Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan; Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland.
Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
Ann Thorac Surg. 2018 Dec;106(6):1804-1811. doi: 10.1016/j.athoracsur.2018.05.057. Epub 2018 Jun 27.
Tricuspid valve repair using suture annuloplasty is thought to be more physiologic, but the effect of annular reduction on annular geometry and motion is unknown. We set out to investigate the effect of DeVega suture annuloplasty (DV) on tricuspid annular geometry and dynamics during acute right heart failure (RHF).
Ten adult sheep underwent implantation of sonomicrometry crystals around the tricuspid annulus and on the right ventricle; pressure transducers were placed in right ventricle, left ventricle, and right atrium. RHF was induced by a combination of 500 mL volume infusion, posterior descending artery occlusion, and pulmonary artery constriction. Hemodynamic, echocardiographic, and sonomicrometry data were acquired at baseline, with RHF, and after two progressive (8 to 10 mm) DV suture cinches (DV-1, DV-2) during RHF. Annular size, geometry, and dynamics were determined from crystal coordinates.
Combination of volume infusion, ischemia, and pulmonary hypertension resulted in acute RHF and significant functional tricuspid regurgitation grade (0.5 ± 0.5 versus 2.7 ± 0.8, p < 0.001). Annular area increased with RHF from 700 ± 98 mm to 801 ± 128 mm (p < 0.001). DV-1 and DV-2 reduced annular area to 342 ± 88 mm and 180 ± 57 mm while reducing regurgitation grade to 1.2 ± 0.4 and 0.4 ± 0.5, respectively (all p < 0.001 versus RHF). Tricuspid annular area contraction was 12% ± 7%, 10% ± 6%, and 12% ± 6% for RHF, DV-1, and DV-2, respectively (p = 0.25) and annular height was 4.9 ± 2.0 mm, 5.6 ± 1.4 mm, and 5.5 ± 1.7 mm (p = 0.43). Mean transvalvular gradient was 1.3 ± 0.7 mm Hg and 2.0 ± 1.0 mm Hg with DV-1 and DV-2, respectively.
During acute ovine RHF, DeVega annuloplasty successfully treated tricuspid regurgitation and preserved normal tricuspid annular dynamics and geometry. These data may lead to more physiologic tricuspid reparative techniques.
使用缝合环成形术修复三尖瓣被认为更符合生理，但环缩术对环的几何形状和运动的影响尚不清楚。我们旨在研究 DeVega 缝合环成形术（DV）在急性右心衰竭（RHF）期间对三尖瓣环几何形状和动力学的影响。
10 只成年绵羊在三尖瓣环周围和右心室上植入声反射测量晶体；右心室、左心室和右心房内放置压力传感器。通过 500 毫升容量输注、后降支动脉闭塞和肺动脉缩窄的组合诱导 RHF。在基线、RHF 期间以及 RHF 期间进行两次渐进性（8 至 10 毫米）DV 缝合收紧（DV-1、DV-2）时，获得血流动力学、超声心动图和声反射测量数据。从晶体坐标确定环的大小、几何形状和动力学。
容量输注、缺血和肺动脉高压的组合导致急性 RHF 和显著的功能性三尖瓣反流程度（0.5 ± 0.5 与 2.7 ± 0.8，p < 0.001）。环面积随着 RHF 从 700 ± 98 毫米增加到 801 ± 128 毫米（p < 0.001）。DV-1 和 DV-2 将环面积减少到 342 ± 88 毫米和 180 ± 57 毫米，同时将反流程度降低到 1.2 ± 0.4 和 0.4 ± 0.5，分别（均 p < 0.001 与 RHF）。RHF、DV-1 和 DV-2 时三尖瓣环面积收缩率分别为 12% ± 7%、10% ± 6%和 12% ± 6%（p = 0.25），环高度分别为 4.9 ± 2.0 毫米、5.6 ± 1.4 毫米和 5.5 ± 1.7 毫米（p = 0.43）。DV-1 和 DV-2 时平均跨瓣梯度分别为 1.3 ± 0.7 毫米汞柱和 2.0 ± 1.0 毫米汞柱。
在急性绵羊 RHF 期间，DeVega 环成形术成功治疗了三尖瓣反流并保留了正常的三尖瓣环动力学和几何形状。这些数据可能导致更符合生理的三尖瓣修复技术。
