Lauten Alexander, Laube Adrian, Schubert Harald, Bischoff Sabine, Nietzsche Sandor, Horstkötter Kim, Poudel-Bochmann Bhawana, Franz Marcus, Lichtenberg Artur, Figulla Hans R, Akhyari Payam
Department of Internal Medicine I (Cardiology, Angiology, Pneumology, Intensive Care Medicine), University Heart Center, Friedrich-Schiller-University, Jena, Germany.
Catheter Cardiovasc Interv. 2015 Jan 1;85(1):150-60. doi: 10.1002/ccd.25380. Epub 2014 Feb 1.
Caval valve implantation has been suggested for transcatheter treatment of severe tricuspid regurgitation (TR). Combining the interventional technique with the promising surgical experience with decellularized valves, we sought to evaluate the functional and structural outcome of decellularized pericardial tissue valves (dTVs) in the low-pressure venous circulation in a chronic model of TR.
Sixteen pericardial tissue valves were heterotopically implanted in the inferior and superior vena cava in a sheep model (54-98 kg; median 74.5 kg, n = 8) of severe TR. The devices were assembled using self-expanding nitinol stents and bovine pericardia decellularized by a detergent-based protocol (group dTV; n = 8). Glutaraldehyde-fixed pericardial tissue valves served as control (GaTV, n = 8). After 6 months, device function and structural maturation were analyzed using echocardiographic, histologic, immunohistologic, and electron microscopic approaches. After implantation, cardiac output increased significantly from 3.7 ± 1.1 l/min to 4.8 ± 1.1 l/min (P < 0.05) and competent valve function was verified by angiography. At 6 months, angiographic and echocardiographic evaluation revealed moderate to severe regurgitation in all GaTV. In contrast, five of the eight dTVs functioned well with only minor regurgitation. In these animals, autopsy revealed preserved valve structure with tender leaflets without signs of thrombosis or calcification. Conversely, GaTV showed severe degeneration with large calcification areas. Microscopic and histologic analysis confirmed endothelial repopulation in both valve types. However, additional interstitial reseeding was observed in decellularized valves.
In the venous circulation in severe TR, decellularized valves show superior functional performance compared to Ga-fixed tissue valves. Macroscopic and microscopic analyses suggest preserved structural integrity and advanced endothelial and interstitial repopulation with evidence of less degradation in dTV. © 2014 Wiley Periodicals, Inc.
有人提出采用腔静脉瓣植入术经导管治疗严重三尖瓣反流（TR）。我们将介入技术与脱细胞瓣膜的成功手术经验相结合，试图在TR慢性模型的低压静脉循环中评估脱细胞心包组织瓣膜（dTV）的功能和结构转归。
在严重TR的绵羊模型（体重54 - 98千克；中位数74.5千克，n = 8）的下腔静脉和上腔静脉中异位植入16个心包组织瓣膜。这些装置使用自膨胀镍钛诺支架和经基于去污剂方案脱细胞的牛心包组装而成（dTV组；n = 8）。戊二醛固定的心包组织瓣膜作为对照（GaTV，n = 8）。6个月后，采用超声心动图、组织学、免疫组织学和电子显微镜方法分析装置功能和结构成熟情况。植入后，心输出量从3.7±1.1升/分钟显著增加至4.8±1.1升/分钟（P < 0.05），血管造影证实瓣膜功能良好。6个月时，血管造影和超声心动图评估显示所有GaTV均有中度至重度反流。相比之下，8个dTV中有5个功能良好，仅有轻微反流。在这些动物中，尸检显示瓣膜结构保存完好，瓣叶柔软，无血栓形成或钙化迹象。相反，GaTV显示严重退变，有大片钙化区域。显微镜和组织学分析证实两种瓣膜类型均有内皮细胞重新生长。然而，在脱细胞瓣膜中观察到额外的心间质再植入。
在严重TR的静脉循环中，脱细胞瓣膜与戊二醛固定的组织瓣膜相比，具有更好的功能表现。宏观和微观分析表明，dTV结构完整性得以保留，内皮细胞和心间质重新生长进展良好，且降解程度较轻。© 2014威利期刊公司。
