Wang Yanmin, Wang Mengjun, Guo Xiaomei, Han Ling, Kassab Ghassan
California Medical Innovations Institute, San Diego, CA, United States.
3DT Holdings, LCC, San Diego, CA, United States.
Front Bioeng Biotechnol. 2023 Feb 16;11:1011121. doi: 10.3389/fbioe.2023.1011121. eCollection 2023.
Left atrial appendage (LAA) occlusion or exclusion has been used in patients with atrial fibrillation to prevent stroke, but the techniques and devices have shortcomings. This study aims to validate the safety and feasibility of a novel LAA inversion procedure. LAA inversion procedures were done in six pigs. Before the procedure and at 8 weeks postoperatively, heart rate, blood pressure, and electrocardiogram (ECG) were recorded. The serum concentration of atrial natriuretic peptide (ANP) was measured. The LAA was observed and measured by transesophageal echocardiogram (TEE) and intracardiac echocardiogram (ICE). At 8 weeks after LAA inversion, the animal was euthanized. The heart was collected for morphology and histology, including hematoxylin-eosin, Masson trichrome, and immunofluorescence staining. TEE and ICE showed that LAA was inverted, and the inversion was maintained during the 8-week study duration. Food intake, body weight gain, heart rate, blood pressure, ECG, and serum ANP level were comparable before and after the procedure. Morphology and histological staining showed that there was no obvious inflammation or thrombus. Tissue remodeling and fibrosis were observed at the LAA inverted site. The inversion of LAA effectively eliminates the dead space of LAA and thus may reduce the risk of embolic stroke. The novel procedure is safe and feasible, but the efficacy in reducing embolization remains to be demonstrated in future studies.
左心耳（LAA）封堵或切除已用于房颤患者以预防中风，但这些技术和装置存在缺点。本研究旨在验证一种新型LAA翻转术的安全性和可行性。对6头猪进行了LAA翻转术。在手术前及术后8周，记录心率、血压和心电图（ECG）。测量心房利钠肽（ANP）的血清浓度。通过经食管超声心动图（TEE）和心内超声心动图（ICE）观察和测量LAA。在LAA翻转术后8周，对动物实施安乐死。采集心脏进行形态学和组织学检查，包括苏木精-伊红染色、Masson三色染色和免疫荧光染色。TEE和ICE显示LAA已翻转，且在为期8周的研究期间翻转状态得以维持。手术前后的食物摄入量、体重增加、心率、血压、ECG和血清ANP水平相当。形态学和组织学染色显示无明显炎症或血栓形成。在LAA翻转部位观察到组织重塑和纤维化。LAA翻转有效消除了LAA的死腔，因此可能降低栓塞性中风的风险。该新型手术安全可行，但在减少栓塞方面的疗效仍有待未来研究证实。
