The Effects of Transcatheter Valve Crimping on Pericardial Leaflets
The Effects of Transcatheter Valve Crimping on Pericardial Leaflets
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DOI：
10.1016/j.athoracsur.2013.11.009
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发表时间：
2014-04-01
影响因子：
4.6
通讯作者：
Kheradvar, Arash
中科院分区：
文献类型：
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作者：
Alavi, S. Hamed;Groves, Elliott M.;Kheradvar, Arash
背景经导管主动脉瓣置换术已成为治疗严重主动脉瓣狭窄的一种有前途的治疗方法。尽管已经证明这些瓣膜可以安全地输送和植入，但由于该技术尚处于起步阶段，因此缺乏对瓣膜寿命的研究。特别是，支架卷曲对瓣膜小叶的影响尚未得到充分研究。在这项研究中，我们的特点是压握对心包瓣叶的影响，在时间和通过组织的深度。为了检测牛心包瓣叶表面和深层的结构变化，使用扫描电子显微镜和二次谐波发生显微镜。对未压握的组织样本进行成像，然后在压握后即刻、压握后20分钟和压握后60分钟对植入支架的经导管瓣膜中的压握后组织段进行成像。对多种预置尺寸（即14 F、16 F和18 F）进行预置实验。我们定义了一个损伤指数，量化了卷曲导致的瓣叶结构变化的水平。根据计算的损伤指数和对原始图像的分析，确定预置对瓣叶组织造成可测量的损伤，并随时间持续。结论。在瓣叶表层观察到显著组织损伤。在较深的组织层中，14 F预置的损伤很大;但是，对于较大的塌陷轮廓，损伤变得不太明显，但仍然可见。卷曲可能会对心包瓣叶造成实质性结构损伤，并且不会随着时间的推移而改善。(C)2014年由胸外科医师协会
Background. Transcatheter aortic valve replacement has emerged as a promising therapy for treatment of severe aortic stenosis. Although it has been shown that these valves can be safely delivered and implanted, studies of valve longevity are lacking because of the infancy of the technology. Particularly, the effects of stent crimping on the valve's leaflets have not yet been sufficiently investigated. In this study, we have characterized the effects of crimping on pericardial leaflets in time and through the depth of the tissue.Methods. To test the structural changes at the surface and deep layers of bovine pericardial leaflets, scanning electron microscopy and second-harmonic generation microscopy were used. An uncrimped tissue sample was imaged, followed by imaging a segment of tissue after crimping in a stented transcatheter valve, immediately after, at 20 minutes, and 60 minutes after crimping. The crimping experiment was performed for multiple crimping sizes (ie, 14F, 16F, and 18F). We defined a damage index that quantifies the level of leaflet structural changes as a result of crimping.Results. Based on the calculated damage indices and analyses of the raw images, it was determined that crimping does measurable damage to the leaflet tissue that persists with time.Conclusions. Significant tissue damage was observed at the surface layers of the leaflets. In the deeper tissue layers, damage was substantial for 14F crimping; however, it became less significant but still visible for larger collapse profiles. Crimping may induce substantial structural damage to pericardial leaflets that does not improve with time. (C) 2014 by The Society of Thoracic Surgeons