The Third Hospital of Beijing Medical University opened an outpatient clinic for valvular heart disease, and no thoracotomy was needed for valve replacement.

165438+1On October 8th, the outpatient department of valvular heart disease in the Department of Cardiology of Peking University Third Hospital was opened. Following the establishment of outpatient clinics for cardiovascular diseases such as heart failure, atrial fibrillation, anticoagulation, pacing and metabolism, the hospital has taken a new step on the road of cardiovascular precision medicine.

Professor Tang Yida, director of the Department of Cardiology, Peking University Third Hospital, introduced that the most advanced Transcatheter Aortic Valve Replacement (TAVR) will be carried out here, equipped with a multidisciplinary diagnosis and treatment (MDT) team composed of experts in endocardium, epicardium, respiration, anesthesia and rehabilitation. Under the dual escort of new technology and new mode, patients with moderate or severe aortic stenosis or reflux will benefit better.

TAVR surgery has created more treatment opportunities.

10 On June 55438+05, we intervened in the operating room of the Chest Pain Center of the Department of Cardiology, Third Hospital of Beijing Medical University, and a difficult TAVR was successfully completed. The team of experts led by Professor Tang Yida exchanged hearts for an 84-year-old patient with high-risk aortic stenosis and heart failure, and the old man regained his "heart" life.

"It is both risky and challenging to replace the aortic valve for the elderly." Professor Tang Yida said that the aortic valve opening of this patient is less than that of normal people 1/4, and his heart function is very bad, so he needs aortic valve replacement urgently. Conventional surgery needs to open the chest to replace the aortic valve, and the heart needs to stop beating during the operation, and cardiopulmonary bypass is used to keep the patient alive. Surgical trauma, bleeding, recovery time is longer. Moreover, this patient is old, with renal failure, less than normal 1/3, complicated with lung infection, and it is very likely that he will not be able to step down safely. Even if the operation is successfully completed, postoperative rehabilitation is very difficult.

After comprehensive evaluation, Professor Tang Yida suggested TAVR operation for patients. TAVR is a revolutionary interventional therapy technology, which accurately delivers a special artificial valve to the position of aortic valve through femoral artery intubation to replace the original diseased aortic valve. The operation avoids surgical thoracotomy and cardiopulmonary bypass, does not need blood transfusion, has little trauma and the patient recovers quickly after operation.

With the close cooperation of the team, the operation was a success. Postoperative ultrasound examination showed that the prosthetic valve in the elderly patients had good function and closely adhered to the original valve ring, and there was almost no common complication of TAVR- perivalvular leakage.

According to Professor Tang Yida, TAVR surgery means hope for some patients with severe aortic stenosis. He introduced that traditional surgery is the first choice for most patients with severe valvular disease, but there are risks such as large trauma, high postoperative mortality and many complications. Moreover, with the aging of the population, the incidence of senile valve degenerative diseases is getting higher and higher, and aortic stenosis has gradually become the most common valvular heart disease in this population. These elderly patients are basically unable to undergo thoracotomy because of their advanced age, poor health, serious illness or various diseases. TAVR surgery has broken this treatment dilemma because of its minimally invasive surgery.

After the establishment of the valvular heart disease clinic, TAVR operation will be carried out more smoothly in the Department of Cardiology of the Third Hospital of Beijing Medical University. "Once patients with valvular disease have symptoms, their health will turn sharply in the later period. In times of crisis, patients will go to the' green channel' for diagnosis and treatment through special disease clinics, be found and intervened at the first time, and perform TAVR surgery if necessary. " Professor Tang Yida said.

Multidisciplinary cooperation promotes individualized treatment

In addition to providing patients with more convenient and accurate access to medical treatment, MDT is another "good card" for the valvular heart disease clinic of the Department of Cardiology, Third Hospital of Beijing Medical University.

The outpatient department of valvular heart disease is mainly aimed at patients with aortic stenosis or reflux. This kind of patients are often older, with many clinical complications, poor heart function, and kidney and lung functions may also have problems. The risk of complications during surgery and the whole treatment process is relatively high. This requires close cooperation among departments including cardiology, anesthesiology, respiratory department, infection department, nutrition department, rehabilitation department and so on in the process of treatment and rehabilitation, so as to provide more perfect individualized treatment for patients.

MDT is an advanced diagnosis and treatment model developed in China in recent years. The Third Hospital of Beijing Medical University, as a well-known general hospital, has strong multidisciplinary support ability and accumulated rich experience in MDT. Nowadays, it is natural and easy to carry out MDT in the outpatient department of cardiac valvular disease in cardiology department.

Strong professional ability is the foundation. The Department of Cardiology of the Third Hospital of Beijing Medical University was established in 1958. It is a key discipline of the Ministry of Education, a well-known scientific research and teaching unit for diagnosis and treatment of cardiovascular diseases in China, a national training base for interventional therapy, pacing electrophysiology and cardiac rehabilitation of coronary heart disease, a certification unit of national chest pain center, and a construction unit of national heart failure center and atrial fibrillation center. In particular, this department cooperates with rehabilitation department to lead the domestic cardiac exercise rehabilitation, and rehabilitation education and training have become the basic treatment content of patients in cardiology department.

"In the past, the rehabilitation of patients with cardiovascular diseases was usually carried out after discharge. Now we advocate promoting rehabilitation-from discharge to hospitalization, from hospitalization to sickbed, and from sickbed to sickbed. Patients will soon receive training in grip strength and breathing after surgery, which will help restore their functions. " Professor Tang Yida said that the cardiac rehabilitation team of the Third Hospital of Beijing Medical University is very sound, with not only experts in nutrition and respiration, but also cooperation with Beijing Sport University.

How to cooperate with other specialists to realize the efficient operation of MDT mode in outpatient department of valvular heart disease? Xu Xinye, deputy chief physician of the Department of Cardiovascular Medicine of the Third Hospital of Beijing Medical University, said that the TAVR team is composed of physicians specializing in endocardium, epicardium, anesthesia, breathing, rehabilitation and nutrition, and has formed a relatively complete cooperation mechanism. Before, during and after the operation, the group provides full chain services for patients.

Xu Xinyi, for example, said that before each patient with aortic stenosis underwent TAVR surgery, the team would discuss the patient's condition and make suggestions on the diagnosis and treatment of the patient from various professional perspectives. The operation is mainly completed by cardiologists and anesthesiologists, while cardiac surgeons prepare for cardiopulmonary bypass and emergency operation to cope with severe hemodynamic instability during the operation. If the patient is complicated with or secondary to pulmonary infection and respiratory failure during perioperative period, the respiratory doctor will intervene in time. From the second day after operation, doctors from rehabilitation department and cardiac rehabilitation department will guide patients to carry out a phase of cardiac rehabilitation training. Every patient will get professional lifestyle and dietary advice during hospitalization and discharge.

"After the patient recovers and is discharged from the hospital, the team will review the diagnosis and treatment process of the patient during hospitalization and sum up the experience and lessons." Xu Xinyi said that this can continuously improve the diagnosis and treatment level of the TAVR team.

Only by strengthening the division of colleges can we expand the department of cardiology.

With the opening of the valvular heart disease clinic, there is another member in the specialist outpatient team of the Department of Cardiology of the Third Hospital of Beijing Medical University. Together with coronary heart disease, heart failure, atrial fibrillation, anticoagulation, pacing, metabolism and other cardiovascular clinics, it has built the skeleton of the development of cardiology in this hospital.

"This is the result of subdivision and specialization." Professor Tang Yida said. Cardiologists are more familiar with the treatment and technical application of a certain type of cardiovascular diseases by specializing in a certain professional direction. The treatment of cardiovascular diseases is different, and the emphasis is different in interdisciplinary aspects. For example, the treatment of atrial fibrillation is related to neurology, and the treatment of valvular disease overlaps with nephrology and respiratory medicine. Only by continuously strengthening sub-specialties can a department be full and accurate treatment be better realized.

Although the number of cases is not as good as that of cardiovascular hospital, the Third Hospital of Beijing Medical University, as a university affiliated hospital, has always maintained the rigorous tradition of "academic school". Professor Tang Yida said: "Prevention is the key to diseases. Carrying out health education in outpatient department to improve patients' awareness of prevention and health management is an effective measure to prevent cardiovascular disease and delay the progress of the disease. As a university affiliated hospital, doctors can give lectures to medical students in class, which can cultivate future medical talents; Doctors can improve the level of public health literacy by conducting popular science education for outpatients. "In addition, the diversity of disciplines in general hospitals also provides strong support for MDT diagnosis and treatment in cardiology.

On the road of building fist departments and brand departments, the Department of Cardiology of the Third Hospital of Beijing Medical University will not stop.