房颤的外科治疗课件.ppt

Van Gogh;房颤的患病率;“食物链”的顶端;房颤外科手术治疗;HRS/EHRA/ECAS 有关房颤导管及外科消融的教授共识: 对于人员，政策，程序及随访的提议;消除全部假设的双房折返环路 切-和-缝技术: 双房线性消融+ LA/RA 大部切除 + PV隔离);房颤的病理生理学;房颤外科消融治疗的基本原理形成两种措施: ;房颤外科治疗的目的;;Isolator? Atricure ;射频 (单极) 干燥 [Osypka / BSC-Estech Thermaline, Cobra] 需要压力保持探头-组织之间的接触/电传导/预防阻抗过高 使用时间Osypka 10 – 30 秒/ BS 60 – 120 秒 并发症- 食道穿孔(~ 1%) 灌注 [Medtronic] 电极与冷盐水相连，不需要压力 提升电阻加热的深度 经过传导继发被动加热是必需的; Flex 4?, Afx 使用 心内膜l: 60 sec.  心外膜l: 90 sec. 65 瓦 最大. 一次使用 ;措施 正中切口 前部小切口 使用 心外膜; 氩气冷却装置 (最大-160°C) 可变冷冻部分 (4 mm- 100 mm ) 灵活的弯曲尖端的外科低温探头 –适合解剖形状 T型温热电偶用以监测探头尖端的温度变化 一次性使用 ;对于接受微创二尖瓣手术的房颤患者可使用冷冻消融;患者和措施;左房消融位置;术前患者特征;围手术期成果;随访;消融工艺;;经胸小切口;定位装置以“关胸”;消融部位;暴露;三角区消融检测;总结 ;;Van Gogh;Prevalence of atrial fibrillation;End of “food chain”;Surgical treatment of atrial fibrillation;HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up;Elimination of all hypothetic biatrial reentry circuits Cut-and-sew technique: Biatrial linear lesions + LA/RA mass reduction + PV-Isolation);Pathophysiology of Atrial Fibrillation;The rationale for the surgical treatment of AF ablation consists of two approaches: ;Aims of Surgical Treatment of Atrial Fibrillation;;Isolator? Atricure ;Radiofrequency (Unipolar) Dry [Osypka / BSC-Estech Thermaline, Cobra] Pressure required to maintain probe - tissue contact / electrical conduction / prevent excessive impedance Application time Osypka 10 – 30 sec / BS 60 – 120 sec Complications - Oesophageal perforation (~ 1%) Irrigation [Medtronic] Electrical coupling by saline and NOT Pressure Increases depth of direct resistive heating Secondary passive heating by conduction is necessary; Flex 4?, Afx Application endocardial: 60 sec.  epicardial: 90 sec. 65 Watt max. Single use ;Approach Median sternotomy Small anterior incision Application Epicardial; Argon gas cooled system (max-160°C) Variable freezing s