冠心病外科治疗英文.ppt

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,LI BEI,The Actuality and Development of,Coronary Artery surgery,Li Bei,MD,INTRODUCTION,Coronary Artery Disease（CAD)is one of the most common and serious effects of aging.Fatty deposits build up in blood vessel walls and narrow the passageway for the movement of blood.The resulting condition,called atherosclerosis often leads to eventual blockage of the coronary arteries and a“heart attack”.,Since 1900,CAD has been the No.1 killer in the United States every year but 1918.,Nearly 2,600 Americans die of CAD each day,an average of 1 death every 33 seconds.,CAD claims more lives each year than the next 5 leading causes of death combined,which are cancer,chronic lower respiratory diseases,accidents,diabetes mellitus,influenza and pneumonia.,Almost 150,000 Americans killed by CAD each year are under age 65.,Bet you didnt know.,IN CHINA,From 19841998,the mortality rate has risen.CAD has been the,No.3 killer in China.,In 2003,the prevalence rate of CAD is,4.6,In 2004,the mortality rate of CAD is,46.27/100thousand.,This rate is lower than the rate in 2000,New trend:the patients are become more and more younger,from 19841998,the,mortality rate of young mankind has largely risen,the extent reach to 154%,data is come from,The Chinese Cardiovascular Disease report 2005,These celebrities are all died of CAD.most of them are not very old.There death evoked peoples more attention to CAD,THE RISK,Hypertension,Smoking,Abnormity of blood lipid,Obesity or overweight,Abnormity of blood sugar,Unhealthy lifestyle,Risk Factors,Uncontrollable,Sex,Hereditary,Race,Age,Controllable,High blood pressure,High blood lipid,Smoking,Physical activity,Obesity,Diabetes,Stress and anger,Signs and Symptoms,None:This is referred to as silent ischemia.Blood to your heart may be restricted due to CAD,but you dont feel any effects.,Chest pain:If your coronary arteries cant supply enough blood to meet the oxygen demands of your heart,the result may be chest pain called angina pectoris,Shortness of breath:Some people may not be aware they have CAD until they develop symptoms of congestive heart failure-extreme fatigue with exertion,shortness of breath and swelling in their feet and ankles.,Heart attack:,Results,when an artery to your heart muscle becomes completely blocked and the party of your heart muscles fed by that artery dies.,Signs&,Symptoms,None,Chest,Pain,Shortness,Of Breath,Heart,Attack,Electrocardiogram,：,we can see the ECG signs of myocardial ischemia or injury.This is valuable for our diagnoses,Coronary Angiography,:this is a very useful test,the result would be the king standard for the diagnoses.It also can definitude the pathological arteries,Blood tests,:used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia.,Chest X-ray,:shows the size of your heart and whether there is fluid build up around the heart and lungs.,Echocardiogram,:shows a graphic outline of the hearts movement,Tests Include,Many people are able to manage coronary artery disease with lifestyle changes and medications.,Other people with severe coronary artery disease may need angioplasty(PCI)or surgery(CABG).,Treatment,Treatment(continued),1)Stenting,a,stent,is introduced into a blood vessel on a balloon catheter and advanced into the blocked area of the artery,the balloon is then inflated and causes the,stent,to expand until it fits the inner wall of the vessel,conforming to contours as needed,the balloon is then deflated and drawn back,The,stent,stays in place permanently,holding the vessel open and improving the flow of blood.,surgical Treatment(continued),Bypass surgery,healthy blood vessel is removed from leg,arm or chest,blood vessel is used to create new blood flow path in your heart,the“bypass graft”enables blood to reach your heart by flowing,around(bypassing)the blocked portion of the diseased artery.The increased blood flow reduces angina pectoris and the risk of heart attack.,Conventional CABG（international recognition）,1 one artery graft,(left internal mammary artery,or,left subclavian artery),2 others are vein,Grafts,(great saphenous vein),The best graft for CABGITA,ITA（internal thoracic artery）is the best graft and in common use.Data shows,10 years after operation,90%patients ITA grafts are still patency,ITA can rise the livability,decrease the heart attack and re-operation,STS Database shows,in American,88%patients use one ITA;In England,the rate is 90%;In our hospital(XiangYa hospital),the rate is also 90%.,one ITA must be used!,BITA OR ALL ARTERIAL GRAFT,Some hospital using two ITAs.Dose it better than single ITA?(,conclusion,)In American,only 3.5%patients use BITA.,We also can use more than 2 arterial grafts.They are:,ITA,(one or two);,RA,(radial artery)and,GE,(right gastroepiploic artery),Its better for young patients to use BITA!,This way is not a routine!,SITA vs BITA,Livability,7 years,10years,15years,20 years,SITA,87,78,58,37,BITA,89,81,67,50,Ann Thorac Surg 2004；78：2005-14,Operative methods,On-pump CABG 70-80%,Off-pump CABG 20-30%,Difference：while the heart is arrested and use cardiopulmonary bypass or not when operating,The conclusion from AHA(,American Heart Association,),Circulation，2005,1、,on-pump and off-pump,which is better is still unconfirmed.,Because the mortality rate,neural function and the heart,function after operation is still analogical.,2、Both of them have good curative effect,no matter on-pump,or off-pump they both can improve the prognosis.But the,patients prognosis is more depend on other non-operative,factors.,3,、,A lot of research indicated that the mortality rate of CABG has,great difference,from 1%to 6%.That means the operators,technique,the holistic medical level and the patients own,condition will affect the prognosis a lot.,Off-pump is more better?,Off-pump ON PUMP,Technical difficulty,is small,Doctors can grasp this operative way fast,the grafts can be patency for long time after operation,Easy to operating on the circumflex artery,Maybe a lot of grafts,Maybe a Little bleeding,Renal insufficiency,maybe seldom,Short-term neural,function injury maybe seldom,The number of days in hospital maybe small,(Circulation 2005 111:2858,evidencebased medicine,),On-pump or Off-pump？,depending on,the further research!,New Technique of coronary artery surgery in the last 10 years,Off-pump CABG,MIDCAB Minimally Invasive Direct Coronary,Artery Bypass（1-2 grafts）,R-CAB Robotic-coronary artery bypass,E-SVH,endoscopic saphenous vein harvesting,Thank you very much,MID-CAB,Robotic-CAB,Difficult,expensive,effect is unknown,E-SVH,The wound after E-SVH,E-SVH can reduce the complication of the wound,now 80%patients use this technique,the effect is,wonderful,The wound after normal way,