PDF(Pubmed)
Abstract：
The use of bioprostheses is increasing in younger patients, but it is associated with the risk of later valve deterioration, especially in the mitral position. A new bioprosthesis for mitral valve replacement offers possible longer-term durability and improved hemodynamics. Objectives: Here, we report the implantation of the novel Edwards MITRIS RESILIA mitral valve (Edwards Lifesciences Inc., Irvine, CA, USA) through microinvasive fully endoscopic access as an innovative surgical approach based on a series of twelve patients. Methods: Contrast-based ECG gated CT was preoperatively performed in all patients to determine the intravascular calcifications and vascular parameters, as well as to assess noticeable problems during the operation. CT software for cardiac interventions (3Mensio Medical Imaging BV) was used to simulate surgical prostheses digitally inside the native annulus. With this, a digital LVOT and neo LVOT was created, and the difference between the valve prostheses was measured. Implantation of the MITRIS RESILIA valve was performed in 12 patients according to the instructions for use through microinvasive access in a fully endoscopic fashion using 3D visualization. Results: The mean patient age was 56.50 years, and 7/12 (58.33%) were redo procedures. All patients survived the first 30 days after the procedure, the mean aortic cross-clamp time was 40.17 ± 13.72 min. and mean postoperative transvalvular gradient was 4.45 ± 1.74 mmHg. The neo LVOT in the CT-based simulation was measured with an average area of 414.98 ± 88.69 mm2. The average difference between the LVOT and neo LVOT area was 65.35 ± 34.99 mm2. There was no case of paravalvular leakage or obstruction of the left ventricular outflow tract. Conclusions: The novel MITRIS RESILIA valve is a promising new bioprosthesis for mitral valve replacement that offers improved features as compared to other prostheses. The ease of implantation is increased by this prosthesis by the improved pliability of the sewing cuff and the inward folding of the struts, which was confirmed by short operative times in our series.
摘要：
在年轻患者中，生物假体的使用正在增加，但它与后来瓣膜恶化的风险有关，尤其是在二尖瓣位置。用于二尖瓣置换的新型生物假体提供了可能的长期耐久性和改善的血液动力学。目标:这里,我们报道了新型EdwardsMITRISRESILIA二尖瓣的植入（EdwardsLifesciencesInc.，Irvine,CA,USA）通过微创完全内窥镜入路作为基于一系列12名患者的创新手术方法。方法：所有患者术前进行基于造影的心电门控CT检查，以确定血管内钙化和血管参数。以及评估操作过程中的明显问题。用于心脏介入的CT软件（3MensioMedicalImagingBV）用于在天然环内数字模拟手术假体。有了这个,创建了数字LVOT和新LVOT，并测量了瓣膜假体之间的差异。根据使用说明书，对12例患者进行了MITRISRESILIA瓣膜的植入，并使用3D可视化以完全内窥镜方式通过微创进入。结果：患者平均年龄为56.50岁，7/12（58.33%）是重做程序。所有患者在手术后的前30天都存活了下来，平均主动脉阻断时间为40.17±13.72min.术后平均经瓣膜梯度为4.45±1.74mmHg。测量基于CT的模拟中的neoLVOT,平均面积为414.98±88.69mm2。LVOT和neoLVOT面积之间的平均差异为65.35±34.99mm2。无瓣周漏或左心室流出道阻塞的病例。结论：新型MITRISRESILIA瓣膜是一种有前途的用于二尖瓣置换的新型生物假体，与其他假体相比，具有改进的功能。该假体通过改善缝合套的柔韧性和支柱的向内折叠而增加了植入的便利性。这在我们的系列中得到了很短的手术时间的证实。
