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1、 LIBEI TheActualityandDevelopmentofCoronaryArterysurgery LiBeiMD INTRODUCTION CoronaryArteryDisease CAD isoneofthemostcommonandseriouseffectsofaging Fattydepositsbuildupinbloodvesselwallsandnarrowthepassagewayforthemovementofblood Theresultingcondition calledatherosclerosisoftenleadstoeventualblocka
2、geofthecoronaryarteriesanda heartattack Since1900 CADhasbeentheNo 1killerintheUnitedStateseveryyearbut1918 Nearly2 600AmericansdieofCADeachday anaverageof1deathevery33seconds CADclaimsmoreliveseachyearthanthenext5leadingcausesofdeathcombined whicharecancer chroniclowerrespiratorydiseases accidents d
3、iabetesmellitus influenzaandpneumonia Almost150 000AmericanskilledbyCADeachyearareunderage65 Betyoudidn tknow INCHINA From1984 1998 themortalityratehasrisen CADhasbeentheNo 3killerinChina In2003 theprevalencerateofCADis4 6 In2004 themortalityrateofCADis46 27 100thousand Thisrateislowerthantheratein2
4、000Newtrend thepatientsarebecomemoreandmoreyounger from1984 1998 themortalityrateofyoungmankindhaslargelyrisen theextentreachto154 dataiscomefrom TheChineseCardiovascularDiseasereport2005 ThesecelebritiesarealldiedofCAD mostofthemarenotveryold Theredeathevokedpeople smoreattentiontoCAD THERISK Hyper
5、tensionSmokingAbnormityofbloodlipidObesityoroverweightAbnormityofbloodsugarUnhealthylifestyle RiskFactors Uncontrollable SexHereditaryRaceAge Controllable HighbloodpressureHighbloodlipidSmokingPhysicalactivityObesityDiabetesStressandanger SignsandSymptoms None Thisisreferredtoassilentischemia Bloodt
6、oyourheartmayberestrictedduetoCAD butyoudon tfeelanyeffects Chestpain Ifyourcoronaryarteriescan tsupplyenoughbloodtomeettheoxygendemandsofyourheart theresultmaybechestpaincalledanginapectorisShortnessofbreath SomepeoplemaynotbeawaretheyhaveCADuntiltheydevelopsymptomsofcongestiveheartfailure extremef
7、atiguewithexertion shortnessofbreathandswellingintheirfeetandankles Heartattack Resultswhenanarterytoyourheartmusclebecomescompletelyblockedandthepartyofyourheartmusclesfedbythatarterydies Signs Symptoms None ChestPain ShortnessOfBreath HeartAttack Electrocardiogram wecanseetheECGsignsofmyocardialis
8、chemiaorinjury ThisisvaluableforourdiagnosesCoronaryAngiography thisisaveryusefultest theresultwouldbethekingstandardforthediagnoses ItalsocandefinitudethepathologicalarteriesBloodtests usedtoevaluatekidneyandthyroidfunctionaswellastocheckcholesterollevelsandthepresenceofanemia ChestX ray showsthesi
9、zeofyourheartandwhetherthereisfluidbuilduparoundtheheartandlungs Echocardiogram showsagraphicoutlineoftheheart smovement TestsInclude Manypeopleareabletomanagecoronaryarterydiseasewithlifestylechangesandmedications Otherpeoplewithseverecoronaryarterydiseasemayneedangioplasty PCI orsurgery CABG Treat
10、ment Treatment continued 1 Stenting astentisintroducedintoabloodvesselonaballooncatheterandadvancedintotheblockedareaofthearterytheballoonistheninflatedandcausesthestenttoexpanduntilitfitstheinnerwallofthevessel conformingtocontoursasneededtheballoonisthendeflatedanddrawnbackThestentstaysinplaceperm
11、anently holdingthevesselopenandimprovingtheflowofblood surgicalTreatment continued Bypasssurgery healthybloodvesselisremovedfromleg armorchestbloodvesselisusedtocreatenewbloodflowpathinyourheartthe bypassgraft enablesbloodtoreachyourheartbyflowing around bypassing theblockedportionofthediseasedarter
12、y Theincreasedbloodflowreducesanginapectorisandtheriskofheartattack ConventionalCABG internationalrecognition 1onearterygraft leftinternalmammaryarteryorleftsubclavianartery 2othersareveinGrafts greatsaphenousvein ThebestgraftforCABG ITA ITA internalthoracicartery isthebestgraftandincommonuse Datash
13、ows 10yearsafteroperation 90 patients ITAgraftsarestillpatencyITAcanrisethelivability decreasetheheartattackandre operationSTSDatabaseshows inAmerican 88 patientsuseoneITA InEngland therateis90 Inourhospital XiangYahospital therateisalso90 oneITAmustbeused BITAORALLARTERIALGRAFT Somehospitalusingtwo
14、ITAs DoseitbetterthansingleITA conclusion InAmerican only3 5 patientsuseBITA Wealsocanusemorethan2arterialgrafts Theyare ITA oneortwo RA radialartery andGE rightgastroepiploicartery It sbetterforyoungpatientstouseBITA Thiswayisnotaroutine SITAvsBITA AnnThoracSurg2004 78 2005 14 Operativemethods On p
15、umpCABG70 80 Off pumpCABG20 30 Difference whiletheheartisarrestedandusecardiopulmonarybypassornotwhenoperating TheconclusionfromAHA AmericanHeartAssociation Circulation 20051 on pumpandoff pump whichisbetterisstillunconfirmed Becausethemortalityrate neuralfunctionandtheheartfunctionafteroperationiss
16、tillanalogical 2 Bothofthemhavegoodcurativeeffect nomatteron pumporoff pumptheybothcanimprovetheprognosis Butthepatients prognosisismoredependonothernon operativefactors 3 AlotofresearchindicatedthatthemortalityrateofCABGhasgreatdifference from1 to6 Thatmeanstheoperator stechnique theholisticmedicallevelandthepatients ownconditionwillaffecttheprognosisalot Off pumpismorebetter Off pumpONPUMP TechnicaldifficultyissmallDoctorscangraspthisoperativewayfastthegraftscanbepatencyforlongtimeafteroperati
