这项工作得到了瑞士心血管基金会的赠款 (N° 32117) 的支持。

该议定书遵循人类研究伦理学委员会的机构准则。
1. 病人的预先选择
<ol><li>使用手术前计算机断层扫描 (CT) 检查佛氏的鼻窦扩张不超过60毫米的患者。</li>
	<li>接下来, 在这些患者中选择一个正常或接近正常出现的主动脉瓣尖头的亚群在其术前超声心动图。</li>
	<li>通知工作人员有无瓣膜备用主动脉根置换术的可能性。</li>
	<li>在主动脉瓣检查后, 进行手术后的最终决定。验证没有钙化的尖头和/或增厚和撤回他们的自由边缘。</li>
</ol>2. 手术准备
注: 外科准备工作遵循了成人心脏外科患者的机构指南和建议。
<ol><li>准备外科手术套件和病人的手术, 如前所述的13。</li>
</ol>3. 手术
<ol><li>通过中位胸骨访问心脏, 如前所述13 (图 1A)。</li>
	<li>准备主动脉根部替换。
	<ol>
<li>用 Carpentier 解剖钳抓住中管交界的提升主动脉。用 #11 刃刀做一个水平开口。</li>
		<li>完成 aortotomy 圆周和水平的 Metzenbaum 剪刀。</li>
		<li>在切断主动脉后, 验证尖头的钙化和/或其游离边缘的增厚和收缩。检查冠状动脉的提亚。</li>
		<li>解剖游离于周围组织外侧的非冠状动脉窦下至屋顶的左心房。</li>
		<li>用一个慷慨的圆形补丁从主动脉壁分离右冠状动脉口, 将5毫米的主动脉壁残余附着在尖点的插入上 (图 1B)。</li>
		<li>从周围组织中释放非冠状动脉和右冠状动脉窦之间的合生面。</li>
		<li>从右心室流出道游离右冠状动脉窦残余物的外侧解剖。</li>
		<li>将非冠状动脉和左冠状动脉窦之间的合生面的外侧释放到左心房的顶部。</li>
		<li>保留非冠状动脉窦的主动脉壁, 将5毫米的主动脉壁残余附着在尖点的插入物上。</li>
		<li>将左冠状动脉窦与周围组织的合生面的外侧分开。注意不要伤害肺动脉。</li>
		<li>用一个慷慨的圆形补丁将左冠状动脉口从主动脉壁分离出来, 将5毫米的主动脉壁残余附着在尖点的插入上 (图 1B)。调动左主干冠状动脉在其前10毫米。</li>
		<li>从左心房的顶部解剖游离左冠状动脉窦左侧的主动脉壁残余部分。</li>
		<li>在每个合生面上放一个床垫4/0 聚丙烯保持缝合。</li>
	</ol></li>
	<li>启动假体的近端植入。
	<ol>
<li>用12床垫非 pledgeted 2/0 编织聚酯缝线进行近端吻合术的第一行。将这些缝合圆周在水平平面 1-2 毫米以下插入尖头和连合三角形的底部, 除了非冠状动脉和右冠状动脉窦之间的合生面(图 2A)。</li>
		<li>在非冠状动脉和左冠状动脉窦之间连合三角形的底部放置第一个床垫缝合。把第二和第三缝线 1-2 毫米以下的插入非冠状动脉尖点, 方向的合生面之间的非冠状动脉和右冠状动脉窦。</li>
		<li>在非冠状动脉和右冠状动脉窦之间的连合三角形的基础上, 在合生面的方向上放置第三个缝合线, 从而不损害膜隔膜。</li>
		<li>从非冠状动脉和右冠状动脉窦之间的合生面连合三角形的底部开始第一缝合右冠状动脉窦2毫米, 从而跳过膜隔膜(图 2B)。</li>
		<li>将右冠状动脉窦的以下缝线缝合在左、右冠状动脉窦的合生面方向。</li>
		<li>在左、右冠状动脉窦之间的合生面连合三角形的基底处放置右冠状动脉窦的来回缝合。</li>
		<li>接下来, 通过4等距床垫缝合 1-2 毫米以下插入左冠状动脉尖点, 以固定左冠状动脉窦。</li>
		<li>要选择假体的大小, 增加4到6毫米到一个商业上可用的生物阀粒的大小, 通过左心室主动脉瓣连接舒适通过。</li>
		<li>根据连合三角形确定连合留缝线与床垫缝合之间的连合高度。要将病人的连合高度调整至假体的预形鼻窦, 请在其中管交界附近通过4/0 聚丙烯连合留缝线。</li>
		<li>要注意, 左、右冠状动脉窦之间的合生面高度往往略小于其他两个。修剪圆周的假肢的下颈部2毫米以下的测量连合高度, 以适应的高度, 假体的鼻窦的 commissures, 并能够通过第一行的床垫缝合通过假肢。</li>
		<li>现在把床垫缝合线放进假肢里。向下滑动假肢, 从而将阀门放在它的内部 (图 3A)。轻轻地系上床垫缝线, 切开它们。</li>
		<li>开始第二行近端吻合三5/0 聚丙烯运行缝线, 一个为每一个窦。</li>
		<li>在左冠状动脉窦的最低点开始前5/0 次聚丙烯连续缝合, 通过平行插入尖角到左冠状动脉和右冠之间的合生面, 然后由上到下, 固定在假体内的主动脉壁残余物。合生面在左、非冠状动脉窦之间。把2的两端放在轻微的张力下。</li>
		<li>继续第二5/0 聚丙烯运行缝合在右冠状动脉窦的最低点, 以固定在假肢内的主动脉壁的残余通过平行地跟随插入尖点由合生面在右和左冠状动脉之间和然后由右侧和非冠状动脉窦之间的合生面。把2的两端放在轻微的张力下。</li>
		<li>将第三5/0 聚丙烯在非冠状动脉窦的最低点进行缝合, 固定在假体内的主动脉壁的残余物, 方法是平行插入合生面至非冠状动脉和左冠状动脉窦之间的尖角。</li>
		<li>通过固定主动脉壁的残余物平行于非冠状动脉和右冠状动脉窦之间的合生面的插入, 完成近端吻合术的第二行。将两个缝合线的两端合生面在一起 (图3B)。</li>
		<li>检查无主动脉返流, 填补假体与生理盐水, 并应用吸入的通气口放置通过右肺静脉和二尖瓣进入左心室。</li>
	</ol></li>
	<li>将冠状动脉的提亚连接至假肢 (图 4)。
	<ol>
<li>创建一个按钮孔在左窦的假肢调整到大小的左冠状动脉口补丁。</li>
		<li>通过6/0 聚丙烯连续缝合, 在假体内从内而外和左冠状动脉口开始吻合。</li>
		<li>放置第二针2毫米右侧的第一个从内部的假肢和外部的左冠状动脉口由中间高度的右脊吻合。将缝合端置于轻张力下。</li>
		<li>继续缝合左脊的吻合体从外部的假肢和从内而外的左冠状动脉口, 以满足另一端。把两头绑在一起。</li>
		<li>创建一个按钮孔在右窦的假肢调整到大小的右冠状动脉口补丁。</li>
		<li>将右冠状动脉口与假体连接, 由6/0 聚丙烯连续缝合, 从右冠状动脉口的最低点开始从内而外进入假体外。</li>
		<li>继续缝合至右脊的中高度, 并将末端置于轻张力下。</li>
		<li>完成吻合的左脊的吻合, 以满足另一端。把两头绑在一起。</li>
	</ol></li>
	<li>执行远端吻合术 (图 4)。
	<ol>
<li>在5/0 聚丙烯连续缝合术中, 从外而外进入远端升主动脉, 在假体远端的最低点开始吻合。先把缝线缝合到吻合的右脊的中高度。</li>
		<li>通过在左脊上进行缝合以达到另一端, 完成远端吻合术。把两端绑在一起。</li>
		<li>将操作表倾斜到向健位置。让泵的流量减少到50% 的全流, 并慢慢删除主动脉交叉钳在温和的愿望左心室通气。</li>
		<li>恢复全流程的心肺旁路。检查手术现场是否有不适当的手术出血。</li>
		<li>复温患者到37摄氏度, 并将患者与心肺旁路分离。用1:1 的比例 (3 毫克/千克对应300的肝素), 稳定血压, 中和肝素。</li>
		<li>检查止血, 并根据需要把胸腔引流。以标准的方式关闭胸部 reapproximating 胸骨与胸骨线和软组织可吸收缝线在两层13。</li>
	</ol></li>
</ol>4. 术后病人护理
<ol><li>在转移到重症监护病房后, 为病人提供在主动脉根部进行心脏外科手术的标准手术后护理13。</li>
</ol>

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作者没有什么可透露的。

在主动脉根部动脉瘤与正常或接近正常主动脉尖头的患者中, 保留瓣膜的主动脉根置换术是一种更具生理性, 因此更有吸引力的替代主动脉和主动脉瓣复合移植替换机械或组织瓣膜。在本协议中, 我们描述了一个简单的技术, 备用瓣膜置换术的主动脉瓣重新植入。与以前报告的大多数技术3、8不同, 在本协议中, 第一行的床垫缝合不对称地分布, 以避免对膜隔膜的损伤。此外, 在《议定书》中, 这些床垫缝线在 pledgets 上没有加强。省略这些缝线的 pledgets 的基本原理是基于这样一种意图, 即不仅要在早期直接扰动的情况下降低对阀门正常运动的干扰风险, 而且还要在以后的时间内通过周围可能的肉芽肿形成来减少干预。15. 这种简化的技术也可以在具有两个相应鼻窦的二尖瓣的薄和柔韧性瓣膜患者中完成。在0型二尖瓣主动脉瓣中, 根再植在 180°/180°圆周方向16上执行。在1型二尖瓣主动脉瓣中, 210°和非联合小叶的周向方向受到尊重, 同时 reimplanting 阀门进入 neosinuses16。
两个不同的程序, 称为重塑和重新植入技术, 是由先驱心脏外科医生设计, 以解决 VSRR 程序1,2。围绕佛氏鼻窦的作用和主动脉环的长期命运引起的争论导致了这两种技术的一些修改, 包括在合成管中手工定制或织物创建新鼻窦1,3,4,6和支持主动脉环10、11、12的各种技术。在最近的一项研究中17重新植入技术的先驱对手工定制的新鼻窦的基本原理表示不确定, 他本人在长时间内介绍和执行了这种方法。因此, 他的历史系列333瓣备用主动脉根置换程序包括一个初始队列患者的管状移植没有新窦, 一个中间队列的病人手工定制的新鼻窦, 和最后一组患者类似于第一个没有新窦的管状移植。在最近的研究中, 新窦的产生甚至与单变量中度或重度主动脉返流的晚期发展有关, 而非多变量分析17。因此, 不仅由不同的外科医生报告, 而且由重新植入技术的先驱提出的关于瓣膜保留程序的大量技术修改不利于其他心脏外科医生的决策, 有技能执行这些过程并开始执行此操作7。
考虑到这些因素, 我们选择了一种简化和标准化的阀门备用操作方法。我们同意作者的看法, 认为保留主动脉窦更具生理性, 并可能有利于主动脉瓣的耐久性18。我们还发现, 支持所有患者的主动脉环, 可能是有利的, 因为扩张的动态主动脉室结仍然不确定的 19.由于这些原因, 我们使用一个商业上可利用的合成移植与预成型, uncrimped 窦部分, 以重新植入主动脉瓣膜的所有患者, 其中主动脉瓣的判断适合保存。相反的意见, 这个嫁接窦部分是球形的和变形的主动脉室结 17, 我们发现这个移植 uncrimped 窦部分, 而圆锥状, 适合重新植入 commissures 内.
在该协议中, 近端缝合线是以标准化的方式进行的, 所有患者12聚酯2/0 床垫缝合没有 pledgets, 4 下每个尖角。这些床垫缝线的分布是不对称的, 与其他外科医生1、3所描述的略有不同。在本议定书中, 每一个窦都有4床垫缝合, 特别注意不要将任何缝合通过膜隔膜 (图 3A, B)。按照这个概念, 并保持 1-2 毫米在每个窦的最低点在一个水平的计划, 我们不必痛惜任何伤害的前小叶的二尖瓣, 膜隔膜, 或 AV 节点。在 VSRR 的最大系列患者中, 全心阻滞永久起搏器植入的发生率为 1.5%17。
在一些研究中, 采用复杂的公式, 在主动脉室结直径、尖头高度和窦径关系的理论假设的基础上, 对接枝尺寸进行了选择 8, 20,21。这种复杂性是导致有经验的外科医生报告的再植入技术的有限传播的一个额外因素。值得注意的是, 通过应用他的公式, 大卫et 等人使用一个狭窄的范围内的移植大小的平均30.7 ±2.8 毫米22。该技术的另一个技术方面是使用商用的阀门 sizers, 以实际的方式简化了合成接枝的尺寸选择。要选择这种技术中的嫁接大小, 4-6 毫米添加到阀门粒的直径, 舒适地适合通过主动脉室连接。De Paulis et使用一种类似的方法, 在 Hegar 扩张19测量的主动脉环的直径增加5毫米。通过这种简化, 植入在系列中的移植物的平均直径是31.2 ±1.3 毫米, 这是非常接近30.4 ±1.4 毫米报告的 De Paulis19和报告的大卫22。
有人声称, 病人鼻窦的高度可能会有所不同, 而不符合预形窦移植的高度, 这种差异可能会造成技术和解剖困难17。在这里提出的标准化技术中, 这一问题的解决, 通过剪裁的近侧裙的同位语后, commissures 在中管交界内的嫁接。近端缝合然后通过量身定做的近端裙子的移植。
植入假体的平均直径为31.2 ±1.3 毫米, 在 5-6 毫米以上的患者中均大于实测平均主动脉环形直径。然而, 在28毫米以上的主动脉环扩张的情况下, 选择假体大小可以通过增加少于4-6 毫米的测量主动脉环, 并与连合三尖瓣, 以提高尖角缝合。
由于本系列的数量少, 后续行动有限, 因此应期待的结果。然而, 早期和中期的死亡率和发病率是低和令人鼓舞的。在我们的患者中, 1.8 和3.8% 的早期和晚期死亡率与更大的系列报告的较长的后续行动17,19,23比较有利。同样, 从再手术的自由, 从中至重复发性主动脉返流, 包括接受再手术的患者都非常好, 类似于同一作者所观察到的17,19,23.所提出的系列的好结果将被归因于在被选择的患者的简化的技术。理想情况下, 重新植入的良好候选者有适度扩张窦 (< 55 毫米), 无或跟踪主动脉返流, 正常或接近正常尖点解剖学17。这项研究的大多数患者都属于这种描述。
如前所述, 小数目的病人和有限的随访期是本研究的主要局限性。然而, 根据这项议定书的技术考虑, 将允许更多的心脏外科医生执行 VSRR。

在过去的二十年中, 由于一系列旨在保存本机主动脉瓣的外科手术, 在正常或接近正常的主动脉尖头手术治疗主动脉根动脉瘤的过程已经演变为:1,2, 3,4,5。瓣膜备用主动脉根置换主要是通过在合成接枝内的主动脉瓣重新植入1,3,4,6或通过重塑技术完成的。恢复主动脉根的生理解剖2。尽管在主动脉根部置换术中保留正常主动脉瓣的明显优点, 许多心脏外科医生还是用机械或生物瓣膜替代物代替主动脉瓣。根据胸外科医生数据库的数据, 在美国2004和2010间接受主动脉根置换术的患者中, 只有14% 的人收到了一个瓣膜备用程序7。
在原有的再植入技术中, 主动脉瓣在管状水平卷曲的合成接枝中缝合8。虽然这种技术稳定的主动脉环, 它消除了鼻窦的佛氏。为了重新创建佛氏的鼻窦, 这项技术已经经历了一些修改由它的发明者以及其他作者9。这种技术的变化已经提出了拉玛et 等人, 其中的主动脉壁残余的支持 commissures 被缝合成纵向开口, 在管状聚乙烯对苯二甲酸乙二醇酯接枝4。
重构技术实现了对主动脉根的更多解剖重建, 但使主动脉环不受支持, 暴露于未来的扩张。各种外科技术的设计, 以适应主动脉环形基地的主动脉根部重塑, 包括亚连合主动脉三尖瓣 10, 周向缝合三尖瓣 11, 以及内部或外部三尖瓣通过合成部分或完整环12。
尽管有经验的作者报告了优秀的结果, 这些程序的复杂性和周期性的修改, 阻碍了其他心脏外科医生的重现性, 从而防止一些合适的患者受益于保留其自己的主动脉瓣。为了提高再植入技术的重现性, 我们使用了一种具有 uncrimped、预成形窦部分的商用合成嫁接, 并简化了植入技术。本议定书的目的是详细描述这一标准化和可重复的技术, 特别强调对近端缝合线第一行的管理和在移植内的 commissures 位置和移植的选择大小.提出了早期结果和中期结果。对患者的正确选择和本程序的局限性进行了讨论。

<table>
	<tbody>
		<tr>
			<td>Heart surgery infrastructure:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Heart Lung Machine</td>
			<td>Stockert</td>
			<td>SIII</td>
			<td></td>
		</tr>
		<tr>
			<td>EOPA 24Fr. arterial cannula</td>
			<td>Medtronic</td>
			<td>77624</td>
			<td></td>
		</tr>
		<tr>
			<td>Atrial caval venous cannula 34/48Fr.</td>
			<td>Medtronic</td>
			<td>93448</td>
			<td></td>
		</tr>
		<tr>
			<td>LV vent catheter 17Fr.</td>
			<td>Edwards</td>
			<td>E061</td>
			<td></td>
		</tr>
		<tr>
			<td>Antegrade 9Fr. cardioplegia cannula</td>
			<td>Edwards</td>
			<td>AR012V</td>
			<td></td>
		</tr>
		<tr>
			<td>Retrograde 14Fr. cardioplegia cannula&#160;</td>
			<td>Edwards</td>
			<td>NPC014&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Coronary artery ostial cannula 90&#176;</td>
			<td>Medtronic</td>
			<td>30155</td>
			<td></td>
		</tr>
		<tr>
			<td>Coronary artery ostial cannula 45&#176;</td>
			<td>Medtronic</td>
			<td>30255</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Pre-shaped sinus graft</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cardioroot 28 mm</td>
			<td>Maquet</td>
			<td>HEWROOT0028</td>
			<td></td>
		</tr>
		<tr>
			<td>Cardioroot 30 mm</td>
			<td>Maquet</td>
			<td>HEWROOT0030</td>
			<td></td>
		</tr>
		<tr>
			<td>Cardioroot 32 mm</td>
			<td>Maquet</td>
			<td>HEWROOT0032</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Electrocautery</td>
			<td>Covidien</td>
			<td>Force FX</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Sutures:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Polypropylene 4/0</td>
			<td>Ethicon</td>
			<td>8871H</td>
			<td></td>
		</tr>
		<tr>
			<td>Polypropylene 5/0</td>
			<td>Ethicon</td>
			<td>8870H</td>
			<td></td>
		</tr>
		<tr>
			<td>Polypropylene 6/0</td>
			<td>Ethicon</td>
			<td>EH7400H</td>
			<td></td>
		</tr>
		<tr>
			<td>Braided polyesther 2/0 ligature with polybutylate coating&#160;</td>
			<td>Ethicon</td>
			<td>X305H</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Micro knife Sharpoint&#160;</td>
			<td>TYCO Healthcare PTY&#160;</td>
			<td>78-6900</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Drugs:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Midazolam</td>
			<td>Roche Pharma</td>
			<td>N05CD08</td>
			<td></td>
		</tr>
		<tr>
			<td>Rocuronium</td>
			<td>MSD Merck Sharp &#38; Dohme&#160;</td>
			<td>M03AC09</td>
			<td></td>
		</tr>
		<tr>
			<td>Propofol</td>
			<td>Fresenius Kabi</td>
			<td>N01AX10</td>
			<td></td>
		</tr>
		<tr>
			<td>Fentanil</td>
			<td>Actavis</td>
			<td>N01AH01</td>
			<td></td>
		</tr>
		<tr>
			<td>Heparin</td>
			<td>Braun</td>
			<td>B01AB01</td>
			<td></td>
		</tr>
		<tr>
			<td>Protamin</td>
			<td>MEDA Pharmaceutical</td>
			<td>V03AB14</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Instruments:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cooley vascular aortic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC40810-16</td>
			<td></td>
		</tr>
		<tr>
			<td>Dissection forceps Carpentier</td>
			<td>Delacroix-Chevalier</td>
			<td>DC13110-28&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors Metzenbaum</td>
			<td>Delacroix-Chevalier</td>
			<td>B351751</td>
			<td></td>
		</tr>
		<tr>
			<td>Needle holder Ryder</td>
			<td>Delacroix-Chevalier</td>
			<td>DC51130-20&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Dissection forceps DeBakey</td>
			<td>Delacroix-Chevalier</td>
			<td>DC12000-21&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro needle holder Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC50002-21&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Micro scisors Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC20057-21&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Lung retractor</td>
			<td>Delacroix-Chevalier</td>
			<td>B803990</td>
			<td></td>
		</tr>
		<tr>
			<td>Allis clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC45907-25&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>O&#8217;Shaugnessy Dissector</td>
			<td>Delacroix-Chevalier</td>
			<td>B60650</td>
			<td></td>
		</tr>
		<tr>
			<td>18 blade knife</td>
			<td>Delacroix-Chevalier</td>
			<td>B130180</td>
			<td></td>
		</tr>
		<tr>
			<td>Leriche haemostatic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>B86555</td>
			<td></td>
		</tr>
		<tr>
			<td>Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>Data analysis</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Kaplan Meier curves</td>
			<td>GraphPad</td>
			<td>Prism 7</td>
			<td></td>
		</tr>
	</tbody>
</table>

standardized technique of aortic valve re-implantation for valve-sparing aortic root replacement

尽管在主动脉根部置换术中保留正常主动脉瓣具有明显的优越性, 但瓣膜备用程序的复杂性使许多心脏外科医生无法将其纳入其实践中。本协议的目的是描述一个简化和用户友好的技术, 主动脉瓣备用根置换 (VSRR) 程序的重新植入主动脉瓣。对患者的正确选择和技术的局限性进行了探讨。
在连续54例患者中, 正常出现的主动脉瓣在商用聚酯假体中重新植入, 并采用一种简化和标准化的方法。放置第一行的近缝合线, 选择的假肢大小, 和调整的高度 commissures 的病人到固定高度的假体的窦部分, 从参考技术略有修改, 与目的提高其他心脏外科医生使用的可行性。所有患者都收集了早期死亡率和发病率以及5年生存期、主动脉瓣再手术的自由以及从复发性中返流中解脱出来的自由。
三十天的死亡率, 胸骨出血, 重新胸骨纵隔, 中风的发病率非常低, 每 1.8% (1 54)。没有病人需要永久性的速度制造者植入。5年来, 存活, 从主动脉瓣膜再手术的自由, 以及从复发性中返流的自由分别为97.5%、95.2% 和91.6%。
我们对主动脉瓣瓣膜置换术的规范化技术的中期结果是非常好的, 与经验丰富的外科医生报告的复杂技术比较。按照现行的标准化再植入技术的协议, 更多的心脏外科医生可以执行这一程序, 效果可比较好。

统计分析:
连续变量被表示为平均的标准偏差和分类变量作为百分比。卡普兰-梅尔曲线是为生存, 从主动脉瓣再手术的自由, 并从复发性中返流的自由使用一个商业上可用的软件包计算。
患者人数:
VSRR 根据本协议在连续54例患者中进行了主动脉根部动脉瘤≤60毫米和正常或接近正常出现的主动脉瓣 (表 1)。多数患者是成年男性在稳定的临床情况 (表 1)。三十二例患者接受隔离 VSRR, 而二十二 VSRR 合并其他心脏手术程序 (表 2)。对于接受隔离 VSRR 的患者, 交叉钳和体外循环时间比有联合操作的病人短 (表 2)。
早期结果:
三十天的死亡率, 胸骨出血, 重新胸骨纵隔, 中风的发病率非常低, 每 1.8% (1 54)。没有病人需要永久性的速度制造者植入。
中期生存:
随访期间有2人死亡。一名病人在猝死4年后死亡。一年前的超声心动图研究显示, 无主动脉返流和正常射血分数。第二个病人在车祸后6年后死亡。该患者有稳定的中主动脉返流, 左心室尺寸稳定, 左心室功能不受损伤, 连续随访超声心动图检查。因此, 本系列中的5年和10年生存期分别为97.5% 和 92.5% (图 5A)。
主动脉瓣再手术的中期自由:
主动脉瓣再手术的中期自由: 四例复发性中主动脉返流患者 progredient 左室扩张后再次手术。这两名病人中有一人在纵隔的一周后 reoperated。在36月后再次手术治疗瓣膜置换术后, 右冠状动脉尖角被撕裂, 想必是由于陪同败血症在他的纵隔。在第二次瓣膜手术中, 他接受了全根无支架主动脉瓣置换术并幸存下来。第二名病人 reoperated 主动脉瓣置换术后49月。再手术时, 复杂左、右冠状动脉尖头的游离边缘纤维化, 并有明显的收缩。他接受了机械主动脉瓣置换通过人工假肢和幸存。因此, 5 岁和10岁的主动脉瓣膜置换术的自由再手术率分别为95.2% 和 93% (图 5B)。
中主动脉返流的中期自由:
四例患者在随访期间发育中度 (2 +) 主动脉返流14 。所有这些患者都有三尖瓣主动脉瓣。这四名病人中只有一人离开手术室, 手术结束时轻度不全。由于其稳定无症状的临床状况和超声心动图监测参数 (左心室功能和尺寸), 他正在随访, 不再次手术。四例患者中有两人在主动脉瓣膜上再次手术。第四名病人是车祸后死亡的人。因此, 5 岁和10岁时, 从中等主动脉返流的自由分别为91.6% 和 90% (图 5C)。

<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56790/56790fig1.jpg"> 图 1: 心肺旁路建立后心脏的示意图.(A) 上升主动脉交叉夹在无名动脉的原点以下。(B) 冠状动脉按钮与主动脉壁分离, 鼻窦切除。<a href="//cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56790/56790fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56790/56790fig2.jpg"> 图 2: 在近端吻合的第一排床垫缝合线的分布.(A) 床垫缝线通过圆周在主动脉瓣的最低点下的水平平面 1-2 毫米的主动脉室连接处通过。(B) 注意避免通过膜隔膜缝合。<a href="//cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56790/56790fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56790/56790fig3.jpg"> 图 3: 预成型鼻窦移植的植入.(A) 近端吻合术的第一排床垫缝合, 然后通过特制的近端裙子的移植。(B) 第二行缝合线修复了移植物内主动脉壁的残余。<a href="//cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56790/56790fig3large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56790/56790fig4.jpg"> 图 4: 完成移植的植入.冠状动脉蒂提物与移植物相连, 远端吻合完成。<a href="//cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56790/56790fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56790/56790fig5.jpg"> 图 5: 卡普兰-Meier 曲线在10年.(A) 生存。(B) 从主动脉瓣膜上再手术的自由。(C) 从复发性中主动脉返流的自由<a href="//cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/56790/56790fig5large.jpg" target="_blank">请单击此处查看此图的更大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td></td>
			<td>年龄 (年)</td>
			<td>61±11</td>
		</tr>
<tr>
<td></td>
			<td>男性性别</td>
			<td>46 (85%)</td>
		</tr>
<tr>
<td>诊断</td>
			<td></td>
			<td></td>
		</tr>
<tr>
<td></td>
			<td>动脉瘤</td>
			<td>48 (89%)</td>
		</tr>
<tr>
<td></td>
			<td>键入解剖</td>
			<td>6 (11%)</td>
		</tr>
<tr>
<td>NYHA 类</td>
			<td></td>
			<td></td>
		</tr>
<tr>
<td></td>
			<td>我</td>
			<td>31 (57%)</td>
		</tr>
<tr>
<td></td>
			<td>二</td>
			<td>7 (13%)</td>
		</tr>
<tr>
<td></td>
			<td>三</td>
			<td>10 (19%)</td>
		</tr>
<tr>
<td></td>
			<td>四</td>
			<td>6 (11%)</td>
		</tr>
<tr>
<td></td>
			<td>紧急</td>
			<td>7 (13%)</td>
		</tr>
<tr>
<td>ef</td>
			<td></td>
			<td></td>
		</tr>
<tr>
<td></td>
			<td>≥50%</td>
			<td>45 (83%)</td>
		</tr>
<tr>
<td></td>
			<td>> 35%, < 50%</td>
			<td>6 (11%)</td>
		</tr>
<tr>
<td></td>
			<td>≤35%</td>
			<td>3 (6%)</td>
		</tr>
<tr>
<td>术前主动脉返流</td>
			<td></td>
			<td></td>
		</tr>
<tr>
<td></td>
			<td>0</td>
			<td>10 (19%)</td>
		</tr>
<tr>
<td></td>
			<td>1 +</td>
			<td>9 (17%)</td>
		</tr>
<tr>
<td></td>
			<td>2 +</td>
			<td>18 (33%)</td>
		</tr>
<tr>
<td></td>
			<td>3 +</td>
			<td>17 (31%)</td>
		</tr>
<tr>
<td></td>
			<td>主动脉室结 (mm)</td>
			<td>26.2 ±1。3</td>
		</tr>
<tr>
<td></td>
			<td>佛氏窦 (mm)</td>
			<td>49.2 ±9。2</td>
		</tr>
</tbody></table>表 1: 病人的特点.本表描述了患者的特点。决定考虑一个瓣膜备用根更换是根据直径的主动脉-心室连接小于28毫米和鼻窦的佛氏少于60毫米。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td></td>
			<td>隔离 VSRR</td>
			<td>与其他操作关联的 VSRR</td>
			<td>总</td>
		</tr>
<tr>
<td>N (%)</td>
			<td>32 (59%)</td>
			<td>22 (41%)</td>
			<td>54</td>
		</tr>
<tr>
<td>尖点修复</td>
			<td>3</td>
			<td>11</td>
			<td>14</td>
		</tr>
<tr>
<td>接枝尺寸</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
<tr>
<td>28</td>
			<td>2</td>
			<td>2</td>
			<td>4</td>
		</tr>
<tr>
<td>30</td>
			<td>5</td>
			<td>9</td>
			<td>14</td>
		</tr>
<tr>
<td>32</td>
			<td>25</td>
			<td>11</td>
			<td>36</td>
		</tr>
<tr>
<td>交叉钳位时间 (分钟)</td>
			<td>159±14</td>
			<td>192±41</td>
			<td></td>
		</tr>
<tr>
<td>体外循环时间 (分钟)</td>
			<td>217±24</td>
			<td>258±55</td>
			<td></td>
		</tr>
<tr>
<td colspan="2">VSRR = 备用阀根替换</td>
			<td></td>
			<td></td>
		</tr>
</tbody></table>表 2: 隔离或联合瓣膜备用根置换术患者的手术内数据.独立瓣膜备用根置换术的交叉钳和心肺旁路时间较短。

Watch this Scientific Journal Video about Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement at JoVE.com

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

瓣膜备用主动脉根置换具有保留患者自身主动脉瓣的优点。迄今为止, 报告的技术的复杂性限制了它们对数量有限的心脏外科医生的使用。该协议描述了由更多的心脏外科医生可重现的标准化技术的循序渐进。

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

standardized-technique-aortic-valve-re-implantation-for-valve-sparing

Nanyang Technological University

Research

JoVE Journal

Medicine

13.9K 次观看.  Hopitaux de Paris (APHP), Institut de Cardiologie. 瓣膜备用主动脉根置换具有保留患者自身主动脉瓣的优点。迄今为止, 报告的技术的复杂性限制了它们对数量有限的心脏外科医生的使用。该协议描述了由更多的心脏外科医生可重现的标准化技术的循序渐进。

视频: Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Orthotopic Aortic Transplantation in Mice for the Study of Vascular Disease

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. This is largely true, but there are a number of important principles that can reduce the difficulty of these procedures and enhance reproducibility. Orthotopic aortic transplantation is an excellent procedure in which to learn these principles because it involves only two end-to-end anastomoses, but requires good suturing technique and handling of the vessels for consistent success. This procedure begins with the procurement of a length of abdominal aorta from a donor animal, followed by division of the native aorta in the recipient. The procured aorta is then placed between the divided ends of the recipient aorta and sutured into place using end-to-end anastomoses. To accomplish this objective successfully requires a high degree of concentration, good tools, a steady hand, and an appreciation of how easily the vasculature of a mouse can be damaged, resulting in thrombosis. Learning these important principles is what occupies most of the beginner's time when learning microsurgery in small rodents. Throughout this protocol, we refer to these important points. This model can be used to study vascular disease in a variety of different experimental systems1-8. In the context shown here, it is most often used for the study of post-transplant vascular disease, a common long-term complication of solid organ transplantation in which intimal hyperplasia occurs within the allograft. The primary advantage of the model is that it facilitates quantitative morphometric analyses and the transplanted vessel lies contiguous to the endogenous vessel, which can serve as an additional control9. The technique shown here is most often used for mice weighing 18-25 grams. We have accumulated most of our experience using the C57BL/6J, BALB/cJ, and C3H/HeJ strains.

We describe a technique in which a section of the abdominal aorta from a mouse is transplanted orthotopically to just below the renal arteries in an allogeneic or syngeneic recipient. This technique can be useful in studies in which transplantation of large arteries of uniform size is deemed advantageous.

原位主动脉瓣移植在小鼠血管疾病的研究

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. ...

科研

医学

A New Murine Model of Endovascular Aortic Aneurysm Repair

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Histological and biochemical modifications after aneurysm endograft exclusion are still unclear. We describe a new model of endograft implantation on a murine aneurysm. Through thrombus analysis with and without persistant circulating blood stream interface, and new endovascular biomaterials evaluation, this model will help to better understand endovascular aneurysm exclusion pathobiology.

一种新的小鼠模型主动脉瘤腔内修复

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

Minimally Invasive Transverse Aortic Constriction in Mice

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard open-chest transverse aortic constriction (TAC). Although transverse aortic constriction is a highly functional method for the induction of high pressure in the left ventricle, it is a more difficult and lengthy procedure due to its use of artificial ventilation with tracheal intubation. TAC is oftentimes also less survivable, as the newer method, MTAC, neither requires the cutting of the ribs and intercostal muscles nor tracheal intubation with a ventilation setup. In MTAC, as opposed to a thoracotomy to access to the chest cavity, the aortic arch is reached through a midline incision in the anterior neck. The thyroid is pulled back to reveal the sternal notch. The sternum is subsequently cut down to the second rib level, and the aortic arch is reached simply by separating the connective tissues and thymus. From there, a suture can be wrapped around the arch and tied with a spacer, and then the sternal cut and skin can be closed. MTAC is a much faster and less invasive way to induce left ventricular hypertension and enables the possibility for high-throughput studies. The success of the constriction can be verified using high-frequency trans-thoracic echocardiography, particularly color Doppler and pulsed-wave Doppler, to determine the flow velocities of the aortic arch and left and right carotid arteries, the dimension of the blood vessels, and the left ventricular function and morphology. A successful constriction will also trigger significant histopathological changes, such as cardiac muscle cell hypertrophy with interstitial and perivascular fibrosis. Here, the procedure of MTAC is described, demonstrating how the resulting flow changes in the carotid arteries can be examined with echocardiography, gross morphology, and histopathological changes in the heart.

Minimally invasive transverse aortic constriction (MTAC) conserves the essentials of regular transverse aortic constriction (TAC) while eliminating the use of a ventilator with tracheal intubation. It proves to be a highly desirable method for high-throughput studies on left ventricular overload, particularly in translational studies.

微创横向主动脉缩窄小鼠

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard ...

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm2/m2, is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms. Persistent left ventricular hypertrophy is associated with an increased risk of arrhythmias and sudden cardiac death. In the case of predictable PPM, there are three options: 1) accept the PPM resulting from the implantation of a stented pericardial valve when comorbidities of the patient forbid the more technically demanding operative technique of implanting a larger prosthesis, 2) enlarge the aortic root to accommodate a larger stented valve substitute, or 3) implant a stentless biological valve or a homograft. Compared to classical aortic valve replacement with stented pericardial valves, the full-root implantation of stentless aortic xenografts offers the possibility of implanting a 3-4 mm larger valve in a given patient, thus allowing significant reduction in transvalvular gradients. However, a number of cardiac surgeons are reluctant to transform a classical aortic valve replacement with stented pericardial valves into the more technically challenging full-root implantation of stentless aortic xenografts. Given the potential hemodynamic advantages of stentless aortic xenografts, we have adopted full-root implantation to avoid PPM in patients with small aortic roots necessitating an aortic valve replacement. Here, we describe in detail a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses. Limitations of this technique and alternative options are discussed.

Full-root aortic valve replacement by stentless aortic xenograft is a viable option in patients with small aortic roots. We describe, a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses, and discuss its limitations and alternative options.

全根主动脉瓣置换主动脉瓣狭窄主动脉异种移植患者小主动脉根

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial ...

Technique of Minimally Invasive Transverse Aortic Constriction in Mice for Induction of Left Ventricular Hypertrophy

Transverse aortic constriction (TAC) in mice is one of the most commonly used surgical techniques for experimental investigation of pressure overload-induced left ventricular hypertrophy (LVH) and its progression to heart failure. In the majority of the reported investigations, this procedure is performed with intubation and ventilation of the animal which renders it demanding and time-consuming and adds to the surgical burden to the animal. The aim of this protocol is to describe a simplified technique of minimally invasive TAC without intubation and ventilation of mice. Critical steps of the technique are emphasized in order to achieve low mortality and high efficiency in inducing LVH.
Male C57BL/6 mice (10-week-old, 25-30 g, n=60) were anesthetized with a single intraperitoneal injection of a mixture of ketamine and xylazine. In a spontaneously breathing animal following a 3-4 mm upper partial sternotomy, a segment of 6/0 silk suture threaded through the eye of a ligation aid was passed under the aortic arch and tied over a blunted 27-gauge needle. Sham-operated animals underwent the same surgical preparation but without aortic constriction. The efficacy of the procedure in inducing LVH is attested by a significant increase in the heart/body weight ratio. This ratio is obtained at days 3, 7, 14 and 28 after surgery (n = 6 - 10 in each group and each time point). Using our technique, LVH is observed in TAC compared to sham animals from day 7 through day 28. Operative and late (over 28 days) mortalities are both very low at 1.7%.
In conclusion, our cost-effective technique of minimally invasive TAC in mice carries very low operative and post-operative mortalities and is highly efficient in inducing LVH. It simplifies the operative procedure and reduces the strain put on the animal. It can be easily performed by following the critical steps described in this protocol.

The aim of this protocol is to describe step-by-step the technique of minimally invasive transverse aortic constriction (TAC) in mice. By elimination of intubation and ventilation which are mandatory for the commonly used standard procedure, minimally invasive TAC simplifies the operative procedure and reduces the strain put on the animal.

小鼠横主动脉狭窄诱导左心室肥厚的技术研究

Transverse aortic constriction (TAC) in mice is one of the most commonly used surgical techniques for experimental investigation of pressure ...

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer tomography measurements. The indications and limitations of this technique, as well as its alternatives, are discussed.

The goal of this protocol is to describe in detail the technique of minimally invasive aortic valve replacement through a right anterior mini-thoracotomy and central aortic cannulation. This technique can potentially enhance patients&#39; comfort and, by reducing post-operative morbidity, promote lowering the length of stay and global costs.

右前小切口主动脉瓣置换术的技术及患者选择标准

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The ...

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to facilitate anatomical guidance is of huge interest for complex cardiac interventions like TAVI procedures with cerebral protection. Co-registration of CTA and XR has been introduced either based on additional intraoperative non-/contrast-enhanced cone-beam computed tomography (CBCT) or two separate aortograms. With the related increase of radiation exposure and/or contrast agent (CA) dose, a potential additional risk for the patient is introduced. Here, we propose a modified co-registration approach making use of arteriograms of the iliofemoral arteries, routinely performed during the femoral puncture and sheath introduction. On-the-fly refinement of the co-registration during the on-going procedure enables accurate co-registration without any additional angiograms, thus reducing CA, XR dose and procedure time, while simultaneously improving operator confidence and procedure safety.

The aim of this study was to improve the co-registration for image fusion (IF) of pre-interventional CT data with real-time x-ray (XR) fluoroscopy during transfemoral transcatheter aortic valve implantation (TAVI).

经导管主动脉瓣植入术中 X 线透视 3D CT 血管造影的改进与影像融合

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to ...

Murine Cervical Aortic Transplantation Model using a Modified Non-Suture Cuff Technique

With the introduction of powerful immunosuppressive protocols, distinct advances are possible in the prevention and therapy of acute rejection episodes. However, only minor improvement in the long-term results of transplanted solid organs could be observed over the past decades. In this context, chronic allograft vasculopathy (CAV) still represents the leading cause of late organ failure in cardiac, renal and pulmonary transplantation.
Thus far, the underlying pathogenesis of CAV development remains unclear, explaining why effective treatment strategies are presently missing and emphasizing a need for relevant experimental models in order to study the underlying pathophysiology leading to CAV formation. The following protocol describes a murine heterotopic cervical aortic transplantation model using a modified non-suture cuff technique. In this technique, a segment of the thoracic aorta is interpositioned in the right common carotid artery. With the use of the non-suture cuff technique, an easy to learn and reproducible model can be established, minimizing the possible heterogeneity of sutured vascular micro anastomoses.

Here, we present a protocol of heterotopic aortic transplantation in mice using the non-suture cuff technique in a cervical murine model. This model can be used to study the underlying pathology of chronic allograft vasculopathy (CAV) and can help evaluate new therapeutic agents in order to prevent its formation.

使用改性非缝合铐技术的宫颈主动脉移植模型

With the introduction of powerful immunosuppressive protocols, distinct advances are possible in the prevention and therapy of acute rejection episodes. ...

Porcine Model of Infrarenal Abdominal Aortic Aneurysm

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal abdominal aortic aneurysms (AAA) in swine. To achieve this, we use a combination of balloon angioplasty, elastase and collagenase, and a lysyl oxidase inhibitor, called &#946;-aminopropionitrile (BAPN), to create clinically significant infrarenal aortic aneurysms, analogous to human disease.
Noncastrated male swine are fed BAPN for 7 days prior to surgery to achieve a steady state in the blood. A midline laparotomy is performed and the infrarenal aorta is circumferentially dissected. An initial measurement is recorded prior to aneurysm induction with a combination of balloon angioplasty, elastase (500 units)/collagenase (8000 units) perfusion, and topical elastase application. Swine are fed BAPN daily until terminal procedure on either postoperative day 7, 14, or 28, at which time the aneurysm is measured, and tissue procured. BAPN + surgery pigs are compared to pigs that underwent surgery alone.
Swine treated with BAPN and surgery had a mean aortic dilation of 89.9% &#177; 47.4% at day 7, 105.4% &#177; 58.1% at day 14, and 113.5% &#177; 30.2% at day 28. Pigs treated with surgery alone had significantly smaller aneurysms compared to BAPN + surgery animals at day 28 (p &#60; 0.0003). The BAPN + surgery group had macroscopic and immunohistochemical evidence of end stage aneurysmal disease.
Clinically significant infrarenal AAA can be induced using balloon angioplasty, elastase/collagenase perfusion and topical application, supplemented with oral BAPN. This model creates large, clinically significant AAA with hallmarks of human disease. This has important implications for the elucidation of AAA pathogenesis and testing of novel therapies and devices for the treatment of AAA. Limitations of the model include variation in BAPN ingested by swine, quality of elastase perfusion, and cost of BAPN.&#160;

This novel model creates robust infrarenal abdominal aortic aneurysms in swine using a combination of balloon angioplasty, elastase/collagenase perfusion, topical elastase application, and oral compound &#946;-aminopropionitrile administration, which interferes with collagen cross-linking.

肾上腺腹动脉瘤的猪模型

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal ...

The Intra-Aortic Balloon Pump

Cardiogenic shock remains one of the most challenging clinical syndromes in modern medicine. Mechanical support is being increasingly used in the management of cardiogenic shock. Intra-aortic balloon pump (IABP) is one of the earliest and most widely used types of mechanical circulatory support. The device acts by external counterpulsation and uses systolic unloading and diastolic augmentation of aortic pressure to improve hemodynamics. Although IABP provides less hemodynamic support when compared with newer mechanical circulatory support devices, it can still be the mechanical support device of choice in appropriate situations because of its relative simplicity of insertion and removal, need for smaller size vascular access and better safety profile. In this review, we discuss the equipment, procedural and technical aspects, hemodynamic effects, indications, evidence, current status and recent advances in the use of IABP in cardiogenic shock.

We describe the steps for the percutaneous implantation of the intra-aortic balloon pump (IABP), a mechanical circulatory support device. It acts by counterpulsation, inflating at the onset of diastole, augmenting diastolic aortic pressure and improving coronary blood flow and systemic perfusion, and deflating before systole, reducing left ventricular afterload.