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首页> 外文期刊>Textile research journal >New sutureless 'atrial-mitral-valve prosthesis' for minimally invasive mitral valve therapy
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New sutureless 'atrial-mitral-valve prosthesis' for minimally invasive mitral valve therapy

机译：用于微创二尖瓣治疗的新型无缝合“心房二尖瓣假体”

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Incompetence is the most relevant dysfunction of the mitral valve. Surgical replacement and reconstruction is the treatment of choice whereas trans-catheter replacement or repair of mitral valve regurgitation proved demanding. We aimed for a new sutureless approach to anchor a biological heart valve in the mitral position without major surgery by inserting a valve-carrying hollow body into the left atrium. A mould representing the porcine left atrium from the pulmonary veins as far as the mitral valve was created. A superelastic Nitinol-skeleton was sutured onto a warp knitted tubular bifurcation of polyvinylidene fluoride (PVDF) multifilaments fitting the mould. This new self-expandable composite-material hollow body customized to the porcine anatomy was equipped with a commercially available biological heart valve. The functionality of this prosthesis was investigated in a circulatory mock loop simulator and the overall properties were examined in an open animal operation. The left atrium was incised and the prosthesis was placed in eight female pigs of 70 kg, under extracorporeal circulation. Prior to implantation, an artificial valve incompetence was created. Hemodynamic, echocardiographic, and radiological examinations were performed. A post mortem examination of the entire heart was performed. In the simulator we could demonstrate that the composite-material hollow body exhibited enough self-expansion to anchor onto the surrounding structures and that the function of the expanded valve was not compromised. In the animal, the prostheses walls almost completely adapted to surrounding structures leading to an exclusion of the left atrium. Sufficient treatment of mitral regurgitation was displayed hemodynamically and by echocardiography, although overall visualization was difficult. Therefore, in the last four animals a CT scan was performed demonstrating full expansion. Autopsy revealed an excellent anchorage of the prostheses. The relevant intracavitary injury and thrombotic formation were not seen. By the use of a composite-material self-expanding hollow body it is possible exclude a complete heart chamber and thereby to anchor a biological heart valve without sutures.
机译：机能不全是二尖瓣最相关的功能障碍。手术置换和重建是首选治疗方法，而经导管置换或修复二尖瓣反流被证明是必需的。我们的目标是一种新的无缝合方法，通过将携带瓣膜的空心体插入左心房，将生物心脏瓣膜固定在二尖瓣位置，而无需进行大手术。一个代表猪左心房的模具，从肺静脉一直到二尖瓣。将超弹性镍钛合金骨架缝合到适合模具的聚偏二氟乙烯 （PVDF） 复丝的经编管状分叉上。这种根据猪解剖结构定制的新型自膨胀复合材料空心体配备了市售的生物心脏瓣膜。在循环模拟环模拟器中研究了该假体的功能，并在开放性动物手术中检查了整体特性。切开左心房，将假体放置在8头70公斤的母猪体内，在体外循环下。在植入之前，已经产生了人工瓣膜功能不全。进行血流动力学、超声心动图和放射学检查。对整个心脏进行了尸检。在模拟器中，我们可以证明复合材料空心体表现出足够的自膨胀能力以锚定在周围的结构上，并且膨胀阀的功能没有受到影响。在动物中，假体壁几乎完全适应周围的结构，导致左心房被排除在外。血流动力学和超声心动图显示二尖瓣反流得到充分治疗，但整体可视化困难。因此，在最后四只动物中进行了CT扫描，显示完全扩张。尸检显示假肢的锚固性极好。未见相关腔内损伤和血栓形成。通过使用复合材料自膨胀空心体，可以排除完整的心腔，从而在没有缝合线的情况下锚定生物心脏瓣膜。

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