra-vascularinterventionElephantprocedure

60cases(FWH1997-2003)Ascendingaortaandtotalarchreplacementcombinedwithstentedgraftimplantationintothedescendingaorta18

AnewdesignatFWHThe3rdGenerationofVADMegneticactivatedsubaorticpump

SurgicalTreatmentfor

EndstageHeartFailure

continue2.Ventricularassistdevice(VAD)Novacor,BAS,Meados,BerlinHeartItistooexpensiveandcomplextechnically20SurgicalTreatmentfor

EndstageHeartFailure3.Celltransplantation

Itisnowonlyinthestageofbasicresearch,andveryfewprimaryclinicaltrial.

Mostly:Usingmarrowstemcells(putstemcellsintocoronaryartery)Continue21SummarycontinueCardiacsurgeryinChinaisnowatitsfullspeedofdevelopment.Fromthepointoftechnologyinthefieldofcoronaryandvalvularsurgery,thereisnosignificantgapcomparedwithde