Hannah J Rando, Rachael W Quinn, Zachary Darby, Emily L Larson, Emily Rodriguez, Jin Kook Kang, Ifeanyi Chinedozi, James S Gammie
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引用次数: 0
Abstract
Objective: Annuloplasty is the most common strategy for repair of functional tricuspid regurgitation (FTR) but is not effective in patients with massive/torrential FTR or leaflet tethering. To address the deficits of tricuspid annuloplasty, TRicuspid Anterior and Posterior Patch (TRAPP) repair was developed, which is a pericardial patch augmentation of the anterior and posterior leaflets.
Methods: To test this repair, a previously validated ex vivo model in an explanted porcine heart was used, wherein annular and leaflet geometry were evaluated using a 3-dimensional structured light scanner at 4 time points: (1) baseline, (2) induction of FTR, (3) annuloplasty repair, and (4) patch repair.
Results: Compared with the regurgitant tricuspid valve, annuloplasty reduced annular circumference (13.7 to 9.5 cm) and area (13.7 vs 6.1 cm2), whereas TRAPP repair did not alter annular dimensions (circumference: 13.7 vs 13.5 cm; area: 13.7 vs 13.6 cm2). Annuloplasty increased leaflet tenting angles (anterior: 53.5° vs 41.0°; posterior: 59.7° vs 48.2°; septal: 38.9° vs 31.4°) whereas TRAPP repair relieved anterior and posterior leaflet tenting (anterior: 28.9° vs 41.0°; posterior: 34.9° vs 48.2°; septal: 33.2° vs 31.4°) and restored geometry comparable to the native tricuspid valve. Central coaptation lengths were greater with TRAPP repair than with annuloplasty for all 3 leaflets (anterior: 12.7 vs 9.5 mm; posterior: 12.2 vs 8.2 mm; septal: 7.4 vs 4.6 mm).
Conclusions: Compared with annuloplasty, TRAPP repair yielded greater coaptation length, resolved leaflet tethering, and resulted in a larger annular area that may facilitate durable repair of advanced FTR, which previously would have required replacement.
目的：瓣环成形术是修复功能性三尖瓣反流（FTR）最常用的方法，但对大面积/侵入性 FTR 或瓣叶拴住的患者无效。为了解决三尖瓣瓣环成形术的缺陷，开发了三尖瓣前后补片（TRAPP）修复术，即心包补片增强前后瓣叶：为了测试这种修补方法，我们使用了之前验证过的猪心体外模型，在 4 个时间点使用三维结构光扫描仪评估了瓣环和瓣叶的几何形状：（1）基线；（2）诱导 FTR；（3）瓣环成形术修补；（4）补片修补：结果：与反流性三尖瓣相比，瓣环成形术缩小了瓣环周长（13.7 至 9.5 厘米）和面积（13.7 vs 6.1 平方厘米），而 TRAPP 修复术没有改变瓣环尺寸（周长：13.7 vs 13.5 厘米；面积：13.7 vs 13.6 平方厘米）。瓣环成形术增加了瓣叶折角（前：53.5° vs 41.0°；后：59.7° vs 48.2°；室间隔：38.9° vs 31.4°），而 TRAPP 修复术缓解了前后瓣叶折角（前：28.9° vs 41.0°；后：34.9° vs 48.2°；室间隔：33.2° vs 31.4°），并恢复了与原生三尖瓣相似的几何形状。与瓣环成形术相比，TRAPP修复术后所有3个瓣叶的中心瓣合长度都更大（前瓣：12.7 mm vs 9.5 mm；后瓣：12.2 mm vs 8.2 mm；隔瓣：7.4 mm vs 4.6 mm）：与瓣环成形术相比，TRAPP修复术可获得更大的合流长度，解决了瓣叶系带问题，并可获得更大的瓣环面积，这可能有助于晚期FTR的持久修复，而在此之前则需要进行置换。
期刊介绍：
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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