组织工程瓣膜肺导管临床前生长动物模型的一年结果

M. Schweiger, B. Krüger, Alexandra Malbon, T. Fleischmann, M. Weisskopf, Thomas Frauenfelder, F. Lemme, Nikola Cesarovic, W. Knirsch, Michael Hübler
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摘要

目的:在慢性生长羔羊模型中测试了一种由去细胞化猪小肠粘膜下细胞外基质生物支架制成的自建瓣膜肺导管。方法:将导管植入羔羊的肺部:将导管植入 19 只羔羊的肺动脉瓣位置。我们对临床、实验室和超声心动图结果进行了监测,直至术后 12 个月。有两只羔羊分别在九个月和十二个月时被实施了安乐术。我们进行了死前胸部计算机断层扫描和死后病理检查。数据以频率和百分比、中位数和范围或平均值和标准偏差表示。结果12只动物(63.2%)在围手术期存活。三只动物在随访期间意外死亡:一只在术后23天因吸入性肺炎死亡,两只分别在术后18天和256天因导管早期和晚期感染性心内膜炎死亡。在两只计划进行瘢痕手术的动物中,死前 CT 扫描显示导管或瓣叶内有轻微或无钙化。在12个月时进行的超声心动图检查中,导管瓣膜的收缩压梯度峰值和平均值分别为6.5(3-21)毫米汞柱和3(2-12)毫米汞柱,而瓣膜反流情况为无(2只)、轻微(5只)、中度(1只)或严重(1只)。未发现溶血的临床或实验室迹象。随访 12 个月后,动物体重从 33 (27-38) 千克增加到 53 (38-66) 千克(P = 0.010)。结论在生长羔羊模型中植入带瓣肺导管是可行的。植入瓣膜导管的感染性心内膜炎仍然是一个重要的并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
One-Year Outcome of an Ongoing Pre-Clinical Growing Animal Model for a Tissue-Engineered Valved Pulmonary Conduit
Objectives: A self-constructed valved pulmonary conduit made out of a de-cellularized porcine small intestinal submucosal extracellular matrix biological scaffold was tested in a chronic growing lamb model. Methods: The conduit was implanted in pulmonary valve position in 19 lambs. We monitored clinical, laboratory, and echocardiographic findings until 12 months after surgery. In two animals, euthanasia was planned at nine and twelve months. Pre-mortem chest computed tomography and post-mortem pathologic work up were performed. Data are presented as frequency and percentage, median and range, or mean and standard deviation. Results: Twelve (63.2%) animals survived the perioperative period. Three unexpected deaths occurred during the follow-up period: one due to aspiration pneumonia at 23 days after surgery, and two due to early and late infective endocarditis of the conduit at 18 and 256 days. In the two animals with planned scarification, the pre-mortem CT scan revealed mild or no calcification within the conduit or valve leaflets. In the echocardiographic examination at 12 months, peak and mean systolic pressure gradients across the conduit valve were 6.5 (3–21) mmHg and 3 (2–12) mmHg, while valve regurgitation was none (n = 2), trivial (n = 5), moderate (n = 1), or severe (n = 1). No clinical or laboratory signs of hemolysis were seen. After 12 months of follow-up, the animals’ body weights had increased from 33 (27–38) kg to 53 (38–66) kg (p = 0.010). Conclusions: Implantation of a valved pulmonary conduit in our growing lamb model was feasible. Infective endocarditis of the implanted valved conduit remained a significant complication.
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