Akiyama Masatoshi, Popović Zoran B, Kamohara Keiji, Cingoz Faruk, Daimon Masao, Ootaki Chiyo, Ootaki Yoshio, Martin Maureen, Liu Jenny, Kopcak Michael W, Dessoffy Raymond, Fukamachi Kiyotaka
Department of Biomedical Engineering, Lerner Research Institute, Cleveland, Ohio, USA.
Ann Thorac Surg. 2008 May;85(5):1771-5. doi: 10.1016/j.athoracsur.2007.11.036.
This study evaluated the short-term feasibility of a novel epicardial device that treats functional mitral regurgitation by simultaneously changing the mitral and the left ventricular geometry.
We implanted a prototype device that consists of 2 tissue anchors, a deflector, and a flexible tightening chord in 7 mongrel dogs with heart failure and functional mitral regurgitation induced by rapid ventricular pacing. Hemodynamic and echocardiographic data were obtained before and after device implantation.
The device acutely reduced the mitral regurgitation grade from 3.2 +/- 0.3 to 0.9 +/- 0.5 (p < 0.001). Left ventricular end-diastolic volume (79.6 +/- 23.6 to 61.2 +/- 16.9 mL; p = 0.004) and end-systolic volume (63.1 +/- 17.3 to 49.2 +/- 12.3 mL; p = 0.006) decreased substantially. End-systolic elastance significantly increased from 1.9 +/- 1.0 to 2.6 +/- 1.4 mm Hg/mL (p = 0.02). Device implantation did not alter coronary perfusion.
The epicardial device acutely reduced functional mitral regurgitation and improved left ventricular geometry. Further studies are required to demonstrate the long-term safety and efficacy of this concept.
本研究评估了一种新型心外膜装置的短期可行性，该装置通过同时改变二尖瓣和左心室几何形状来治疗功能性二尖瓣反流。
我们将一种由2个组织锚、一个偏转器和一根柔性收紧弦组成的原型装置植入7只因快速心室起搏诱发心力衰竭和功能性二尖瓣反流的杂种犬体内。在装置植入前后获取血流动力学和超声心动图数据。
该装置使二尖瓣反流分级从3.2±0.3急剧降至0.9±0.5（p<0.001）。左心室舒张末期容积（从79.6±23.6降至61.2±16.9 mL；p = 0.004）和收缩末期容积（从63.1±17.3降至49.2±12.3 mL；p = 0.006）大幅下降。收缩末期弹性显著从1.9±1.0增加至2.6±1.4 mmHg/mL（p = 0.02）。装置植入未改变冠状动脉灌注。
心外膜装置可急性减少功能性二尖瓣反流并改善左心室几何形状。需要进一步研究来证明这一概念的长期安全性和有效性。
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