Borgarelli M, Lanz O, Pavlisko N, Abbott J A, Menciotti G, Aherne M, Lahmers S M, Lahmers K K, Gammie J S
Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA.
Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Phase II, Duck Pond Dr., VA 24061, USA.
J Vet Cardiol. 2017 Jun;19(3):256-267. doi: 10.1016/j.jvc.2017.03.002. Epub 2017 May 31.
Mitral valve (MV) regurgitation due to degenerative MV disease is the leading cause of cardiac death in dogs. We carried out preliminary experiments to determine the feasibility and short-term effects of beating-heart MV repair using an expanded polytetrafluorethylene (ePTFE) chordal implantation device (Harpoon TSD-5) in dogs.
This study involved six healthy purpose-bred Beagles (weight range 8.9-11.4 kg).
Following a mini-thoracotomy performed under general anesthesia, the TSD-5 was used to place 1 or 2 artificial ePTFE cords on the anterior MV leaflet or the posterior MV leaflet via a left-ventricular transapical approach. The procedure was guided and monitored by transesophageal echocardiography. Postoperative antithrombotic treatment consisted of clopidogrel or a combination of clopidogrel and apixaban. Dogs were serially evaluated by transthoracic echocardiography at day 1, 7, 14, 21, and 30. The hearts were then examined for evaluation of tissues reactions and to detect signs of endothelialization.
One or two chords were successfully implanted in five dogs. Four dogs completed the 30 days follow-up. One dog died intra-operatively because of aortic perforation. One dog died early post-operatively from a hemorrhagic pleural effusion attributed to overly aggressive antithrombotic treatment. One dog developed a thrombus surrounding both the knot and the synthetic cord. Postmortem exam confirmed secure placement of ePTFE knots in the mitral leaflets in all dogs and the presence of endothelialization of the knots and chords.
These preliminary results demonstrate the feasibility of artificial chordal placement using an ePTFE cordal implantation device in dogs.
退行性二尖瓣疾病导致的二尖瓣反流是犬类心脏死亡的主要原因。我们进行了初步实验，以确定在犬类中使用膨体聚四氟乙烯（ePTFE）腱索植入装置（Harpoon TSD - 5）进行心脏跳动下二尖瓣修复的可行性和短期效果。
本研究涉及6只健康的特定品种比格犬（体重范围8.9 - 11.4千克）。
在全身麻醉下进行小切口开胸术后，通过经左心室心尖途径，使用TSD - 5在二尖瓣前叶或后叶放置1或2根人工ePTFE腱索。该手术由经食管超声心动图引导和监测。术后抗血栓治疗包括氯吡格雷或氯吡格雷与阿哌沙班的联合使用。在第1、7、14、21和30天通过经胸超声心动图对犬进行连续评估。然后检查心脏以评估组织反应并检测内皮化迹象。
5只犬成功植入了1或2根腱索。4只犬完成了30天的随访。1只犬术中因主动脉穿孔死亡。1只犬术后早期因抗血栓治疗过度导致出血性胸腔积液死亡。1只犬在结和合成腱索周围形成血栓。尸检证实所有犬的二尖瓣叶中ePTFE结放置牢固，且结和腱索存在内皮化。
这些初步结果证明了在犬类中使用ePTFE腱索植入装置进行人工腱索放置的可行性。
