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1CardiacSurgeryinChinaCurrentstatusandSomeCharacteristicsZhuXiaodongFuwaiCardiovascularInstitute2004.102CHINA:Adevelopingcountrywithahugepopulationof1.3billions*EventhegrowingpaceofthepopulationhasgraduallysloweddownIncreasingrate:stillashighas0.7%peryearOutof16.6millionsofnewborns>100,000babieswithCHD(6.7‰)areaddedeachyear*ReportoftheMinistryofPublicHealth.20013PotentialPatientswhomayneedcardiacsurgery:Myocardialinfarction2.967millions*Rheumaticvalvulardisease2.235millionsCongenitalheartdisease1.80-1.95millions（6.7‰innewborns)Idiopathiccardiomyopathy1.60millions**OthersTotal>8millions*GuDongfeng.PrevalenceofcardiovasculardiseasesinChina42ndconferenceoncardiovasculardiseaseepidemiologyandprevention2002.04Hawaii**YubaoZouetal.AmJMedicine2004,116:14-84DistributionofdifferentkindsofheartoperationsIngeneral:Numberone:Congenital(60%-65%)Second:Valvesurgery(20%-25%);Third:Coronarysurgery(10%-20%）*CABG>50%infewunitsFuwaiHospital：(1977~2003)25,279casesCongenitalCABGValves5CABGhasgraduallysurpassedvalveoperations010203040506020022003CongenitalCoronaryValvesAVaneurysmOthersFu-WaiHospital6LimitedMedicalresourcesThecapacityofcardiacsurgery•Thereareabout900cardiothoracicunits(includingabout500heartunits)•Nearly80,000heartoperationsin2003•13bigheartcenters(>1000openhearts/year)(阜外,安贞,新华,上海中山,长海,武汉协和,亚心,霍英东,湘雅,沈军区,华西,四医大,三医大…)7Ourmission:Millionsofheartoperations/yAnotherhundredofheartcentersasbigasFu-waihearthospitalorasgoodasTHIshouldbebuiltupinChina.Awholenetworkofserviceandareliableinsurancesystemnationwidealsoshouldbeestablished.81.Increasingnumberofbaby-patients01020304050Case1973-199015261991-19992150NeonateYoungInfant苏肇伉：心血管病国际论坛2004.09北京characteristic349operationsofcomplicatedcongenitalheartdiseases.57％under6monthsofage徐志伟)*：*晚期心脏病外科治疗研讨会，上海2004SurgeryofCongenitalHeartDisease92.MorecomplicatedanomaliesAbout25％arecomplicatedcasesOveralloperativemortality------10%to15％Unlikewesterncountries,mostcyanoticcasesareTetralogyofFallot(mortality1.1%-5%)Becauseofsmallpercentageofneonates.Inaseriesof115neonatesofcongenitalheartdiseasenearly50%ofthemwereTGA**苏肇伉：心血管病国际论坛2004.09北京SurgeryofCongenitalHeartDiseaseContinue10ImprovementofCoronarySurgeryFirstCABG1974GuoJiaqiang1110%-20%oftotalnumberofheartoperationsingeneral(infewheartcenters,thepercentageofCABGhasbeenashighas50%)Operativemortality:2%-3%inbigcentersThenumberofCABG0%1%2%3%4%5%19961997199819992000200120022003YearMortalityFWH12Off-pumpCoronarybypassNumberofOPCABhasbeenincreasingOutoftotalnumberofCABG,20%-30%areoff-pumpingeneral.Aseriesof1198cases(79.5%oftotalCABG)Mortality1.2%Earlyresultsweresatisfactory79336317374195586466513375214610342861288593020040060080010001200140019961997199819992000200120022003CABGOPCABItwas46%atFWH200313Promotion&competitionfromPTCAPTCAhasbeenincreasingmuchfasterinrecentyearsEspeciallysincedrug-elutingstentcameintouse.SirolimuselutingstenthasbeenwidelyusedinChina.PTCAwasoneandahalftimesmorethanCABGatFWHPTCAisstillfacing“re-stenosis”Guidelineupdate:severeproximalLADstenosisand/or3-vesseldiseasemayachieveimprovedsurvivalwithCABG.So,Surgeonswillhavemorecomplicatedorrestenosiscases.59.80%1.81%2.11%2.21%5.73%8.54%19.80%ReumasticCongenitalDegenerateGreatVessleSBECADOthersEtiologyofValveDiseaseThemajorityof...