Expert interview | Hu Hao: Change the mind, prevent stroke, adhere to standardized operation, for patients to bring better prognostication

In recent years, China's structural heart disease field has developed rapidly, in congenital heart disease, left heart ear blocking and other fields have been in the international leading level;
recently, "Outpatient" magazine invited Professor Hu Hao of Lanzhou University Second Hospital to discuss the future development direction of China's structural heart disease field with a point-to-face, combined with the development course of structural heart disease in northwest China.
as a leader in the field of structural heart disease in the Northwest Territories, could you tell us about the development of structural cardiast intervention in the Northwest Territories in recent years? Share successful experiences in the construction of your department? Professor Hu Hao: The northwest region is sparsely populated and the medical level is unevenly developed among different regions, among which the medical level in Shaanxi is developing rapidly and is in the leading domestic level, and the field of structural heart disease also has a certain influence in the international community under the leadership of Professor Zhang Yushun.
At present, the level of medical treatment in Ganqingning area is stable, and a lot of work has been done in the field of structural heart disease, while The Second Hospital of Landa, as a representative general hospital in Gansu Province, is developing rapidly in the field of structural heart disease.
, one of the earliest public hospitals in Gansu Province, the Department of Cardiology established four sub-specialties in 2011, including coronary heart disease, hypertension, electrostatology and structural cardiology.
In the last five years, our hospital in the field of structural heart disease, especially in the prevention of cardiac stroke, that is, the ovary hole is not closed (PFO) blocking and left ear blocking technology has been rapidly developed.
First of all, in the PFO blocking, our hospital in 2019 PFO surgery volume ranked seventh in the country, and achieved gratifying results, our hospital also took this as an opportunity to further promote the overall development of structural heart disease field; High fatality rate and high recurrence rate and other characteristics, in the past clinicians did not recognize the dangers of thromboembolism caused by atrial fibrillation, but now with the continuous promotion of left heart ear sealing surgery, clinicians' philosophy is also changing, our hospital department of internal medicine actively learn new technologies, new ideas, early in the country carried out left heart ear blocking.
The development course of the left heart ear blocking technology in our hospital is also a microcosm of the development process of left heart ear blocking in our hospital, and on June 26, 2016, our hospital carried out the first case of left heart ear sealing surgery, mainly to learn and understand in the early stages. Mastering technology-based, did not widely carry out the technology, and after accumulating some experience, our hospital began to independently carry out left-heart ear blocking surgery, to 2019, our hospital has been routine independent of left-heart ear blocking surgery, the annual surgical volume of more than 70 cases.
through the development of advantageous disciplines, but also led to the overall development of other disciplines.
In contrast, the development of primary hospitals in our province is not optimistic, only half of the county-level hospitals in the province have catheter rooms, and the work is concentrated in the field of coronary intervention and electrophysiology, structural heart disease is relatively weak.
The future, structural heart disease will be an important development direction of interventional cardiology, landa second hospital has the obligation and responsibility to further popularize new treatment concepts and treatment strategies to more primary care physicians, and promote the further development of the province's structural cardiology capacity.
"one-stop" operation of blocking the joint ASD with the left heart and ear is a popular procedure in the field of interventional treatment for ASD patients.
your hospital has just completed the country's first joint application of Lefort left-heart ear sealer and ASD blocker to carry out a one-stop left-heart ear and ASD blocking, can you please share the experience and experience of this joint application? Professor Hu Hao: This "first case" is both accidental and inevitable, on the one hand, Lefort left-heart ear sealer has just been listed, the first application of the device line one-stop left-heart ear and ASD blocking is accidental;
In the process of carrying out such one-stop surgery, the patient must first identify the location of the room gap defect, and then develop a detailed surgical strategy, if the room interval defect location is biased, choose the direct room interval puncture and then the left heart ear blocking may be a better choice.
Now in ASD blocking, MemoCarna oxide film single riveting ASD sealer has been officially listed, its excellent design is impressive, the sealer using single riveting design and oxidation film surface treatment process, not only to make the left plate more flat, but also greatly reduce the occurrence of device-related thrombosis events;
And in the left heart ear sealer, the majority of clinicians may be the first contact with plug-type blocker, such as Lefort left heart ear sealer, such a sealer in the process of release needs to extend the conveyor into the left heart ear, at this time need to be careful not to damage the left heart ear.
And in the process of carrying out left heart ear sealing surgery, the operator must follow the standard procedure, while carrying out strict preoperative screening and careful postoperative management, do a good job in every step of the surgical process, every "old-school" are in mind, and constantly optimize the surgical process.
To this day, the team has adhered to the standardized surgical procedures, under the guidance of esoviran ultrasound to carry out left heart ear blocking surgery, and standardize anticoagulant, has been completed more than 200 cases of left heart ear blocking patients, there is no case of device-related blood clots.
the future look forward to domestic devices can go further, in the development of new devices at the same time, for the vast number of physicians to provide technical support, academic support, will better benefit more patients.
china's structural heart disease intervention treatment after decades of continuous transformation, has made considerable progress.
what challenges do you think you still face in this area? What is the future direction? Professor Hu Hao: The most important problem at present is that the concept of clinicians has not changed in time, the majority of primary care physicians do not understand the dangers of atrial fibrillation, the need for more academic promotion.
The focus of left ear blocking is even more so, not only need to further publicize the positive role of left heart ear blocking in the prevention of stroke in patients with atrial fibrillation, popularize relevant knowledge, but also let more grass-roots doctors understand the dangers of atrial fibrillation, recognize the advantages of left heart ear blocking.
a number of clinical studies have confirmed that in the prevention of stroke, left heart ear blocking is not inferior to oral anticoagulant therapy, and has a tendency to further reduce stroke events.
should continue in the future to further demonstrate the benefits of left-heart ear sealing in ischemic stroke.
addition, the risk of bleeding caused by left ear sealing is reduced, but also to improve the quality of life of the vast number of patients.
After a period of anticoagulant treatment due to left heart and ear blockage, patients do not have to continue to take anticoagulant drugs, not only reducing the risk of bleeding in elderly patients, but also reducing a series of possible bleeding events caused by falls in elderly patients;
In the future, the majority of physicians should not only pay attention to atrial fibrillation itself, but also pay attention to the thromboembolism event caused by atrial fibrillation, the thinking will be converted, for patients with atrial fibrillation, the need for the necessary left heart ear blocking, in order to prevent the occurrence of stroke.
in order to better carry out related work, the physician needs to communicate extensively with neurology, stroke center and other disciplines to develop more reasonable treatment strategies for patients.
If the position is further moved forward, it will require the majority of primary care physicians to have a deeper understanding of the disease itself, strengthen atrial fibrillation screening, find more likely atrial fibrillation patients, early prevention, early diagnosis, early treatment, will be possible serious complications smothered in the cradle, so as to bring a better prognosis for the vast number of patients.
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