Duerr Georg Daniel, Sinning Jan-Malte, Welz Armin Georg, Mellert Fritz
Department of Cardiac Surgery, University Heart Center Bonn, Bonn, Nordrhein-Westfalen, Germany.
Department of Medicine II-Cardiology, University Heart Center Bonn, Bonn, Nordrhein-Westfalen, Germany.
Thorac Cardiovasc Surg. 2017 Sep;65(6):460-466. doi: 10.1055/s-0037-1598029. Epub 2017 Feb 10.
Transcatheter valve-in-ring strategies have been developed to treat recurrent mitral regurgitation (MR) after failing surgical annuloplasty. However, suboptimal THV expansion with consecutive paravalvular leakage (PVL) is a procedure-immanent issue. A rigid, saddle-shaped ring was cut at four locations. The segments were reconnected with pull-springs, rearranged to the original shape, and covered with a sewing cuff. The length of the annuloplasty ring construct, including extended pull-springs, was defined by the perimeter of an appropriate THV. We deployed a Sapien XT within the new ring, expanded it to its maximum extent, and investigated the geometrical changes. Fluoroscopy confirmed oval, saddle-shaped ring before dilation. After THV implantation, the ring segments spread apart and pull-springs were stretched. The extended ring changed its configuration from "oval" to "round" and anchored the THV leaving no paravalvular or central gaps as potential source for PVL. We developed an expandable annuloplasty ring that is perfectly concerted to THV implantation. This proof-of-concept study revealed no PVL and good oversizing ability that might impact future annuloplasty ring design. Further studies have to evaluate durability and device safety.
经导管瓣中瓣策略已被开发用于治疗手术瓣环成形术失败后的复发性二尖瓣反流（MR）。然而，连续瓣周漏（PVL）导致的经导管心脏瓣膜（THV）扩张欠佳是该手术固有的问题。在四个位置切割一个刚性鞍形环。各段用拉簧重新连接，重新排列成原始形状，并用缝合袖口覆盖。包括延长拉簧在内的瓣环成形环结构的长度由合适的THV周长确定。我们在新环内植入一个Sapien XT，将其扩张到最大程度，并研究几何变化。透视确认扩张前为椭圆形鞍形环。THV植入后，环段分开，拉簧被拉伸。扩张后的环构型从“椭圆形”变为“圆形”，固定了THV，没有留下作为PVL潜在来源的瓣周或中心间隙。我们开发了一种与THV植入完美配合的可扩张瓣环成形环。这项概念验证研究未发现PVL，且具有良好的尺寸过大能力，这可能会影响未来瓣环成形环的设计。进一步的研究必须评估耐久性和器械安全性。
