心胸麻醉进展

null心胸麻醉进展 The advancement of cardiothoracic anesthesia心胸麻醉进展 The advancement of cardiothoracic anesthesia2012VAT房颤射频消融术VAT房颤射频消融术术后6m有效率>90% TEE排除左心耳血栓 胸外除颤电极 无需肝素化 OLV 麻醉体会 较侧卧易低氧症；阻断肺静脉时低血压。 瓣膜病治疗进展瓣膜病治疗进展Transcatheter transseptal double-orifice repair,　短、中期明显缓解MVR. nullHemodynamic Outcome of a Double MitraClip Implant (A) Bidimensional echocardiography at 60° to show the intercommissural view. Two clips are implanted in the middle of the valve. (B) The diastolic flow shows no turbulence. (C) A residual minimal jet is found laterally to the second implanted clip.Minimally Invasive Valve SurgeryMinimally Invasive Valve Surgery创伤小； 相对长的主A阻断时间和CPB时间； 相同死亡率和CNS损伤； 股A灌注可能使老年病患术后中风风险高. 麻醉体会 OLV，体外除颤，放置右侧CVP（左颈内16~18F辅助静脉引流），TEE引导静脉导管置入，CPB中持续CVP测量。 null示经股静脉插入的静脉引流管，需使其开口位于上腔静脉入口。nullTranscatheter Aortic Valve ImplantationTranscatheter Aortic Valve Implantation适用于不能耐受常规瓣膜手术的重度主动脉瓣狭窄病人，经股动、静脉，或经心尖。 30d死亡率12~14%，而经心尖为6~10% 麻醉挑战，心功差，高龄且合并症多 全麻，或局麻结合深度镇静 ADVANCES IN CORONARY ARTERY DISEASEADVANCES IN CORONARY ARTERY DISEASECoronary Artery Surgery in Heart Failure An assessment of myocardial viability did not correlate with enhanced survival after CABG surgery as compared with medical therapy. In patients with triple-vessel coronary artery disease, CABG surgery offers better relief from angina than PCI with drugeluting stents. Patients with significant ischemic but viable myocardium in the distribution of a coronary artery with severe proximal disease should be revascularized whether by PCI or CABG surgery.ADVANCES IN HEMATOLOGY ADVANCES IN HEMATOLOGY The Oral Factor Xa Inhibitors Rivaroxaban 利伐沙班, Apixaban 阿哌沙班 拮抗药物尚处于研究阶段，prothrombin complex Thrombin Inhibitors Dabigatran 达比加群，快速起效，无需监测，但没有拮抗剂。其导致的严重出血需要recombinant activated factor VII治疗 Blood ConservationBlood ConservationPreoperative Interventions for Blood Conservation Erythropoeitin Antifibrinolytic Therapy Fresh Frozen Plasma, Recombinant factor VIIa, Factor XIII, Factor IX Leukoreduction, platelet plasmapharesis, and blood salvage are all components of a multimodal approach to optimize perioperative transfusion practice.