Endovascular Reconstruction from Aortic Valve to Aortic Arch Using One-Piece Valved-Fenestrated Stent Graft with a Branch: A Proof-of-Concept Study
Endovascular Reconstruction from Aortic Valve to Aortic Arch Using One-Piece Valved-Fenestrated Stent Graft with a Branch: A Proof-of-Concept Study
复制标题
使用带分支的一体式带瓣有窗覆膜支架进行从主动脉瓣到主动脉弓的血管内重建：一项概念验证研究
DOI：
10.1532/hsf.2585
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发表时间：
2019-01-01
影响因子：
0.6
通讯作者：
Jing, Zaiping
中科院分区：
文献类型：
--
作者：
Li, Tao;Bao, Xianhao;Jing, Zaiping
目的：为探讨单枚覆膜支架血管内重建主动脉根部（包括主动脉瓣、主动脉窦和升主动脉）的可行性，设计了一种新型的双开窗带瓣覆膜支架，并在体外模拟猪心循环系统上进行了实验。处死前行主动脉CTA检查，测量主动脉根部形态学参数。然后我们根据CTA测量值定制带瓣覆膜支架。将猪心按原始方向固定在专用平台上，并与循环系统连接后，在DSA（数字减影血管造影）引导下经心尖入路输送覆膜支架，覆盖主动脉瓣环至主动脉弓近端段。结果：冠状动脉开窗术总的技术成功率为100%。在120 mmHg循环压力下，超声检测瓣膜功能良好。左冠状动脉（LCA）的流量在覆膜支架植入后没有减少，而是增加（340 +/- 2.06 mL/min vs 288 +/- 5.29 mL/min，P <0.05）。同样，右冠状动脉（RCA）的流量也增加（392 +/- 9.17 mL/min vs 348 +/- 8.01 mL/min; P <0.05）。最终血管造影证实两条冠状动脉均通畅。从主动脉窦外壁大体观察，右冠状动脉和左冠状动脉口均与窦口对齐。在4例患者中，自体瓣叶阻塞了近20%的LCA窗面积，但这些病例的流量并未明显减少。在基于猪心的循环模拟系统上模拟，带分支的一体式带瓣-开孔型覆膜支架可经心尖入路输送并准确展开，实现主动脉瓣的血管内重建，主动脉窦和升主动脉，同时通过开窗保留冠状动脉灌注。必须进行更多的动物模型体内实验，以进一步验证其有效性和安全性。
Objective: To explore the feasibility of endovascular reconstruction of aortic root including aortic valve, sinus of valsalva and ascending aorta by a single stent-graft, a novel valved stent-graft with two fenestrae for preserving the coronary arteries was designed and performed in-vitro on a pig heart based circulation simulating system.Methods: Pig hearts were harvested from 30 healthy adult female pigs weighing between 60-65 kilograms. Before sacrifice, all the pigs received aortic computed tomography angiography (CTA) examinations and morphologic parameters of aortic root were measured. Then we customized the valved stent-grafts according to the CTA measurements. After the pig heart was fixed on the special platform according to the original orientation and connected to the circulation system, the stent graft was delivered through transapical access and covered the segment from aortic annulus to proximal part of aortic arch under DSA (digital subtraction angiography) guidance. Then changes of coronary flow before and after the procedure and fenestration alignment with coronary ostia were analyzed.Results: The overall technical success rate was 100%. The valve functions tested by ultrasound were in good condition under 120 mmHg circulation pressure. The flow of left coronary artery (LCA) did not decrease, but increased after the stent-graft implantation (340 +/- 2.06 mL/min versus 288 +/- 5.29 mL/min, P < .05). Similarly, the flow of right coronary artery (RCA) also increased (392 +/- 9.17 mL/min versus 348 +/- 8.01 mL/min; P < .05). The final angiography confirmed that both coronary arteries were patent. When generally observed from outer wall of valsalva sinus, both RCA and LCA orifices were aligned with the fenestrae. In 4 cases, the autologous valve leaflets blocked nearly 20% of the LCA fenestras area, but the flow did not significantly decrease in these cases.Conclusion: Stimulated on a pig heart-based circulation simulation system, the one-piece valved-fenestrated stent graft with a branch could be delivered via the transapical access and deployed accurately, which achieved endovascular reconstruction of aortic valve, sinus of valsalva and ascending aorta while preserving the coronary artery perfusion by fenestrations. More in-vivo experiments on animal models are mandatory to further verify its efficacy and safety.