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经导管主动脉瓣植入术后小主动脉根部的冠状动脉灌注：体外实验评估。

Coronary Perfusion After Valve-in-Valve Transcatheter Aortic Valve Implantation in Small Aortic Root: In Vitro Experimental Assessment.

机构信息

Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Via Golgi 39, 20133, Milan, Italy.

ForcardioLab-Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.

出版信息

J Cardiovasc Transl Res. 2023 Aug;16(4):956-967. doi: 10.1007/s12265-023-10364-y. Epub 2023 Apr 25.

DOI:10.1007/s12265-023-10364-y
PMID:37097591
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10480284/
Abstract

Coronary flow obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) is associated with a high mortality risk. The aim of this work was to quantify the coronary perfusion after VIV-TAVI in a high-risk aortic root anatomy. 3D printed models of small aortic root were used to simulate the implantation of a TAVI prosthesis (Portico 23) into surgical prostheses (Trifecta 19 and 21). The aortic root models were tested in a pulsatile in vitro bench setup with a coronary perfusion simulator. The tests were performed at baseline and post-VIV-TAVI procedure in aligned and misaligned commissural configurations under simulated hemodynamic rest and exercise conditions. The experimental design provided highly controllable and repeatable flow and pressure conditions. The left and right coronary mean flow did not differ significantly at pre- and post-VIV-TAVI procedure in any tested configurations. The commissural misalignment did not induce any significant alterations to the coronary flow. High-risk aortic root anatomy did not trigger coronary ostia obstruction or coronary flow alteration after transcatheter aortic valve implantation in a surgical bioprosthesis as shown from in-vitro flow loop tests.

摘要

经导管主动脉瓣置入术（TAVI）后发生冠状动脉阻塞与高死亡率相关。本研究旨在量化高危主动脉根部解剖结构中 TAVI 后的冠状动脉灌注情况。使用小型主动脉根部的 3D 打印模型模拟 TAVI 假体（Portico 23）植入外科假体（Trifecta 19 和 21）。使用冠状动脉灌注模拟器对主动脉根部模型在脉动体外工作台进行了测试。在模拟血流动力学休息和运动条件下，在对准和不对准的共腔配置下，在基线和 VIV-TAVI 术后进行了测试。实验设计提供了高度可控和可重复的流动和压力条件。在任何测试配置中，VIV-TAVI 术前和术后左、右冠状动脉平均流量均无显著差异。共腔不对准不会引起冠状动脉口阻塞或经导管主动脉瓣植入术后冠状动脉血流改变，这一点从体外流量回路测试中得到了证实。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/4f6c93b3a689/12265_2023_10364_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/5b5267f41b7f/12265_2023_10364_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/545babec298c/12265_2023_10364_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/4f3e4036703e/12265_2023_10364_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/58415cef0304/12265_2023_10364_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/9ab6d2832f7e/12265_2023_10364_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/4f6c93b3a689/12265_2023_10364_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/5b5267f41b7f/12265_2023_10364_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/545babec298c/12265_2023_10364_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/4f3e4036703e/12265_2023_10364_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/58415cef0304/12265_2023_10364_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/9ab6d2832f7e/12265_2023_10364_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd1f/10480284/4f6c93b3a689/12265_2023_10364_Fig6_HTML.jpg

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本文引用的文献

1
Repeated transcatheter aortic valve implantation for the treatment of a degenerated transcatheter aortic valve implantation valve (valve-in-valve technique): a case report.经导管主动脉瓣植入术重复治疗退化的经导管主动脉瓣植入瓣膜（瓣中瓣技术）：一例报告
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Will Transcatheter Replacement Become the New Default Therapy When Bioprosthetic Valves Fail?当生物瓣膜失效时，经导管置换会成为新的默认治疗方法吗？
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