A personalized approach to interventional treatment of tricuspid regurgitation: experiences from an acute animal study.
نویسندگان
چکیده
OBJECTIVES Interventional treatment of tricuspid valve disease has so far received little attention due to the anatomical challenges in a thrombogenic surrounding. In the present study, we present an imaging-based, personalized interventional approach to the therapy of tricuspid regurgitation. METHODS In our porcine model, we used rapid prototyping to build a matrix reproducing the geometry of the right atrium that was previously derived from computer tomography (CT) scans. Over this matrix, a braided nitinol device fitting almost completely the right atrium was crafted. An additional tubular stent component was developed to carry a tissue valve prosthesis. This part was designed to be connectable to the annular portion of the main device. In our feasibility study, the crimped device was implanted via jugular access into the right atrium of 12 pigs and expanded subsequently. Following isolated implantation of the device without the valve-carrying component, further procedures included implantation of the whole composite device, including the mentioned tissue valve. Representing a only feasibility study, all implantations were performed under full bypass and direct sight. On-site visualization was performed by both echocardiography and fluoroscopy. Additional imaging was realized by postoperative CT scans. RESULTS Following implantation, 9 of 12 animals were weaned from cardiopulmonary bypass. Correct positioning of the device and orthodromic blood flow as maintained by the valve prosthesis were demonstrated by echocardiography and fluoroscopy. Postoperative contrast CT evaluation demonstrated proper fitting of the device into the right-sided heart cavities without obstruction of the outflow tract. Autopsy additionally confirmed its correct positioning without major trauma to surrounding structures. CONCLUSIONS We demonstrated the feasibility in principle of a personalized interventional treatment for tricuspid regurgitation using a braided stent, based on individual cardiac imaging, with anchoring forces mainly exerted on the venae cavae and on the inner surface of the right atrium. The design process of this device is a good indicator of the growing potential of an imaging-based personalized simulation and production approach for the treatment of tricuspid valve disease.
منابع مشابه
Percutaneous caval stent valve implantation: investigation of an interventional approach for treatment of tricuspid regurgitation.
AIMS Severe tricuspid regurgitation (TR) reduces cardiac output (CO) and increases central venous pressure leading to secondary organ dysfunction. To date, the open surgical approach is the only option to treat TR. Herein, we report our experience of treatment by percutaneous implantation of valved stents in the inferior vena cava (IVC) and superior vena cava (SVC) to substitute tricuspid valve...
متن کاملProspectively ECG-triggered 256-slice computed tomography findings in a patient with dextrocardia, stent-treated coarctation, and infracardial right-sided pulmonary vein deviation.
Sack S, Hauptmann KE, Richardt G, Figulla HR, Senges J, on behalf of the German Transcatheter Aortic Valve Interventions—Registry Investigators. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 2011;32:198–204. 3. Khambadkone S, Coats L, Taylor A, Boudjemline Y, Derrick G, Tsang V, Cooper J, Muthurangu V, Hegde SR, Razavi RS, Pellerin D...
متن کاملRight sided heart evaluation after successful mitral valve replacement.
Introduction: It is well-documented that right-sided heart dysfunction and significant tricuspid valve regurgitation (TVR) have adverse effects on patient outcomes after left-sided heart valve surgery. Therefore, the evaluation of right ventriclular (RV) function and TR severity in patients who had undergone mitral valve replacement (MVR), associated with/without concomitant su...
متن کاملA new approach to the interventional therapy of tricuspid regurgitation.
Currently, there are no fully developed interventional approaches for the treatment of tricuspid regurgitation (TR). The aim of this study was to evaluate the feasibility of orthotopic interventional placement of a biological prosthetic valve in the tricuspid position by inserting, with a transvenous approach, a self-expandable valve-bearing stent into the right atrium. Based on findings of com...
متن کاملTranscatheter interventions for tricuspid regurgitation - heterotopic technology: TricValve.
Introduction Considering the incidence of tricuspid regurgitation (TR) and its implications on functional status and long-term survival, TR is currently undertreated. With the increasing adoption of catheterbased treatments of other types of structural heart disease there is a growing interest and need for effective interventional treatment also for tricuspid regurgitation. Therefore, multiple ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Interactive cardiovascular and thoracic surgery
دوره 19 3 شماره
صفحات -
تاریخ انتشار 2014