1、心脏瓣膜病手术时机10/19/20221心脏瓣膜病手术时机10/19/20222心脏瓣膜病手术时机10/19/20223心脏瓣膜病手术时机10/19/20224心脏瓣膜病手术时机10/19/20225心脏瓣膜病手术时机10/19/20226心脏瓣膜病手术时机10/19/20227心脏瓣膜病手术时机10/19/20228心脏瓣膜病手术时机10/19/20229心脏瓣膜病手术时机10/19/2022102022-10-1911心脏瓣膜病手术时机10/19/202212心脏瓣膜病手术时机10/19/202213心脏瓣膜病手术时机10/19/202214推荐级别：推荐级别：IIIa心脏瓣膜病手术时机1
2、0/19/202215手术指征 (Indication of Operation)Guidelines on the management of valvular heart disease(version 2012)BSA=体表面积；LV=左心室；LVEF=左心室射血分数；LVESD=左心室收缩末内径SPAP=肺动脉收缩压a推荐级别b证据水平推荐级别：推荐级别：IIb心脏瓣膜病手术时机10/19/202216症状否是LVEF60%60%或或LVESD45mmLVESD45mm否是是是LVEF30%否新发生的AF或SPAP50mmHg否否否否药物难治型药物难治型持久性瓣膜修复的可能，且伴发疾病
3、持久性瓣膜修复的可能，且伴发疾病少少持久性瓣膜修复的可能性大，外科持久性瓣膜修复的可能性大，外科手术风险低，存在危险因素手术风险低，存在危险因素是是随访外科手术外科手术如果可能修复如果可能修复扩展的扩展的HF治疗治疗药物治疗药物治疗是心脏瓣膜病手术时机10/19/202217Rosenhek R,Rader F,Klaar U,Gabriel H,Krejic M,Kalbeck D,Schemper M,Maurer G,Baumgartner H.Outcome of watchful waiting in asymptomatic mitral regurgitation.Circula
4、tion 2006;113:22382244.心脏瓣膜病手术时机10/19/202218Montant P,Chenot F,Robert A,Vancraeynest D,Pasquet A,Gerber B,Noirhomme P,El Khoury G,Vanoverschelde JL.Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation:a propensity scorebased comparison between an early surgical s
5、trategy and a conservative treatment approach.J Thorac Cardiovasc Surg 2009;138:13391348.重度二尖瓣关闭不全但为达到指南标准：早期手术 vs.保守治疗（总体生存率，心血管生存率、脑血管生存率的对比）心脏瓣膜病手术时机10/19/202219Montant P,Chenot F,Robert A,Vancraeynest D,Pasquet A,Gerber B,Noirhomme P,El Khoury G,Vanoverschelde JL.Long-term survival in asymptomat
6、ic patients with severe degenerative mitral regurgitation:a propensity scorebased comparison between an early surgical strategy and a conservative treatment approach.J Thorac Cardiovasc Surg 2009;138:13391348.重度二尖瓣关闭不全但为达到指南标准：早期手术、保守治疗并规则随访、保守治疗未规则随访（总体生存率，心血管生存率、脑血管生存率的对比）心脏瓣膜病手术时机10/19/202220心脏瓣膜
7、病手术时机10/19/2022212022-10-1922心脏瓣膜病手术时机10/19/202223心脏瓣膜病手术时机10/19/202224心脏瓣膜病手术时机10/19/202225心脏瓣膜病手术时机10/19/202226左房前后径90mm右房131*174mm心脏瓣膜病手术时机10/19/202227心脏瓣膜病手术时机10/19/202228心脏瓣膜病手术时机10/19/202229心脏瓣膜病手术时机10/19/202230保留二尖瓣瓣下结构的保留二尖瓣瓣下结构的二尖瓣置换术二尖瓣置换术心脏瓣膜病手术时机10/19/202231心脏瓣膜病手术时机10/19/202232心脏瓣膜病手术时机10/19/202233心脏瓣膜病手术时机10/19/202234心脏瓣膜病手术时机10/19/202235心脏瓣膜病手术时机10/19/202236心脏瓣膜病手术时机10/19/202237谢谢 谢谢2016-我们风雨同舟我们风雨同舟2017-我们携手前行我们携手前行心脏瓣膜病手术时机10/19/202238
