Huber Christoph H, Cohn Lawrence H, von Segesser Ludwig K
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2005 Jul 19;46(2):366-70. doi: 10.1016/j.jacc.2005.04.028.
This study validates the off-pump antegrade transventricular route for ultrasound-guided direct-access aortic valved stent implantation.
Direct-access aortic valved stent implantation offers numerous advantages over the remote-access percutaneous approach and may one day provide an alternative to surgical aortic valve replacement.
Valved stents were implanted off-pump in 12 pigs (68.5.0 +/- 7.3 kg) via direct-access transapical approach using a left-sided mini-thoracotomy and continuous ultrasonic and fluoroscopic guidance. Acute valved stent function was studied with intravascular and intracardiac ultrasound. All valved stents were tested in vitro before insertion. Macroscopic analysis was performed at necropsy.
In 8 of 12 pigs, valved stents were delivered to the target site over the native aortic valve leaflets without interference of coronary blood flow and with good acute valve function. Two valved stents were deployed and supra-annularly occluded the coronary orifice, leading to fatal outcome. Two valved stents dislodged into the left ventricle, one because of size mismatch and one that failed to unfold correctly.
Twelve pigs underwent deployment of a valved stent in the aortic position. Six valves observed for an average 4.5-h period showed satisfactory postimplantation valve function.
本研究验证非体外循环下经心室顺行途径在超声引导下直接植入主动脉带瓣支架的可行性。
直接植入主动脉带瓣支架相对于经皮远程接入方法具有诸多优势，也许有一天能成为外科主动脉瓣置换术的替代方案。
采用左侧小切口开胸，在连续超声和荧光透视引导下，通过经心尖直接接入法，在12头猪（68.5.0±7.3千克）身上非体外循环下植入带瓣支架。通过血管内和心内超声研究急性带瓣支架功能。所有带瓣支架在植入前均进行体外测试。尸检时进行宏观分析。
12头猪中的8头，带瓣支架经天然主动脉瓣叶输送至目标部位，未干扰冠状动脉血流，且急性瓣膜功能良好。有两个带瓣支架展开后超环周阻塞冠状动脉口，导致致命后果。两个带瓣支架移位至左心室，一个是因为尺寸不匹配，另一个是未能正确展开。
12头猪在主动脉位置植入了带瓣支架。观察的6个瓣膜平均4.5小时，植入后瓣膜功能令人满意。
