支架和无支架主动脉瓣膜植入的技术要点和技巧.ppt

* * * * * * * * * * * * * * Top Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini –sternotomy Minimally Invasive AVR Top Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the valve size ahead of time Open aorta widely Most aortic valve procedures can be done through a mini –sternotomy Top Ten Tips and Tricks Replace ascending aorta if 4 cm especially with bicuspid valve No advantage of stentless over stented valves except as a root replacement in small aortic root patients Reinforce aortotomy suture line with autologous or bovine pericardium in patients with fragile aortas (elderly females) Pledgets not necessary (and can narrow outflow tract) Supra-annular implantation If PPM, then aortic root enlargement or stentless aortic root replacement Use sizing charts to avoid patient-prosthesis mismatch (PPM) Know the annulus size ahead of time (also STJ and LVOT) Open aorta widely Most aortic valve procedures can be do