1 / 20

Limites de la chirurgie cardiaque

Limites de la chirurgie cardiaque. Patrick NATAF Bichat Hospital, Paris, France. RVAo traditionnel. Sternotomie CEC Clampage aortique Cardioplégie. Aortic Valve Replacement. Surgery is the Gold Standard. 30-Day Mortality Euro Heart Survey and Surgical Registers.

deacon
Download Presentation

Limites de la chirurgie cardiaque

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Limites de la chirurgie cardiaque Patrick NATAF Bichat Hospital, Paris, France

  2. RVAo traditionnel • Sternotomie • CEC • Clampageaortique • Cardioplégie

  3. Aortic Valve Replacement Surgery is the Gold Standard 30-Day MortalityEuro Heart Survey and Surgical Registers

  4. Thirty-Day Mortality and Actuarial Survival Rates in Patients 80 Years of Age Receiving Bioprosthesis UK Heart Valve Registry. Circulation. 1997;96:3403-3408

  5. COMORBIDITES European Society of Cardiology – Euro Heart Survey

  6. Patients Inopérables par RVAo conventionnel • Co-morbidités majeures • Absence de réserve contractile • Patients grabataires • Difficultés techniques ++++ • Aorte porcelaine • Maladie athérosclérotique sévère de l’aorte ascendante • Greffons perméables (redux de pontages) • Radiotherapie thoracique/médiastinale

  7. Remplacement Valvulaire Aortique RVA percutané RVA transapical RVA conventionnel CEC + Cardioplegie

  8. CoreValve Revalving TM System (CRS) Treated Bovine Tissue Edwards SAPIEN™ THV

  9. Voie Fémorale Voie transapicale Techniques d’implantation 22 or 24F 18F 33 then 26 F

  10. Principes de base • Mini-thoracotomie gauche • Exposition de pointe du cœur • Dilatation de la pointe du cœur • Mise en place du guide • Expansion de la valve sur ballon • Fermeture

  11. Bichat Hospital, ParisSeptember 2007 to May 2008 EuroSCORE≥ 20% orSTS PROM ≥ 10% or C/I to AVR n=115 TF TAVI 35 (30%) CI to TF TAVI 80 (70%) Iliac diameter: 45 (56%) Annulus diameter: 9 (11%) Miscellaneous: 26 (33%) Conventional AVR 19 (17%) Symptomatic Rx 46 (40%) TA TAVI 15 (13%) Ann. Thorac. Surg., 2009; 87: 1757 - 1763

  12. One year survival 1,0 0,9 TF AVI 83±5% Overall 0,8 79±4% TA AVI 0,7 69±9% 0,6 0,5 Survival 0,4 0,3 p = 0.18 0,2 0,1 0,0 0 100 200 300 400 days TF AVI 47 35 28 19 Overall 68 50 40 28 TA AVI 21 15 12 8

  13. Functional status at last FU 13% 39% 48%

  14. Et la chirurgie coronaire?

  15. PCI and CABG both feasible

  16. Absence de réseau coronaire visible et patient très symptomatique

  17. Skeletonized harvesting & Y LIMA-RIMA grafting

  18. Coronary tree reconstruction

  19. Existe-t-il des Patients Inopérables ? RAPPORT RISQUE/BENEFICE: • Co-morbidités majeures • Patients grabataires • Absence de réserve contractile DIFFICULTES D’ORDRE TECHNIQUE: • Anatomie défavorable • Aorte porcelaine ou athérome sévère de l’aorte ascendante • Greffons perméables (redux de pontages) • Radiotherapie thoracique/médiastinale…

More Related