文档介绍：该【主动脉瓣移植的临床展望课件 】是由【glfsnxh】上传分享，文档一共【19】页，该文档可以免费在线阅读，需要了解更多关于【主动脉瓣移植的临床展望课件 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。3/98
*
ValveProsthesis
Mechanical
types:caged-ball,tilting-disk,bi-leaflet
advantage:durability
limitation:thrombogenicity
Bioprosthetic
types:heterografts,homografts
advantage:shorttermanticoagulation
limitation:structuralfailure
3/98
*
MechanicalValveProsthesis
Types
caged-ball(Starr-Edwards)
tilting-disk(Medtronic-Hall)
bileaflet(StJude)
Advantage:durability(1)
Limitation:thrombogenicity
;335:407-416
3/98
*
BioprostheticHeterografts
advantage
longtermanticoagulationunnecessary(1)
limitation:structuralfailure
leafletcalcification&tissuedegenerationleadingtovalvularregurgitation
stenosisisuncommon
rateofporcinevalvedegeneration 26%(aortic),39%(mitral)in10yrs(2)
;329:524-529
;49:370-383
3/98
*
BioprostheticHomografts
1956-firstaorticvalvehomograftwasusedinthedescendingthoracicaortaforaorticregurgitation
1962-firstsub-coronaryuse
highincidenceofpost-opfailure*
(years) 5 10 15 20
survivalrate(%) 85 66 53 38
re-operation(%) 22 62 85 95
*Circulation1991;84(suppl3):III81-III88
3/98
*
BioprostheticHomografts
earlypreservationtechniques
formaldehyde,chlorhexidine,propiolactone,ethyleneoxide, -irridiation,freezingat-70oC
graftsarenonviable
highincidenceofcusprupture
3/98
*
BioprostheticHomografts advances
Improvingvalvedurability
newerpreservationtechniques:cryopreservationbyliquidnitrogenwithlow-doseantibiotics
homovitalgrafts(freshunpreserved)
reducedtimeforgraftprocurement
donorratherthanautopsyspecimens
3/98
*
BioprostheticHomografts UniversityofAlabama
1981-1991
cryopreservedaorticgraftsin178pts
survivalrate
91%at1year
85%at8years
freedomfromre-operation
95%at8years
JThoracCardiovascSurg1993;106:154-165
3/98
*
BioprostheticHomografts PrinceCharlesHsopital
1975-1994
cryopreservedaorticgraftsin680pts
%
survivalrate
77%at10year;45%at20years
freedomfromre-operation
69%at15years
O’;60:S65-S70
3/98
*
Homovitalhomografts London
graftsareharvested,storedintissueculturemedium,andusedin3days
275graftsimplantedover13years:147subcoronary,128aorticroot
notransmissionofdiseasereported
cumulativesurvival
85%at10yrs(94%intheaorticrootgp)
freedomfromre-op:91%in10yrs
JThoracCardiovascSurg1995;110:186-193
3/98
*
BioprostheticHomografts implantationtechniques
Freehandscallopedtechnique
retentionofminimaldonortissue
technicallychallenging,requireexactsizingtopreventregurgitation
Cylindertechnique
retentionofnativeaorticsinusesandsinotubularjunction
requirescoronaryreimplantation
AnnThoracSurg1996;62:1069-1075