Wipper Sabine, Lohrenz Christina, Kersten Jan F, Akkra Mohamad Marwan, Tsilimparis Nikos, Detter Christian, von Kodolitsch Yskert, Larena-Avellaneda Axel, Debus Eike Sebastian, Kölbel Tilo
Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Vascular Medicine, German Aortic Center, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2016 Jun;23(3):493-500. doi: 10.1177/1526602816643939. Epub 2016 Apr 18.
To describe and prove the concept of a technique for complete transapical deployment of a single-branch aortic arch endograft in a porcine model.
Eight domestic pigs underwent antegrade transapical delivery of a single-branch arch endograft, including a mating stent-graft to the innominate artery. Technical feasibility, operating time, radiation parameters, and hemodynamic changes were studied according to a standardized protocol during baseline (T0), after establishing the transapical access and through-and-through wire (T1), and after stent-graft deployment (T2). Myocardial and cerebral blood flow status was assessed using fluorescent microspheres (FM) and transit-time flow measurement (TTFM) monitoring.
Transapical access, introduction and deployment of the endograft, side branch catheterization, and deployment of the mating stent-graft were feasible in 6 of 8 animals. One animal died due to irreversible heart rhythm disorders and one due to accidental graft rotation during deployment, resulting in unintended coverage of the innominate artery. The mean operating and fluoroscopy times were 223±11 minutes and 27.2±6.3 minutes, respectively. During introduction and deployment of the stent-graft, transient aortic valve insufficiency occurred in all animals. Hemodynamic stability recovered within 10 minutes after retrieval of the delivery system in all animals. The innominate artery was patent, with unchanged TTFM measurements throughout the procedure. FM evaluation revealed stable cerebral blood flow.
An antegrade transapical access to the aortic arch for implantation of a single-branch endograft is feasible in a porcine model with reversible impact on hemodynamic measures during deployment. Transapical access allows deployment of a complex endograft through a single large-bore access site in a porcine model.
描述并验证在猪模型中经心尖完全植入单分支主动脉弓腔内移植物技术的概念。
八只家猪接受经心尖顺行植入单分支主动脉弓腔内移植物，包括与无名动脉匹配的支架型人工血管。根据标准化方案，在基线期（T0）、建立经心尖入路并置入贯穿导丝后（T1）以及支架型人工血管植入后（T2），研究技术可行性、手术时间、放射参数和血流动力学变化。使用荧光微球（FM）和渡越时间血流测量（TTFM）监测评估心肌和脑血流状态。
八只动物中有六只成功完成经心尖入路、腔内移植物的导入和植入、侧支导管插入以及匹配支架型人工血管的植入。一只动物因不可逆的心律失常死亡，一只因植入过程中移植物意外旋转导致无名动脉意外被覆盖而死亡。平均手术时间和透视时间分别为223±11分钟和27.2±6.3分钟。在支架型人工血管导入和植入过程中，所有动物均出现短暂性主动脉瓣关闭不全。在所有动物中，取出输送系统后10分钟内血流动力学恢复稳定。无名动脉通畅，整个手术过程中TTFM测量值无变化。FM评估显示脑血流稳定。
在猪模型中，经心尖顺行进入主动脉弓植入单分支腔内移植物是可行的，且在植入过程中对血流动力学指标有可逆性影响。经心尖入路可通过猪模型中的单个大口径入路部位植入复杂的腔内移植物。
