开胸经导管植入带瓣膜主动脉瓣支架置换犬主动脉瓣膜的短期疗效观察  

Transapical aortic valve implantation with a new self-expanding valved stent in canines:an observation of short-term outcomes

作　　者：顾明标[1] 陈翔[1] 白元[1] 宗刚军[1] 朱玉峰[1] 姚颖龙[2] 赵仙先[1] 吴弘[1] 秦永文[1] 

机构地区：[1]第二军医大学长海医院心内科,上海200433 [2]第二军医大学长海医院胸心外科,上海200433

出　　处：《第二军医大学学报》2009年第10期1150-1153,共4页Academic Journal of Second Military Medical University

基　　金：国家高技术研究发展计划("863"计划;2006AAOZZ41D7)~~

摘　　要：目的:探讨开胸经导管植入带瓣膜支架置换主动脉瓣膜的可行性及术后短期疗效。方法:新鲜猪心包以0.6%戊二醛浸泡36h后缝合在瓣膜环上,并将其固定在哑铃型镍钛记忆合金自膨胀支架上,制成带瓣膜主动脉瓣支架。选择健康杂种犬8只,通过开胸穿刺左心室心尖部,超声引导下将带瓣膜支架经导管植入至主动脉瓣处,置换犬自身主动脉瓣膜,术后定期行心电图、心脏彩超、CT及DSA造影检查,随访3个月,观察治疗效果。结果:成功制作带瓣膜主动脉瓣支架,经导管植入置换主动脉瓣膜后5只犬成活;心脏彩超及DSA造影检查证实术后支架位置及瓣膜功能良好,冠脉血流未受影响,术后3个月CT检查未发现支架移位,无明显并发症发生。结论:开胸经导管途径植入自制带瓣膜主动脉瓣支架可有效置换犬主动脉瓣膜,短期随访疗效理想。Objective：To discuss the feasibility of using the off-pump antegrade transventricular route for aortic valved stent implantation in canines,and to observe the short-term outcomes. Methods： Fresh porcine pericardium was treated with 0. 6 glutaraldehyde solution for 36 h; then it was trimmed and sutured into a valvular ring and fixed on a new self-expanding dumb- bell shaped nickel-titanium shape-memory alloy stent. The valved stents were then implanted off-pump in 8 canines. A limited or full sternotomy approach was used to access the apex of the heart. The crimped valve was introduced through a sheath in the left ventricular apex under ultrasound guidance. The function of valved stents was evaluated with electrocardiogram, echocardiography,computed tomography and DSA angiography early and 3 months after the procedure. Results： We successfully prepared the valved aortic stent. Five canines survived after implantation of the aortic valved stents. Angiographic and echocardiographic observation confirmed that the location and function of the stent were satisfactory, without influencing coronary blood flow and mitral valve function. CT examination showed no migration of the stent 3 months after the procedure, and there were no other prominent complications. Conclusion： Our new self-expanding valved stent can be deployed over the native aortic valves via transapical route, and the short-term outcome is satisfactory.

关 键 词：主动脉瓣 心脏导管插入术 心脏瓣膜假体植入 支架 

分 类 号：R542.51[医药卫生—心血管疾病]