支架和無支架主動脈瓣膜植入的技術(shù)要點和技巧

MichaelMack,M.D.Dallas,TX

Shanghai1993成人人工主動脈瓣膜機械瓣生物瓣異種移植物帶支架不帶支架同種移植物自體移植物t(Ross)經(jīng)導(dǎo)管主動脈瓣置換NanjingRoad1993微創(chuàng)主動脈瓣置換微創(chuàng)主動脈瓣置換21.2mm20mmNanjingRoad1993Supra-annularImplantation無需

墊片!OutsidePeaceHotel1993無支架生物瓣膜主動脈二瓣化Shanghai1993

TechnicalTipsandTricksforStentedandStentlessAorticValves

MichaelMack,M.D.Dallas,TX

Shanghai1993ProstheticAorticValveOptionsForAdultsMechanicalTissueHeterograftStentedStentlessHomograftAutograft(Ross)TranscatheterAorticValveReplacementNanjingRoad1993TopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomyMinimallyInvasiveAVRTopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomyTopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)Knowtheannulussizeaheadoftime(alsoSTJandLVOT)OpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomy21.2mm20mmTopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUseEffectiveOrificeAreachartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomyNanjingRoad1993TopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomyTopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomySupra-annularImplantationTopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomyNoPledgetsNecessary!OutsidePeaceHotel1993TopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethroughamini–sternotomyTopTenTipsandTricksReplaceascendingaortaif>4cmespeciallywithbicuspidvalveNoadvantageofstentlessoverstentedvalvesexceptasarootreplacementinsmallaorticrootpatientsReinforceaortotomysuturelinewithautologousorbovinepericardiuminpatientswithfragileaortas(elderlyfemales)Pledgetsnotnecessary(andcannarrowoutflowtract)Supra-annularimplantationIfPPM,thenaorticrootenlargementorstentlessaorticrootreplacementUsesizingchartstoavoidpatient-prosthesismismatch(PPM)KnowthevalvesizeaheadoftimeOpenaortawidelyMostaorticvalveprocedurescanbedonethr