Comparison of Different Resection Tools for Human Calcified Aortic Valves
Comparison of Different Resection Tools for Human Calcified Aortic Valves
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DOI：
10.1097/imi.0000000000000085
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发表时间：
2014-07-01
影响因子：
1.5
通讯作者：
Petzina, Rainer
中科院分区：
文献类型：
--
作者：
Marczynski-Buehlow, Martin;Gross, Justus;Petzina, Rainer
目的：有症状的严重主动脉瓣狭窄是一种主要见于高龄患者的疾病。标准疗法是主动脉瓣置换术。经导管主动脉瓣植入术 (TAVI) 是一种针对不适合传统主动脉瓣置换术的患者的治疗方法。为了最大限度地减少 TAVI 相关并发症的发生率，例如瓣周漏、起搏器必要性和冠状动脉口闭塞，我们的研究小组致力于开发主动脉瓣切除工具。本研究的目的是探讨离体不同切除工具对人钙化主动脉瓣的横截面形态的影响。方法：使用12个人钙化主动脉瓣叶，研究激光手术刀、打孔器和剪刀对横截面形态的影响。采用扫描电子显微镜和组织学分析来评估切割表面积。结果：激光手术刀产生的横截面区域光滑、规则且均匀，而使用剪刀或打孔装置时这些区域则粗糙、不规则且不均匀。切削刃的定量分析表明三种切除工具之间存在显着差异。激光手术刀与打孔器比较（P < 0.001）、激光手术刀与剪刀比较（P < 0.05）均获得最佳效果，而剪刀与打孔器比较无显着性差异（P > 0.05）。结论：与打孔器和剪刀相比，激光切割人钙化主动脉瓣的截面形态均匀性最好，似乎成为未来 TAVI 手术期间主动脉瓣切除术的有前景的工具。
Objective: Symptomatic severe aortic valve stenosis is a disease primarily found in patients of advanced age. The standard therapy is the aortic valve replacement. Transcatheter aortic valve implantation (TAVI) is a treatment for patients ineligible for conventional aortic valve replacement. To minimize the incidence of TAVI-related complications, such as paravalvular leakage, pacemaker necessity, and ostial coronary occlusion, our research group works on the development of resection tools for aortic valves. The aim of this study was to investigate ex vivo different resection tools for human calcified aortic valves concerning cross-section morphology.Methods: With the use of 12 human calcified aortic leaflets, the effect of laser scalpel, punching device, and scissors on cross-section morphology was investigated. Scanning electron microscopy and histological analyses were applied to evaluate the cutting surface area.Results: The cross-section areas created by a laser scalpel were smooth, regular, and uniform, whereas these areas were rough, irregular, and inhomogeneous when using the scissors or the punching device. Quantitative analysis of the cutting edges demonstrated significant differences between the three resection tools. The best results were obtained for the laser scalpel compared with the punching device (P < 0.001) and for the laser scalpel compared with the scissors (P < 0.05), whereas the scissors compared with the punching device showed no significant differences (P > 0.05).Conclusions: Laser cutting of human calcified aortic valves demonstrated the best results concerning homogeneous cross-section morphology compared with the punching device and the scissors and seems to be a promising tool for aortic valve resection during TAVI procedures in the future.