Ho Paul C
HOCOR Cardiovascular Technologies, Honolulu - Hawaii.
Int J Artif Organs. 2017 Jul 5;40(7):361-365. doi: 10.5301/ijao.5000596. Epub 2017 May 18.
Device management of hemodynamic instability due to acute aortic regurgitation is not available. A novel, catheter-based, temporary aortic valve (TAV) has been in development. Early prototypes (balloon-based TAV) have undergone proof-of-concept studies in mathematical, bench and animal models. The redesigned membrane-based TAV prototype is evaluated in a rabbit model of acute severe aortic regurgitation.
Acute aortic regurgitation was simulated by deploying a self-expanding endovascular stent across the aortic annulus. Eight rabbits of body weights ranging 4.9-5.4 kg were randomly assigned to two groups: those received additional hemodynamic support with the TAV prototype immediately after aortic regurgitation was induced versus no TAV support. The survival times of the two groups were compared.
Comparing the groups with TAV versus without TAV, the mean body weights were similar: 4.99 ± 0.06 vs. 5.10 ± 0.22 kg (p = 0.71). The mean stent sizes used to create acute aortic regurgitation were similar: 6.25 ± 0.50 vs. 6.75 ± 0.50 mm, respectively (p = 0.53). The mean survival times also did not differ significantly: 21.00 ± 15.41 vs. 8.25 ± 2.75 minutes, respectively (p = 0.45). A slight trend appeared to be in favor of longer survival in the TAV supported group.
In a rabbit model of acute massive aortic regurgitation, the use of the TAV support prototype did not hasten the animals' death, but rather survival may be enhanced by the use of the device. Future studies specifically designed to evaluate the efficacy of the TAV catheter can be valuable in this new technology.
目前尚无针对急性主动脉瓣反流所致血流动力学不稳定的器械管理方法。一种新型的基于导管的临时性主动脉瓣(TAV)正在研发中。早期原型(基于球囊的TAV)已在数学模型、实验台模型和动物模型中进行了概念验证研究。重新设计的基于膜的TAV原型在急性重度主动脉瓣反流的兔模型中进行评估。
通过在主动脉瓣环处植入自膨胀式血管内支架来模拟急性主动脉瓣反流。将8只体重在4.9 - 5.4 kg之间的兔子随机分为两组:一组在诱导主动脉瓣反流后立即使用TAV原型给予额外的血流动力学支持,另一组不给予TAV支持。比较两组的生存时间。
比较使用TAV组和未使用TAV组,平均体重相似:分别为4.99 ± 0.06 kg和5.10 ± 0.22 kg(p = 0.71)。用于造成急性主动脉瓣反流的平均支架尺寸相似:分别为6.25 ± 0.50 mm和6.75 ± 0.50 mm(p = 0.53)。平均生存时间也无显著差异:分别为21.00 ± 15.41分钟和8.25 ± 2.75分钟(p = 0.45)。TAV支持组似乎有生存时间稍长的轻微趋势。
在急性大量主动脉瓣反流的兔模型中,使用TAV支持原型并未加速动物死亡,反而使用该器械可能提高生存率。专门设计用于评估TAV导管疗效的未来研究对这项新技术可能具有重要价值。