Steps toward percutaneous aortic valve replacement
Steps toward percutaneous aortic valve replacement
复制标题
DOI：
10.1161/hc0602.103361
复制
发表时间：
2002-02-12
期刊：
影响因子：
37.8
通讯作者：
Bonhoeffer, P
中科院分区：
文献类型：
--
作者：
Boudjemline, Y;Bonhoeffer, P
背景--到目前为止，手术入路是替换主动脉瓣的唯一选择。经皮肺瓣膜置换术最近为经导管心脏瓣膜置换术开辟了新的前景。我们报告了我们通过经皮技术在羊主动脉瓣膜置换术中的经验。方法和结果-含有瓣膜的牛颈静脉被分离并缝合到支架中。将12只羔羊分为3组。第一种方法是在主动脉瓣关闭不全后在降主动脉植入带瓣支架。第二种方法是将瓣膜植入原位。在第三种方法中，我们使用定位机构将带瓣支架置入天然位置。所有瓣膜均已成功交付，并在短期评估中运行良好。第2组所有实验均失败：1个瓣膜阻塞冠状动脉口，1个支架导致二尖瓣关闭不全，第三个支架过早移位。这组中的最后一只动物发生了假体渗漏。第3组动物成功置入带瓣支架。这种定位机制可以使装置完美对准，而不会对冠脉循环或壁瓣功能造成任何损害。结论：在降主动脉和原生位置的羔羊中，非手术植入主动脉瓣是可行的。为了避免冠脉开口阻塞，显然需要一种定向机制。随着进一步的改进，这项技术在人类身上应该是可行的。
Background-To date, the surgical approach is the only option to replace the aortic valve. Percutaneous pulmonary valve replacement has recently opened new perspectives on transcatheter replacement of cardiac valves. We report our experience of aortic valve replacement through a percutaneous technique in lambs.Methods and Results-A bovine jugular vein containing a valve was dissected and sutured into a stent. Twelve lambs were divided into 3 groups. In the first, a valved stent was implanted in the descending aorta after creation of an aortic insufficiency. In the second, the valve was implanted in the native position. In the third, we inserted a valved stent in the native position using an orientation mechanism. All valves were successfully delivered and functioned perfectly in short-term evaluation. All experiments in group 2 failed: 1 valve obstructed the coronary artery orifices, 1 stent was responsible for a major mitral valve insufficiency, and the third implant migrated prematurely. A paraprosthetic leak occurred in the last animal in this group. Animals in group 3 had successful implantation of the valved stent. The orientation mechanism allowed perfect alignment of the device without any damage to the coronary circulation or to mural valve function.Conclusions-Nonsurgical implantation of an aortic valve is possible in lambs in the descending aorta and in the native position. An orientation mechanism is obviously needed to avoid obstruction of the coronary orifices. With further improvements, this technique should be feasible in humans.