Percutaneous aortic valve replacement:: Endovascular resection of human aortic valves in situ
Percutaneous aortic valve replacement:: Endovascular resection of human aortic valves in situ
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DOI：
10.1016/j.jtcvs.2007.11.036
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发表时间：
2008-05-01
影响因子：
6
通讯作者：
Lutter, Georg
中科院分区：
文献类型：
--
作者：
Quaden, Rene;Attmann, Tim;Lutter, Georg
目的：本课题组已成功地进行了严重钙化的人主动脉瓣的体外经腔切除术。本研究的目的是分析血管内激光辅助切除人主动脉瓣原位在10人cadivers.Material和方法：前外侧小切口后，主动脉瓣隔离室系统被插入到降主动脉和推进transluminally到主动脉的位置，以产生一个单独的操作空间之间的瓣下和近端升主动脉区。在展开和密封腔室后，通过1.58 L/min生理盐水溶液的连续腔室灌洗建立了稳定的功能（8/10例）。通过右颈动脉输送内窥镜引导的激光纤维。用镊子导管固定瓣叶后，用额定功率为20 W的铥：YAG激光切除自体瓣叶。结果：主动脉瓣隔离室经腔定位和展开的时间为7.3 ± 5.8min。荧光镜检查证实腔室密封。所有瓣叶均完成切除，每个瓣叶平均耗时6.0 +/- 3.5分钟。10例中4例主动脉壁中度损伤，2例主动脉瓣环损伤，1例主动脉壁穿孔。周围组织，冠状动脉口，二尖瓣，左心室流出道保持不受影响。结论：这项研究表明，血管内切除原位人主动脉瓣的可行性。这是人类主动脉瓣完全经皮置换（切除和植入）的后续步骤。
Objective: Transluminal in vitro resection of severely calcified human aortic valves has already been successfully carried out by our group. The aim of this study was to analyze endovascular laser-assisted resection of human aortic valves in situ in 10 human cadavers.Material and Methods: After anterolateral minithoracotomy, the aortic valve isolation chamber system was inserted into the descending aorta and pushed forward transluminally into the aortic position to generate a separate operation space between the subvalvular and the proximal ascending aortic area. After deployment and sealing of the chamber, stable function with a continuous chamber lavage of 1.58 L/min saline solution was established (8/10 cases). The endoscopically guided laser fiber was delivered via the right carotid artery. After fixation of a leaflet by a forceps catheter, the native leaflets were resected each by a thulium: YAG laser with 20-W power rating. Macropathology and micropathology of surrounding anatomic structures were analyzed.Results: The duration of transluminal positioning and deployment of the aortic valve isolation chamber took 7.3 +/- 5.8 minutes. Fluoroscopy confirmed sealed chambers. The resection was completed in all leaflets and took, on average, 6.0 +/- 3.5 minutes per leaflet. The aortic wall was moderately injured in 4 of 10 cases and the aortic annulus in two cases with one aortic wall perforation. The surrounding tissue, the coronary ostia, the mitral valve, and the left ventricular outflow tract remained unaffected.Conclusion: This study demonstrates the feasibility of endovascular resection of human aortic valves in situ. This is a subsequent step toward complete percutaneous replacement (resection and implantation) of human aortic valves.