新型无支架猪主动脉瓣膜的研制  

Hemodynamic performance of newly developed composite stentless porcine aortic valve： in vitro testing and in vivo experiment with sheep

作　　者：宋光民[1] 周建业[1] 胡盛寿[1] 崔经纬[1] 宋云虎[1] 唐跃[1] 张岩[1] 蒋虹[1] 袁卫民[1] 宋学营[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院卫生部心血管病再生医学重点实验室,北京100037

出　　处：《中华医学杂志》2008年第29期2059-2063,共5页National Medical Journal of China

基　　金：国家“十五”科技攻关计划课题基金资助项目（2001BA706B-10）

摘　　要：目的采用猪的3个主动脉无冠瓣进行匹配组合，然后缝制成新型的无支架主动脉瓣膜，体外脉动流和动物体内植入对其进行测试。方法采集带有完整升主动脉的新鲜猪心脏，修剪之后保留升主动脉和二尖瓣前瓣及部分室间隔。用0．6％戊二醛进行主动脉根部预扩张和瓣叶零压力差固定之后，分别取3个大小和形态相似的无冠瓣进行拼接缝制，瓣膜的外侧和下缘覆以薄层牛心包。体外脉动流对制作的无支架猪主动脉瓣膜进行有效开口面积（EOA）和跨瓣压差（AP）测试，与同型号有支架牛心包瓣做对照。在体外循环下，用无支架瓣膜替换16只幼年绵羊的主动脉瓣膜，术中经食管内超声、术后定期经胸超声监测瓣膜的功能情况，并进一步观察动物的生存状况以及瓣膜的病理变化。结果新型无支架瓣膜消除了右冠瓣下方的肌肉组织，增加了瓣膜的有效开口面积。体外脉动流测试结果表明，无支架猪主动脉瓣的EOA在各个流量点均高于同型号的有支架牛心包瓣（均P〈0．05），而平均跨瓣膜压差（AP）则明显低于有支架牛心包瓣（均P〈0．05）。16只实验动物有12只术后存活，其中有5只存活大于90d，3只超过180d，2只超过360d。术中超声检查证实所有无支架瓣膜活动情况良好，均没有反流，跨瓣压差低[（3．90±0．78）mmHg]。术后15—360d经胸超声显示瓣膜的启闭功能良好。分别在术后5、15、45、90、180和300d处死动物，病理检查显示，无支架瓣膜有轻到中度的钙化，没有瓣周漏和组织过度增生。结论新型无支架猪主动脉瓣膜具有优良的血液动力学性能，手术植入相对简单，瓣膜具有较低的跨瓣压差。Objective To investigate the effects of a newly developed composite stentless porcine aortic valve constructed from noncoronary leaflets of three porcine aortic valves. Methods Fresh porcine hearts with ascending aorta were obtained from a slaughterhouse. The porcine aortic roots with ascending aorta and anterior leaflet of mitral valve and partial ventricular septum were dissected out and were pressurized to maintain their natural anatomical shapes with the leaflets floating freely at zero-pressure. Three noncoronary leaflets fixed in 0. 6% glutaraldehyde were carefully matched for size and symmetry to construct a novel composite stenttless porcine aortic valve. The lower margin and outside of the valve was covered with a piece of bovine pericardium. The novel stenfless valves were tested in vitro pulsatile flow to detect the effective orifice area （ EOA ） and mean pressure difference （AP） of the valve compared with the stented bovine pericardial bioprostheses of the same size. Sixteen male juvenile sheep underwent implantation of the novel valves in the supra-annular position in under cardio-pulmonary bypass. The intraoperative and postoperative echocardiography and pathological specimen were given to evaluate the hemodynamic performance and observed in the respects of a long-term survival, function of valve and pathological specimen. Results Since novel valves had the unfavorable muscle-based right coronary leaflet characteristic of porcine valve removed it had larger EOA. Pulsatile flow testing indicated that the EOA of the 3 novel valves was （ 3.47±0. 15 ） , （ 3.69 ± 0. 11 ） , and （ 3.92 ± 0. 18 ） cm^2 respectively, all significantly greater than those of the stented bovine pericardial biopresthesis [ （2. 00 ±0. 16）, （2. 21 ±0. 26）, and （2. 37 ± 0. 42） cm^2 respectively] at each integral simulated cardiac output between 3-6 L/min （ all P 〈 0. 05 ）, while the AP levels of the novel valves were （2. 35 ±0. 41 ）, （3.10 ±0. 20）, and （3. 56 ±0. 16） rmn Hg

关 键 词：心脏瓣膜 人工 血液动力学 钙化 生理性 

分 类 号：R686[医药卫生—骨科学]