Sachweh Joerg S, Daebritz Sabine H
Department of Pediatric Cardiac Surgery, RWTH Aachen University, Aachen, Germany.
ASAIO J. 2006 Sep-Oct;52(5):575-80. doi: 10.1097/01.mat.0000237695.87457.2a.
In children, systemic heart valve replacement with bioprostheses is associated with accelerated valve degeneration, and mechanical prostheses require permanent anticoagulation. Novel "biomechanical" polymeric valve prostheses ("bio" = flexible, "mechanical" = synthetic), solely made of polycarbonate urethane (PCU), were tested in vitro and in a growing animal (calf) model with the aim of improved durability without permanent anticoagulation. The trileaflet aortic prosthesis has diminished pressure loss and reduced stress and strain peaks. The asymmetric bileaflet mitral valve mimics natural nonaxial inflow. The valves underwent long-term in vitro testing and in vivo testing in growing calves for 20 weeks [mitral (7), aortic (7)] with comparison to different commercial bioprostheses [mitral (7), aortic (2)]. In vitro durability of PCU valves was proved up to 20 years. Survival of PCU valves versus bioprostheses was 7 versus 2 mitral and 5 versus 0 aortic valves, respectively. Two animals with PCU aortic valves died of pannus overgrowth causing left ventricular outflow tract obstruction. Degeneration and calcification were mild (mitral) and moderate (aortic) in PCU valves but were severe in biological valves. There was no increased thrombogenicity of the PCU valves compared to bioprostheses. The novel polymeric valve prostheses revealed superior durability compared to current bioprostheses in growing animal model without permanent anticoagulation and thus, may be a future option for pediatric patients.
在儿童中,使用生物假体进行全心脏瓣膜置换与瓣膜加速退变相关,而机械假体则需要长期抗凝。新型“生物力学”聚合物瓣膜假体(“生物”=柔性,“机械”=合成),完全由聚碳酸酯聚氨酯(PCU)制成,已在体外和生长中的动物(小牛)模型中进行测试,目的是在无需长期抗凝的情况下提高耐用性。三叶主动脉瓣假体的压力损失减小,应力和应变峰值降低。不对称双叶二尖瓣模仿自然非轴向血流。这些瓣膜在生长中的小牛中进行了为期20周的长期体外测试和体内测试[二尖瓣(7个),主动脉瓣(7个)],并与不同的商用生物假体[二尖瓣(7个),主动脉瓣(2个)]进行了比较。PCU瓣膜的体外耐用性已被证明可达20年。PCU瓣膜与生物假体的存活率分别为二尖瓣7比2和主动脉瓣5比0。两只植入PCU主动脉瓣的动物死于血管翳过度生长导致左心室流出道梗阻。PCU瓣膜的退变和钙化程度较轻(二尖瓣)和中度(主动脉瓣),而生物瓣膜则严重。与生物假体相比,PCU瓣膜的血栓形成性没有增加。新型聚合物瓣膜假体在生长动物模型中显示出比当前生物假体更高的耐用性,且无需长期抗凝,因此可能是儿科患者未来的选择。