Vrandecic M O, Fantini F A, Gontijo B F, Oliveira O C, Martins I C, Oliveira M H, Avelar S O, Vrandecic E, Vrandecic E
Department of Cardiothoracic Surgery, Biocor Institute, Belo Horizonte, Brazil.
Ann Thorac Surg. 1995 Aug;60(2 Suppl):S439-42. doi: 10.1016/0003-4975(95)00292-s.
The new stentless porcine mitral valve was developed to serve as an anatomically correct substitute for a diseased mitral valve. Extensive acute animal experimentation was performed, and from this the logical sequence for selecting the correct valve size and the specific technique for implanting it were determined. The following are the major steps to successfully implant a mitral stentless valve: First, mitral valve complex analysis must be done to determine the correct procedure to be performed and the feasibility of using the stentless mitral valve. Second, the correct size of stentless mitral valve must be chosen. Third, the papillary muscle anatomy must be assessed to determine the site and number of sutures necessary for securely holding the new origin of the new chordae. Fourth, the papillary muscle sutures must be anchored to the free pericardial edge of the new chordal origin. Fifth, the chordal alignment with both trigonal areas must be perfect. Sixth, the annulus may be sutured using either continuous or interrupted sutures. Perioperative echocardiography, preferably transesophageal echocardiography, should be done in every patient. Although reoperation was necessary in 5 patients (non-valve-related), the results in 74 patients (3 early and 3 late non-valve-related deaths excluded) followed up for at most 26 months (mean, 14 months) have been excellent. The quality of the results obtained in this initial clinical trial has reinforced our current preference for this valve in patients requiring mitral valve replacement. Longer follow-up is required to confirm that these good results continue.
新型无支架猪二尖瓣旨在作为病变二尖瓣的解剖学正确替代品。进行了广泛的急性动物实验，并据此确定了选择正确瓣膜尺寸的合理顺序以及植入瓣膜的具体技术。以下是成功植入二尖瓣无支架瓣膜的主要步骤：首先，必须进行二尖瓣复合体分析，以确定要执行的正确手术以及使用无支架二尖瓣的可行性。其次，必须选择正确尺寸的无支架二尖瓣。第三，必须评估乳头肌解剖结构，以确定牢固固定新腱索新起点所需缝线的位置和数量。第四，乳头肌缝线必须固定在新腱索起点的心包游离边缘。第五，与两个三角区的腱索对齐必须完美。第六，瓣环可以使用连续或间断缝线进行缝合。每位患者均应进行围手术期超声心动图检查，最好是经食管超声心动图检查。尽管有5例患者需要再次手术（与瓣膜无关），但对74例患者（排除3例早期和3例晚期与瓣膜无关的死亡）进行了长达26个月（平均14个月）的随访，结果非常出色。这项初步临床试验所获得结果的质量强化了我们目前对该瓣膜在需要二尖瓣置换的患者中的偏好。需要更长时间的随访以确认这些良好结果是否持续。
