In vitro results of a new minimally invasive aortic valve resecting tool
In vitro results of a new minimally invasive aortic valve resecting tool
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DOI：
10.1016/j.ejcts.2009.01.005
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发表时间：
2009-04-01
影响因子：
3.4
通讯作者：
Jakob, Heinz
中科院分区：
文献类型：
--
作者：
Wendt, Daniel;Mueller, Wiebke;Jakob, Heinz
背景：采用体外循环的主动脉瓣置换术（AVR）目前是症状性主动脉瓣狭窄的首选治疗方法。然而，患有多种高风险共病的患者可能受益于通过简化和快速切除结合快速无缝线瓣膜植入缩短的ECC时间。方法：设计了一种新型微创主动脉瓣切除工具的原型，该工具配备有可旋转和可折叠的镍钛合金切割边缘。对市售主动脉瓣生物瓣膜进行人工钙化（第1组：中度钙化，n = 8，第2组：重度钙化，n = 8）。使用21 mm切割刀片进行体外切除。测量切除时间（RT）、最大旋转力矩（MTM）和所需旋转次数（NR）。此外，在切削过程中的颗粒生成得到和量化。结果：所有病例均能顺利完成主动脉瓣切除，无并发症发生。切割过程导致组1的RT为15.5 +/- 3 s，而组2为34.9 +/- 15 s（p = 0.005），第1组的MTM为3 +/- 0.6 Nm，而第2组为3.5 +/- 0.6 Nm（p = 0.068），NR为30.6 = 2.3，而第2组为48.1 +/- 15.5（p = 0.007）。第1组的颗粒生成量为1.77 +/- 0.17 g，而第2组为1.41 +/- 0.44 g（p = 0.047）。结论：这些首次体外结果证实了可行性，并在30 s内加速了主动脉瓣切除。这一新概念有望实现非常快速的AVR，并结合插入免缝合主动脉瓣假体，目标是在心脏直视情况下缺血时间小于10分钟。最后，设想在心脏跳动的情况下在1分钟内切除和经皮AVR。(C)2009年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Background: Aortic valve replacement (AVR) using extracorporeal circulation is currently the treatment of choice for symptomatic aortic stenosis. However, patients with multiple high-risk comorbid conditions may benefit from reduced ECC time by a simplified and faster resection in conjunction with quick sutureless valve implantation. Methods: A prototype of a new minimally invasive aortic valve resection tool equipped with rotating and foldable Nitinol cutting edges was designed. Commercially available aortic valve bioprostheses were artificially calcified (group 1: moderate calcified, n = 8, group 2: severely calcified, n = 8). In vitro resection was performed using a 21 mm cutting blade. Resection time (RT), maximum turning moment (MTM) and number of required rotations (NR) were measured. Furthermore, particle generation during the process of cutting was obtained and quantified. Results: Aortic valve cutting could be obtained without any complications in all cases. Cutting process resulted in a RT of 15.5 +/- 3 s in group 1 compared to 34.9 +/- 15 s in group 2 (p = 0.005), MTM was 3 +/- 0.6 N m in group 1 compared to 3.5 +/- 0.6 N m in group 2 (p = 0.068) and NR were 30.6 = 2.3 in group 1 compared to 48.1 +/- 15.5 in group 2 (p = 0.007). Particle generation was 1.77 +/- 0.17 g in group 1 compared to 1.41 +/- 0.44 g in group 2 (p = 0.047). Conclusions: These first in vitro results confirm feasibility and accelerated aortic valve resection within 30 s. This new concept holds promise for very fast AVR in combination with insertion of sutureless aortic valve prosthesis, targeting for ischemic times less than 10 min in the open heart situation. Finally, resection and percutaneous AVR within 1 min in the beating heart situation is envisioned. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.