CAJ | 학술논문

目的构建微创大动物瓣膜置入模型,评价其效果.方法应用枝化状聚乙二醇交联猪去细胞主动脉瓣构建新型组织工程化瓣膜替代物,参照Corevalve经导管瓣膜置入系统,自制微创瓣膜释放系统.成年雄性山羊18只,分为原位超声引导组(A组)、原位X线造影引导组(B组)和异位直接释放组(C组),每组6只,全麻下借助心脏超声和X线造影引导,于主动脉瓣原位或胸降主动脉异位行微创瓣膜置入.术后4周时行心脏CT和超声以评价瓣膜近期功能.结果手术成功率分别为A组66.7％(4/6只)、B组50.0％(3/6只)和C组100.0％(6/6只),多重x2比较提示A、B组间差异无统计学意义,但与C组间差异均有统计学意义.3组分别手术(79±18) min、(61 ±23) min和(45±15) min,单向方差分析提示组间差异有统计学意义.术后4周存活率分别为100％(4/4只)、100％(3/3只)和83.3％(5/6只),多重x2比较提示组间差异无统计学意义.心脏CT和超声证实术后即刻和4周时,原位置入的瓣膜定位稳定,瓣叶开合良好,无狭窄及反流.结论 3组瓣膜置入羊模型均无需体外循环辅助,并具有创伤小、无需输血、可重复性较好等优点,近期存活率满意.A组技术设备简单,但超声定位精确性有限,操作时间较长；B组定位准确迅速,但依赖X线造影设备；C组手术成功率高,但置入的瓣叶无功能性启闭活动,仅适用于瓣膜生物相容性的在体观察.
목적 구건미창대동물판막치입모형,평개기효과.방법 응용지화상취을이순교련저거세포주동맥판구건신형조직공정화판막체대물,삼조Corevalve경도관판막치입계통,자제미창판막석방계통.성년웅성산양18지,분위원위초성인도조(A조)、원위X선조영인도조(B조)화이위직접석방조(C조),매조6지,전마하차조심장초성화X선조영인도,우주동맥판원위혹흉강주동맥이위행미창판막치입.술후4주시행심장CT화초성이평개판막근기공능.결과 수술성공솔분별위A조66.7％(4/6지)、B조50.0％(3/6지)화C조100.0％(6/6지),다중x2비교제시A、B조간차이무통계학의의,단여C조간차이균유통계학의의.3조분별수술(79±18) min、(61 ±23) min화(45±15) min,단향방차분석제시조간차이유통계학의의.술후4주존활솔분별위100％(4/4지)、100％(3/3지)화83.3％(5/6지),다중x2비교제시조간차이무통계학의의.심장CT화초성증실술후즉각화4주시,원위치입적판막정위은정,판협개합량호,무협착급반류.결론 3조판막치입양모형균무수체외순배보조,병구유창상소、무수수혈、가중복성교호등우점,근기존활솔만의.A조기술설비간단,단초성정위정학성유한,조작시간교장；B조정위준학신속,단의뢰X선조영설비；C조수술성공솔고,단치입적판협무공능성계폐활동,부괄용우판막생물상용성적재체관찰.
Objective To establish and evaluate 3 kinds of minimally-invasive valve implantation model in vivo.Methods A novel tissue engineered heart valve(TEHV) manufactured by branched polyethylene glycol cross-linked acellular porcine valve and a minimally-invasive valve implantation system according to the design of Corevalve revalving system were adopted.After anesthesia,18 adult male goats were randomly divided into 3 groups: the ulrasound-directed orthotropic group (group A,n =6),angiography-directed orthotropic group (group B,n =6) and direct-released heterotopic group (group C,n =6),and all received minimally-invasive valve implantation orthotropically or heterotopically.4 weeks later,the valvular function was evaluated by CTA and/or echocardiography.Results All 3 kinds of caprine model were successfully constructed.The operation success rate of each group was A: 66.7％,B: 50.0％ and C: 100.0％,respectively(multiple x2 analysis,group A and B P ＞0.05; group A and C,group B and C,P ＜0.05).The operation-time of each group was A: (79 ± 18) min,B:(61 ±23) min,C: (45 ± 15) min(one-way ANOVA,P ＜0.05).The survival rate at4 weeks was A: 100％,B: 100％ and C: 83.3％ (multiple x2 analysis,P ＞ 0.05).Echocardiography and CTA proved the short-term function of implanted TEHV was satisfactory.Conclusion All 3 kinds of caprine valve implantation model can be established without cardiopulmonary bypass and blood transfusion.The devices and equipments required in group A is relatively simple,but the procedure cost longer time for it is hard to determine the right position by ultrasound.The application of angiography made the positioning much easier in group B while the procedure had to be performed in specific operation room with angiographic apparatus.Group C did rely on neither special equipments nor complex operation,but the valve leaflets cannot work normally,so this model was only suitable for testing in vivo characteristics such as biocompatiblities.