Stone Gregg W, Sievert Horst, Virmani Renu, Shaler Lea Waisman, Manash Boaz, Neustadter David
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
CardioVascular Center Frankfurt CVC, Frankfurt, Germany.
Struct Heart. 2022 Aug 1;6(4):100075. doi: 10.1016/j.shj.2022.100075. eCollection 2022 Aug.
Reshaping the dilated left ventricle using a surgically implanted papillary muscle sling has been shown to provide long-term improvement in cardiac function compared to annuloplasty alone in patients with systolic heart failure. A papillary muscle sling which can be implanted via a transcatheter approach has the potential to make this treatment more widely available to patients.
The Vsling transcatheter papillary muscle sling device was evaluated in a chronic animal model (sacrificed at 30 and 90 days), in a simulator, and in a human cadaver.
The Vsling device was successfully implanted in 10 pigs, 6 simulator procedures, and 1 human cadaver. Procedure complexity and device usability were rated as reasonable or better by 6 interventional cardiologists. Gross and histological analysis in chronic pigs through 90 days demonstrated near-complete endothelial coverage with mild inflammation and small hematoma formation but without adverse tissue reactions, thrombi, or embolization.
Preliminary feasibility and safety of the Vsling implant and implantation procedure have been demonstrated. Human trials are planned to begin in the summer of 2022.
对于收缩性心力衰竭患者,与单纯瓣环成形术相比,使用手术植入的乳头肌吊带重塑扩张的左心室已显示出能长期改善心脏功能。一种可通过经导管途径植入的乳头肌吊带有可能使更多患者能够接受这种治疗。
在慢性动物模型(分别于30天和90天时处死后进行评估)、模拟器以及人体尸体上对Vsling经导管乳头肌吊带装置进行了评估。
Vsling装置成功植入10头猪、完成6例模拟器操作以及1具人体尸体。6位介入心脏病专家将操作复杂性和装置易用性评为合理或更佳。对90天内的慢性猪进行大体和组织学分析显示,内皮几乎完全覆盖,有轻度炎症和小血肿形成,但无不良组织反应、血栓或栓塞。
已证明Vsling植入物及植入手术的初步可行性和安全性。计划于2022年夏季开始人体试验。