Chawla Surendra K, Shi Weiwei, McIver Bryant V, Vinten-Johansen Jakob, Frater Robert W M, Padala Muralidhar
Division of Cardiothoracic Surgery, Saint Francis Hospital and Medical Center, Hartford, CT, USA.
Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Division of Cardiothoracic Surgery, Emory University, 380-B, Northyards Blvd, Atlanta, GA, 30313, USA.
J Cardiovasc Transl Res. 2016 Apr;9(2):127-34. doi: 10.1007/s12265-016-9674-4. Epub 2016 Jan 22.
Surgical repair of flail mitral valve leaflets with neochordoplasty has good outcomes, but implementing it in anterior and bi-leaflet leaflet repair is challenging. Placing and sizing individual neochordae is time consuming and error prone, with persistent localized flail if performed incorrectly. In this study, we report our pre-clinical experience with a novel multi-chordal patch for mitral valve repair. The device was designed based on human cadaver hearts, and laser cut from expanded polytetrafluoroethylene. The prototypes were tested in: (stage 1) ex vivo hearts with leaflet flail (N = 6), (stage 2) acute swine induced with flail (N = 6), and (stage 3) two chronic swine survived to 23 and 120 days (N = 2). A2 and P2 prolapse were successfully repaired with coaptation length restored to 8.1 ± 2.2mm after posterior repair and to 10.2 ± 1.3mm after anterior repair in ex vivo hearts. In vivo, trace regurgitation was seen after repair with excellent patch durability, healing, and endothelialization at euthanasia. A new device for easier mitral repair is reported, with good early pre-clinical outcomes.
采用新腱索成形术对外科连枷样二尖瓣叶进行修复具有良好的效果，但在进行前叶和双叶瓣叶修复时实施该技术具有挑战性。放置和确定单个新腱索的大小既耗时又容易出错，如果操作不当会导致持续性局部连枷。在本研究中，我们报告了使用一种新型多腱索补片进行二尖瓣修复的临床前经验。该装置基于人体尸体心脏设计，由膨体聚四氟乙烯激光切割而成。原型在以下实验中进行了测试：（第一阶段）离体叶瓣连枷心脏（N = 6），（第二阶段）急性诱导连枷猪（N = 6），以及（第三阶段）两只分别存活23天和120天的慢性猪（N = 2）。在离体心脏中，后叶修复后A2和P2脱垂成功修复，瓣叶对合长度恢复到8.1±2.2mm，前叶修复后恢复到10.2±1.3mm。在体内，修复后可见微量反流，在安乐死时补片具有出色的耐用性、愈合性和内皮化。本文报道了一种便于二尖瓣修复的新装置，临床前早期效果良好。
