背景:左心房辅助装置(LAAD)是一种新型泵,专门用于治疗射血分数保留的心力衰竭。该装置通过手术植入二尖瓣位置。这项研究旨在表征二尖瓣环位置的各种装置配合配置。
方法:快速成型的LAAD模型(n=5)具有五种不同的动力传动系统配置:(A)瓣环水平/袖内运行;(B)袖上/冠状窦(CS)下方;(C)袖上;(D)环上/上CS;(E)左心室游离壁水平。将3D打印的模型植入提取的新鲜猪心脏(80-100千克,成人,健康的猪)以及动力传动系统与CS和冠状动脉(CA)之间的解剖结构的接近度。
结果:对所有5种器械配置进行了装配评估。为了防止传动系统周围形成血凝块,二尖瓣环(MA)作为动力传动系统通道(配置A)已被认为与当前装置有利,因为避免了传动系统接触血液。CS不存在与MA完全相同的级别,与使用左心房游离壁相比,伤害它的风险较小。然而,有不可避免的损害CA的风险,所以在插入动力传动系统之前需要仔细的目视检查。
结论:展示了传动系外置的几种选择,并评估了每种配置的安全性。使用MA作为动力传动系统出口的途径被认为是一种合理且安全的方法。
BACKGROUND: The left atrial assist device (LAAD) is a novel pump that was developed specifically for the treatment of heart failure with preserved ejection fraction. The device is surgically implanted in the mitral position. This study aimed to characterize the various device-fitting configurations in the mitral annular position.
METHODS: Rapidly prototyped LAAD models (n = 5) were fabricated with five different driveline configurations: (A) annulus level/intra-cuff running; (B) supra-cuff/below coronary sinus (CS); (C) infra-cuff; (D) supra-annulus/supra-CS; (E) left ventricular free wall level. The 3D-printed models were implanted in extracted fresh porcine hearts (80-100 kg, adult, healthy porcine) and the proximity of anatomical structures between the driveline and CS and coronary artery (CA) were measured.
RESULTS: All five device configurations were evaluated for fitting. For the purpose of preventing blood clot formation around the driveline, the mitral annulus (MA) as a driveline pass-way (configuration A) has been considered advantageous with the current device, in that the driveline exposure to blood has been avoided. The CS does not exist at exactly the same level as the MA, and there is less risk of injuring it than using the left atrial free wall. However, there is an inevitable risk of damaging the CA, so careful visual inspection before inserting the driveline is needed.
CONCLUSIONS: Several options of driveline exteriorization were demonstrated, and the safety of each configuration was evaluated. Using the MA as a pathway for the driveline exit is considered to be a reasonable and safe method.