Rasmussen Jonas, Skov Søren Nielsen, Nielsen Ditte Bruus, Jensen Ida Lindhardt, Tjørnild Marcell Juan, Johansen Peter, Hjortdal Vibeke E
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
J Cardiothorac Surg. 2019 Jan 9;14(1):6. doi: 10.1186/s13019-019-0830-1.
Management of congenital malformations of the pulmonary artery and valve can be challenging. The severity often demands early intervention, which is rarely definitive due to the natural growth and multiple surgeries may be required. An artificial valve made entirely from biodegradable materials that will serve as a bioscaffold for host recellularization would be an attractive solution for these patients. Such valves have been experimentally evaluated with various results. In this study, a simple valve design supported by an absorbable proximal stabilization ring is evaluated both in-vitro and in-vivo.
From a 6.7 × 5.0 cm sheet of CorMatrix® tissue we created the valve as an inverted tubegraft with three sutured commissures. A non-closed ring of LactoSorb® basally supported the valve. The commissure height was 2 cm. Inserted as an interposition graft the valve was tested in an in-vitro model and an acute porcine model. Right ventricular and pulmonary artery pressures were recorded.
The in-vitro testing indicated a proper opening and closure function of valve at physiological simulated hemodynamic conditions. The in-vivo evaluation showed a peak right ventricular pressure of 38 mmHg and a peak pulmonary artery pressure of 27 mmHg and thereby a peak valve gradient of 11 mmHg. The pulmonary pressure wave demonstrated a dicrotic notch indicating competence of the valve.
This new pulmonary valve made entirely from biodegradable tissue worked in an acute setting and displayed a good hemodynamic profile. The valve gradient observed is equal to or superior of today's surgical treatment options.
肺动脉和瓣膜先天性畸形的管理具有挑战性。其严重程度通常需要早期干预，但由于自然生长，这种干预很少是决定性的，可能需要多次手术。一种完全由可生物降解材料制成的人工瓣膜，作为宿主细胞重新生长的生物支架，对这些患者来说将是一个有吸引力的解决方案。此类瓣膜已通过实验进行评估，结果各异。在本研究中，对一种由可吸收近端稳定环支撑的简单瓣膜设计进行了体外和体内评估。
从一张6.7×5.0厘米的CorMatrix®组织片上，我们制作了一个带有三个缝合瓣叶交界的倒置管状移植物瓣膜。一个未封闭的LactoSorb®环在基部支撑瓣膜。瓣叶交界高度为2厘米。作为插入式移植物植入后，该瓣膜在体外模型和急性猪模型中进行了测试。记录右心室和肺动脉压力。
体外测试表明，在生理模拟血流动力学条件下，瓣膜具有适当的开闭功能。体内评估显示，右心室峰值压力为38 mmHg，肺动脉峰值压力为27 mmHg，因此瓣膜峰值压差为11 mmHg。肺压力波显示出一个重搏切迹，表明瓣膜功能良好。
这种完全由可生物降解组织制成的新型肺动脉瓣膜在急性情况下有效，并显示出良好的血流动力学特征。观察到的瓣膜压差等于或优于当今的手术治疗方案。
