非洲首次植入新型生物心脏瓣膜——弹性主动脉组织瓣膜

I. Okyere, Sanjeev Singh, P. Okyere, B. Gyan, N. Boateng, E. Akowuah
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摘要

人工生物假体或组织心脏瓣膜的耐用性受到长期钙化导致的结构性瓣膜恶化(SVD)的限制,特别是在年轻患者和非洲。一种新型的生物修复瓣膜——弹性主动脉组织瓣膜已经被开发出来,在临床前研究中,它已经显示出减少钙化从而提高耐久性。主动脉瓣是由牛心包组织制成的支架状三叶瓣。该组织是通过爱德华兹完整性保存处理牛心包组织创建的。它包含了一个稳定的封顶抗钙化过程,它阻断了已知与钙结合的残余醛基团。用甘油保存组织使瓣膜无需传统的液体溶液(如戊二醛)即可保存。因此,阀门在干燥包装条件下储存,因此在植入之前不需要冲洗。与标准人工生物修复主动脉瓣Perimount组织瓣相比,新型组织保存技术显著改善了血流动力学和抗钙化性能。这种瓣膜在非洲的植入经验是有限的,因为似乎没有发表过这种特殊的长效生物假体瓣膜在非洲的植入行为的经验,因此本文的目的是分享我们在非洲加纳首次成功植入这种Inspiris Resilia主动脉瓣™的初步经验。植入术是在一位57岁的患者身上进行的,他表现出中度至重度主动脉瓣反流的症状,但左心室收缩功能正常。他已随访一年,伤口愈合良好,经胸超声心动图显示瓣膜定位良好,无反流或瓣旁渗漏。据我们所知,这是第一份描述在非洲使用新型Inspiris Resilia主动脉瓣的报告,它增加了耐用性,而且不需要抗凝。
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The First Implantation of the Novel Biological Heart Valve, the Inspiris Resilia Aortic Tissue Valve in Africa
The durability of artificial bioprosthestic or tissue heart valves is limited by structural valve deterioration (SVD) due to long-term calcification especially in young patients and in Africa. A novel bioprosthestic valve, the Resilia Inspiris Aortic Tissue Valve has been developed which, in preclinical studies, has shown reduced calcification thus improving durability. The Inspiris Resilia Aortic Valve is a stented tri-leaflet valve made from bovine pericardial tissue. The tissue is created by treating bovine pericardial tissue with Edwards Integrity Preservation. It incorporates a stable capping anticalcification process, which blocks residual aldehyde groups known to bind with calcium. Tissue preservation with glycerol allows the valve to be stored without a traditional liquid-based solution, such as glutaraldehyde. Therefore, the valve is stored under dry packaging conditions and consequently does not require rinsing prior to implantation. The novel tissue preservation technology significantly improves hemodynamic and anticalcification properties compared with the standard artificial bioprosthestic aortic valve, the Perimount tissue valve. The experience of the implantation of this valve in Africa is limited for there seems to be no published experience of the behaviour of the implantation of this special long lasting bioprosthestic valve in Africa and therefore the purpose of this paper is to share our initial experience of the first successful implantation of this Inspiris Resilia Aortic Valve™ in Ghana, Africa. The implantation was done in a 57-year-old patient who presented with symptomatic moderate to severe aortic valve regurgitation with adequate left ventricular systolic function. He has been followed-up for a year now with well-healed wounds and a transthoracic echocardiography revealing a well-seated valve with no regurgitant flow or paravalvular leak. This is the first report describing the use of the new Inspiris Resilia Aortic valve which has increased durability and does not require anticoagulation in Africa as far as we know.
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