原位和异位微创瓣膜置入羊模型的建立及效果评价  

Establishment and assessment of orthotropic and heterotrophic valve implantation models in goat with minimally inva- sive methods

作　　者：胡行健[1] 史嘉玮[1] 刘金平[1] 卢晓芳[2] 袁锋[3] 邓诚[1] 史峰[1] 董念国[1] 

机构地区：[1]华中科技大学附属协和医院心血管外科,武汉430022 [2]华中科技大学附属协和医院超声科,武汉430022 [3]华中科技大学附属协和医院介入放射科,武汉430022

出　　处：《中华胸心血管外科杂志》2012年第11期670-673,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家863高技术研究发展计划（2009AA032420）：国家自然科学基金面上项目（30872540、81170214）

摘　　要：目的构建微创大动物瓣膜置入模型，评价其效果。方法应用枝化状聚乙二醇交联猪去细胞主动脉瓣构建新型组织工程化瓣膜替代物，参照Corevalve经导管瓣膜置入系统，自制微创瓣膜释放系统。成年雄性山羊18只，分为原位超声引导组（A组）、原位X线造影引导组（B组）和异位直接释放组（C组），每组6只，全麻下借助心脏超声和X线造影引导，于主动脉瓣原位或胸降主动脉异位行微创瓣膜置入。术后4周时行心脏CT和超声以评价瓣膜近期功能。结果手术成功率分别为A组66．7％（4／6只）、B组50．0％（3／6只）和C组100．0％（6／6只），多重，比较提示A、B组间差异无统计学意义，但与C组间差异均有统计学意义。3组分别手术（79±18）min、（61±23）min和（45±15）min，单向方差分析提示组间差异有统计学意义。术后4周存活率分别为100％（4／4只）、100％（3／3只）和83．3％（5／6只），多重，比较提示组间差异无统计学意义。心脏cT和超声证实术后即刻和4周时，原位置入的瓣膜定位稳定，瓣叶开合良好，无狭窄及反流。结论3组瓣膜置入羊模型均无需体外循环辅助，并具有创伤小、无需输血、可重复性较好等优点，近期存活率满意。A组技术设备简单，但超声定位精确性有限，操作时间较长；B组定位准确迅速，但依赖X线造影设备；C组手术成功率高，但置入的瓣叶无功能性启闭活动，仅适用于瓣膜生物相容性的在体观察。Objective To establish and evaluate 3 kinds of minimally-invasive valve implantation model in vivo. Meth- otis A novel tissue engineered heart valve（TEHV） manufactured by branched polyethylene glycol cross-linked acellular por- cine valve and a minimafly-invasive valve implantation system according to the design of Corevalve revalving system were adopt- ed. After anesthesia, 18 adult male goats were randomly divided into 3 groups： the ultrasound-directed orthotropic group （ group A, n = 6 ） , angiography-directed orthotropie group （ group B, n = 6 ） and direct-released beterotopie group （ group C, n = 6） , and all received minimally-invasive valve implantation orthotropically or heterotopically. 4 weeks later, the valvular function was evaluated by CTA and/or echocardiography. Results All 3 kinds of caprine model were successfully constructed. The op- eration success rate of each group was A： 66.7%, B： 50. 0% and C： 100. 0% , respectively（ multiple ）（2 analysis, group A and B P 〉 0.05 ; group A and C,group B and C, P 〈 0.05 ）. The operation-time of each group was A： （79 ± 18） min, B： （ 61 ± 23 ） min, C ： （45 ± 15 ） min （ one-way ANOVA, P 〈 0.05 ） ＇. The survival rate at 4 weeks was A ： 100% , B ： 100% and C ： 83.3 % （ multiple X2 analysis, P 〉 0.05 ）. Eehocardiography and CTA proved the short-term function of implanted TEHV was satisfactory. Conclusion All 3 kinds of caprine valve implantation model can be established without cardiopulmonary by- pass and blood transfusion. The devices and equipments required in group A is relatively simple, but the procedure cost longer time for it is hard to determine the right position by ultrasound. The application of angiography made the positioning much easi- er in group B while the procedure had to be performed in specific operation room with angiographic apparatus. Group C did rely on neither special equipments nor complex operation, but the valve leaflets cannot work normally, so this model was o

关 键 词：心脏瓣膜假体置入 模型 动物 原位 异位 微创 

分 类 号：R654.2[医药卫生—外科学]