Ropcke Diana M, Ilkjaer Christine, Tjornild Marcell J, Skov Soren N, Ringgaard Steffen, Hjortdal Vibeke E, Nielsen Sten L
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark.
Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):918-924. doi: 10.1093/icvts/ivx017.
Tricuspid valve reconstruction using small intestinal submucosal extracellular matrix (ECM) designed as a tube graft is possible in severe valve pathology. Using cardiac magnetic resonance imaging (MRI) and digital photograph imaging, valves were evaluated after 6 months in a porcine model.
Ten 60 kg pigs received a tricuspid valve tube graft. A baseline MRI was performed after 2 weeks ( n = 8). A follow-up MRI was performed in three of five 6 months' survivors to assess function and haemodynamics of the tricuspid tube graft. Valves were explanted in five animals for gross examination. No statistical comparisons were made due to low numbers.
: Compared to the original tube graft, leaflet area and leaflet height decreased after 6 months (32 ± 0 vs 14.7 ± 4 cm 2 and 3.2 ± 0 vs 1.7 ± 0.3 cm, respectively). Both imaging modalities showed septal dehiscence in all tube grafts after 6 months causing haemodynamically severe paravalvular regurgitation. Cardiac MRI showed a significant remodelling of the right ventricular and annular dimensions. The cardiac output decreased (67 ± 16 vs 34 ± 5 ml/min/kg), while right ventricular stroke volume increased from 64.4 ± 14.6 to 107 ± 63.9 ml. This corresponded to a paravalvular regurgitant volume increasing from 7.2 ± 7.3 to 71.7 ± 69.6 ml.
The ECM tube grafts seemed to remodel over time with loss of redundant ECM material. However, tube graft dehiscence caused severe tricuspid paravalvular regurgitation and heart failure. These data suggest that surgical reinforcement, e.g. adjunct annuloplasty, should be considered to improve durability.
对于严重的瓣膜病变，使用设计为管状移植物的小肠粘膜下层细胞外基质（ECM）进行三尖瓣重建是可行的。在猪模型中，使用心脏磁共振成像（MRI）和数码照片成像，在6个月后对瓣膜进行评估。
10头60公斤重的猪接受了三尖瓣管状移植物。2周后进行了基线MRI（n = 8）。在5只6个月存活猪中的3只进行了随访MRI，以评估三尖瓣管状移植物的功能和血流动力学。在5只动物中取出瓣膜进行大体检查。由于数量较少，未进行统计比较。
与原始管状移植物相比，6个月后瓣叶面积和瓣叶高度减小（分别为32 ± 0 vs 14.7 ± 4 cm²和3.2 ± 0 vs 1.7 ± 0.3 cm）。两种成像方式均显示6个月后所有管状移植物均出现间隔裂开，导致血流动力学上严重的瓣周反流。心脏MRI显示右心室和瓣环尺寸有显著重塑。心输出量下降（67 ± 16 vs 34 ± 5 ml/min/kg），而右心室每搏输出量从64.4 ± 14.6增加到107 ± 63.9 ml。这对应于瓣周反流体积从7.2 ± 7.3增加到71.7 ± 69.6 ml。
ECM管状移植物似乎会随着时间推移而重塑，多余的ECM材料会流失。然而，管状移植物裂开导致严重的三尖瓣瓣周反流和心力衰竭。这些数据表明，应考虑手术加固，如辅助瓣环成形术，以提高耐用性。
