Trilogy pericardial valve: Hemodynamic performance and calcification in adolescent sheep
Trilogy pericardial valve: Hemodynamic performance and calcification in adolescent sheep
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DOI：
10.1016/j.athoracsur.2007.09.041
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发表时间：
2008-02-01
影响因子：
4.6
通讯作者：
Herregods, Marie-Christine
中科院分区：
文献类型：
--
作者：
Flameng, Willem;Meuris, Bart;Herregods, Marie-Christine
背景我们评估了新设计的牛心包瓣膜Trilogy瓣膜（Arbor Surgical Technologies Inc，Irvine，CA）的血流动力学性能和钙化可能性。我们在青少年绵羊的随机前瞻性研究中比较了这种新瓣膜与Perimount瓣膜（Edwards Lifesciences，Irvine，CA）。将9枚Trilogy瓣膜（尺寸21）和6枚Perimount瓣膜（尺寸23或25）植入青少年绵羊的二尖瓣位置，并在5个月内进行研究。使用经胸超声心动图在1周、3个月和5个月时进行血流动力学测量。植入羊体内5个月后，通过X线评估瓣膜钙化，并通过原子吸收光谱法测量钙含量。组织学评价（Von Kossa染色）。与6枚Perimount瓣膜相比，9枚Trilogy瓣膜的峰值速度、峰值压差和平均压差较低。与23 mm和25 mm Perimount瓣膜相比，这些21 mm Trilogy瓣膜具有相似的减速时间和有效瓣口面积。Trilogy瓣膜的钙化显著低于Perimount瓣膜（p < 0.01），特别是在连合（p < 0.01）和游离缘区域（p < 0.03）。在评估的所有参数中，与Perimount瓣膜相比，Trilogy瓣膜的瓣膜间变异较小。结论。这些结果表明，设计用于降低组织应力、改善瓣叶运动学并进行高级抗矿化处理的瓣膜在青少年绵羊二尖瓣位置可表现出上级抗钙化性。三瓣几何结构和独立瓣叶悬吊设计结合先进的组织处理，似乎是开发更耐用和血流动力学有效的生物瓣膜的一个有希望的突破。
Background. We assessed the hemodynamic performance and calcification potential of a new design of bovine pericardial valve, the Trilogy valve (Arbor Surgical Technologies Inc, Irvine, CA). We compared this new valve with the Perimount valve (Edwards Lifesciences, Irvine, CA) in a randomized prospective study in adolescent sheep.Methods. Nine Trilogy valves (size 21) and six Perimount valves (size 23 or 25) were implanted in the mitral position in adolescent sheep and studied during five months. Hemodynamic measurements were performed at one week, three months, and five months using transthoracic echocardiography. Valve calcification was assessed by X-ray and calcium content was measured by atomic absorption spectrometry after five months implantation in sheep. Tissues were also evaluated histologically (Von Kossa staining).Results. The nine Trilogy valves had lower peak velocity, peak gradient, and mean gradient compared with the six Perimount valves. These 21-mm Trilogy valves had similar deceleration time and effective orifice area compared with the 23- and 25- mm Perimount valves. Calcification of the Trilogy valves was significantly lower than Perimount valves (p < 0.01), particularly in the commissural (p < 0.01) and free margin regions (p < 0.03). In all parameters assessed, the Trilogy valves exhibited less variation valve-to-valve compared wit h Perimount valves.Conclusions. These findings demonstrate that a valve designed to reduce stress in the tissue, improve leaflet kinematics, with advanced antimineralization treatment, can exhibit superior calcification resistance in the mitral position of adolescent sheep. The trilobal geometry and independent leaflet suspension design, combined wit h an advanced tissue treatment, appears to be a promising breakthrough in the effort to develop a more durable and hemodynamically efficient bioprosthetic valve.