Kempfert Jörg, Blumenstein Johannes M, Borger Michael A, Linke Axel, Lehmann Sven, Pritzwald-Stegmann Patrick, Chu Michael W A, Schuler Gerhard, Falk Volkmar, Mohr Friedrich Wilhelm, Walther Thomas
Department of Cardiac Surgery, Heartcenter, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany.
Eur Heart J. 2008 Oct;29(19):2382-7. doi: 10.1093/eurheartj/ehn285. Epub 2008 Jun 20.
This study was designed to evaluate the feasibility and haemodynamic performance of transcatheter valve-in-a-valve (VinV) implantation for failed mitral xenografts using a minimally invasive, transatrial, off-pump approach.
Nine adult sheep (71.1 +/- 3.4 kg) underwent mitral valve replacement with a 25 mm bioprosthesis using standard conventional techniques. After weaning from cardiopulmonary bypass, a transcatheter 23 mm pericardial prosthesis mounted on a balloon-inflatable steel stent was deployed within the conventional xenograft. The VinV implantation (10.1 +/- 0.9 min) was performed off-pump using an antegrade transatrial approach under fluoroscopic guidance successfully in all nine sheep. Mean transvalvular gradient was 4.6 +/- 1.0 mmHg, and five of nine sheep had no paravalvular leak with two sheep each having mild and moderate one. All transcatheter prostheses were confirmed in good position on post-mortem analysis. In an in vitro model, the minimum force required to dislodge the valve was 22.5 +/- 3.0 N, which was well above the normal estimated forces generated by the left ventricle (LV). When this model was attached to a LV assist device, the VinV withstood pressure loops of 300 mmHg, without dislocation or embolization.
Transatrial, transcatheter mitral VinV implantation is feasible off pump. This is a truly minimally invasive concept to treat patients with failed xenografts using a right lateral minithoracotomy.
本研究旨在评估采用微创经心房非体外循环方法，对二尖瓣异种移植失败患者进行经导管瓣中瓣（VinV）植入的可行性和血流动力学性能。
9只成年绵羊（71.1±3.4千克）采用标准传统技术植入25毫米生物瓣进行二尖瓣置换。在脱离体外循环后，将一个安装在球囊可膨胀钢支架上的23毫米经导管心包瓣假体部署在传统异种移植瓣内。在透视引导下，所有9只绵羊均成功采用顺行经心房方法在非体外循环下进行了VinV植入（10.1±0.9分钟）。平均跨瓣压差为4.6±1.0毫米汞柱，9只绵羊中有5只无瓣周漏，2只分别有轻度和中度瓣周漏。所有经导管假体在尸检分析中均证实位置良好。在体外模型中，使瓣膜脱位所需的最小力为22.5±3.0牛，远高于左心室（LV）产生的正常估计力。当该模型连接到左心室辅助装置时，VinV可承受300毫米汞柱的压力循环，无脱位或栓塞。
经心房经导管二尖瓣VinV植入在非体外循环下是可行的。这是一种真正的微创概念，可通过右侧小切口开胸术治疗异种移植失败的患者。
