이 연구는 스위스 심장 혈관 재단 (Swiss Cardiovascular Foundation)에서 RT에 대한 보조금으로 지원되었습니다.

<ol>
	<li>Bonow, R. O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Focused+update+incorporated+into+the+ACC/AHA+2006+guidelines+for+the+management+of+patients+with+valvular+heart+disease:+A+report+of+the+American+College+of+Cardiology/American+Heart+Association+Task+Force+on+Practice+Guidelines+(Writing+Committee+to+Revise+the+1998+Guidelines+for+the+Management+of+Patients+With+Valvular+Heart+Disease):+endorsed+by+the+Society+of+Cardiovascular+Anesthesiologists,+Society+for+Cardiovascular+Angiography+and+Interventions,+and+Society+of+Thoracic+Surgeons.">Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.</a> Circulation. 118 (15), e523-e661 (2008).</li><li>Rahimtoola, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+problem+of+valve+prosthesis-patient+mismatch.">The problem of valve prosthesis-patient mismatch.</a> Circulation. 58 (1), 20-24 (1978).</li><li>Pibarot, P., Dumesnil, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prosthesis-patient+mismatch:+definition,+clinical+impact,+and+prevention.">Prosthesis-patient mismatch: definition, clinical impact, and prevention.</a> Heart. 92 (8), 1022-1029 (2006).</li><li>Pibarot, P., Dumesnil, J. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemodynamic+and+clinical+impact+of+prosthesis-patient+mismatch+in+the+aortic+valve+position+and+its+prevention.">Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention.</a> J. Am. Coll. Cardiol. 36 (4), 1131-1141 (2000).</li><li>Kang, Y. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+hypertrophy:+a+risk+factor+for+QT-prolongation+and+cardiac+sudden+death.">Cardiac hypertrophy: a risk factor for QT-prolongation and cardiac sudden death.</a> Toxicol. Pathol. 34 (1), 58-66 (2006).</li><li>Castro, L. J., Arcidi, J. M., Fisher, A. L., Gaudiani, V. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Routine+enlargement+of+the+small+aortic+Root:+a+preventive+strategy+to+minimize+mismatch.">Routine enlargement of the small aortic Root: a preventive strategy to minimize mismatch.</a> Ann. Thorac. Surg. 74 (1), 31-36 (2002).</li><li>Kunihara, T., Schmidt, K., Glombitza, P., Dzindzibadze, V., Lausberg, H., Sch&#228;fers, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Root+replacement+using+stentless+valves+in+the+small+aortic+root:+A+propensity+score+analysis.">Root replacement using stentless valves in the small aortic root: A propensity score analysis.</a> Ann. Thorac. Surg. 82 (4), 1379-1384 (2006).</li><li>Yacoub, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fourteen-year+experience+with+homovital+homografts+for+aortic+valve+replacement.">Fourteen-year experience with homovital homografts for aortic valve replacement.</a> J. Thorac. Cardiovac. Surg. 110 (1), 186-194 (1995).</li><li>Sommers, K. E., David, T. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+valve+replacement+with+patch+enlargement+of+the+aortic+annulus.">Aortic valve replacement with patch enlargement of the aortic annulus.</a> Ann. Thorac. Surg. 63, 1608-1612 (1997).</li><li>El-Hamamsy, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rate+of+progression+and+functional+significance+of+aortic+root+calcification+after+homograft+versus+freestyle+aortic+root+replacement.">Rate of progression and functional significance of aortic root calcification after homograft versus freestyle aortic root replacement.</a> Circulation. 120 (Suppl 1), S269-S275 (2009).</li><li>Bach, D. S., Kon, N. D., Dumesnil, J. G., Sintek, C. F., Doty, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ten-year+outcome+after+aortic+valve+replacement+with+the+Freestyle+stentless+bioprosthesis.">Ten-year outcome after aortic valve replacement with the Freestyle stentless bioprosthesis.</a> Ann. Thorac. Surg. 80 (2), 480-487 (2005).</li><li>Ennker, I. C., Albert, A., Dalladaku, F., Rosendahl, U., Ennker, J., Florath, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Midterm+outcome+after+aortic+root+replacement+with+stentless+porcine+bioprostheses.">Midterm outcome after aortic root replacement with stentless porcine bioprostheses.</a> Eur. J Cardio-thorac. Surg. 40 (2), 429-434 (2011).</li><li>Tavakoli, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Full-root+aortic+valve+replacement+with+stentless+xenograft+achieves+superior+regression+of+left+ventricular+hypertrophy+compared+to+pericardial+stented+aortic+valves.">Full-root aortic valve replacement with stentless xenograft achieves superior regression of left ventricular hypertrophy compared to pericardial stented aortic valves.</a> J. Cardiothorac. Surg. 10, 15 (2015).</li><li>Kon, N. D., Cordell, A. R., Adair, S. M., Dobbins, J. E., Kitzman, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+root+replacement+with+the+Freestyle+stentless+porcine+aortic+root+bioprosthesis.">Aortic root replacement with the Freestyle stentless porcine aortic root bioprosthesis.</a> Ann. Thorac. Surg. 67 (6), 1609-1616 (1999).</li><li>Dapunt, O. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stentless+full-root+bioprosthesis+in+surgery+for+complex+aortic+valve-ascending+aortic+disease:+a+single+center+experience+of+over+300+patients.">Stentless full-root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients.</a> Eur. J. Cardiothorac. Surg. 33 (4), 554-559 (2008).</li><li>Saxena, A., Dinh, D., Smith, J. A., Reid, C. M., Shardey, G., Newcomb, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Training+surgeon+status+is+not+associated+with+an+increased+risk+of+early+or+late+mortality+after+isolated+aortic+valve+replacement+surgery.">Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery.</a> Cardiol. J. 21 (2), 183-190 (2014).</li><li>D'Agostino, R. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Society+of+Thoracic+Surgeons+Adult+Cardiac+Surgery+Database:+2016+Update+on+Outcomes+and+Quality.">The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality.</a> Ann. Thorac. Surg. 101 (1), 24-32 (2016).</li><li>Fries, R., Wendler, O., Schieffer, H., Sch&#228;fers, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+rest+and+exercise+hemodynamics+of+23-mm+stentless+versus+23-mm+stented+aortic+bioprostheses.">Comparative rest and exercise hemodynamics of 23-mm stentless versus 23-mm stented aortic bioprostheses.</a> Ann. Thorac. Surg. 69 (3), 817-822 (2000).</li></ol>

저자는 공개 할 것이 없습니다.

<html> 이 연구는 대동맥 근부의 작은 환자에서 스텐트없는 대동맥 이식편을 이용한 대동맥 판막 치환술의 수술 방법에 대한 상세한 설명을보고합니다. 조기 유병률과 사망률은 매우 낮으며 다른 보고서들과 비교하여 유리합니다. 무겁게 석회화 된 관상 동맥의 구개는이 기법에 대한 해부학 적 제한을 구성합니다. 이 기술의 또 다른 단점은 장기간의 수술 시간을 용납하지 않는 빈약 한 상태의 환?...

생물학적 대동맥 판막 치환은 65 세 이상의 환자에게 권장됩니다 1 . 작은 대동맥 근위를 가진 환자의 경우, 제조자가 제시 한 라벨 크기에 기반한 스텐트 삽입 된 생물학적 밸브 대체물은 기능적 요구를 충족시키지 못할 수도 있습니다. 이 상황에서 라힘 툴라 (Rahimtoola)는 처음에 인공 삽입물 불일치 (PPM)를 다음과 같이 설명했다. &quot; 환자에게 삽입 한 후 효과적인 인공 밸브 영역이 정상적인 인간 밸브의 영역보다 작을 때 불일치가 있다고 간주 될 수 있습니다. &quot; 2 . 밸브 보철물의 유효 오리피스 면적은 환자의 신체 크기,보다 일반적으로 환자의 신체 표면적과 관련됩니다. 너무 작은 인공 밸브의 혈역학 적 결과는 비정상적으로 높은 경추 구배 3 입니다. transvalvular gradient와 effectiv 사이의 관계는체 표면적 (EOAI)으로 인덱싱 된 전자 오리피스 면적은 곡선이며, 지수화 된 EOA가 0.8 내지 0.9 cm2 / m2 미만일 때 그 기울기는 기하 급수적으로 증가한다. 이 관계에 기초하여, 0.85 cm2 / m2 미만의 EOAI는 일반적으로 대동맥 위치 4의 PPM에 대한 문턱 값으로 간주됩니다. PPM이 조기 및 후기 임상 결과에 미치는 영향은 논란의 여지가있다. 그러나 PPM이 좌심실 비대의 퇴행에 부정적인 영향을 미치고 따라서 좌심실 기능의 정상화와 증상의 완화에 영향을 미친다는보고가있다 4 . 지속적인 좌심실 비대는 부정맥과 갑작스런 심장 사망의 위험이 증가합니다 5 . 그러므로 가능한 한 PPM을 피하는 것이 좋습니다. 계획된 대동맥 판막 치환술을위한 예측 가능한 PPM의 경우Ogical valve substitute의 선택은 다음과 같습니다 : 1) 환자의 합병증이 더 큰 보철물을 이식하기 위해보다 기술적으로 요구되는 수술 기법을 금지 할 때 스텐트 심낭 밸브 삽입으로 인한 PPM을 받아들이는 것, 2) 대동맥 근을 확대하여 수용 할 수있는 것 스텐트가없는 스텐트 밸브 교체 6 또는 3) 스텐트리스 생체 밸브 7 또는 동종 이식편 8 삽입. 대동맥 근부 확대는 수술 후 출혈을 향상시켜 재골 제거술을 필요로하고 조기 사망률을 증가시키는 것으로보고되었다. 대동맥 동종 이식편은 숙련 된 외과의 사에 의해 이식 될 때 뛰어난 혈류 역학적 프로파일과 양호한 장기 결과를 나타낼 수 있습니다. 그러나, 제한된 유용성과 빠른 석회화 속도는 대동맥 동종 이식 물보다 덜 적합한 생물학적 밸브 대체물 인 돼지 스텐트없는 대동맥 x이노 그라피 10 . 동종 이식 물의 부족과 단점은 대체 생물학적 밸브 대체물의 개념과 개발을 촉진시켰다. 이를 위해 스텐트없는 대동맥 이식편을 임상 실습 11 에 도입했습니다. 한편으로는 성가신 바느질 링의 제거 덕분에 스텐트없는 대동맥 이식편이 동종 이식의 혈역학 적 이점을 재현 할 수 있습니다. 다른 한편, 석회화 방지 기술을 적용한 결과, 스텐트리스 대동맥 이식편의 내구성은 동종 이식 물의 수명과 일치하거나 심지어는이를 초과하도록 최적화되었습니다. 스텐트리스 대동맥 이종 이식의 혈역학 적 이점은 전립선 이식으로 완전히 달성됩니다 12 . subcoronary 및 root inclusion 기술과는 달리, full-root implantation은 대동맥 주위에 스텐트없는 대동맥 이식편을 놓습니다. 이 사실과스텐트리스 밸브 대체품의 가장 큰 내부 기능 직경을 구현하는 풀 루트 이식 기술을 선택하는 이유를 설명합니다. 또한, 밸브 전단에 일괄 적으로 발 살바 (Valsalva) 부비동을 보존하면 생리 학적 개폐 운동이 더 좋아지고 따라서 전단지 수명이 길어집니다. 이 장점은 장기적인 결과의 개선에 기여합니다 12 . 그러나 출혈의 가능성 증가 및 관상 동맥 문합의 가능한 왜곡에 대한 우려로 인해 많은 심장 외과의 사는 stented 생물학적 밸브로 고전 대동맥 판막 치환술에서 풀 루트 대체술로 대표되는 기술적으로 까다로운 절차로 전환하는 것을 방지합니다 스텐트없는 대동맥 이식편. 스텐트없는 대동맥 이식편의 잠재적 인 혈역학 적 이점을 고려할 때, 우리는 full-roo대동맥 근위 대동맥 판막 치환술이 필요한 대동맥 근부의 환자에서 PPM을 피하기 위해 이식을 시행 하였다 ( 표 1 ). 이 환자들에서 새로이 대동맥 판막을 삽입하기 위해 0.85 cm2 / m2 이상의 EOAI를 달성하는 것이 목표이다. 이 의도는 Pibarot 및 동료들이 0.85 cm2 / m2 미만의 투석 된 EOAI를 갖는 밸브 대체물에 대해 허용 할 수 없을 정도로 높은 비 환형 구배를 나타내 었으며 그 결과 불완전한 증상 완화 및 불리한 결과의 지속적인 위험을 나타냈다. 3 , 4 . 수술 전 심 초음파 상 대동맥 직경이 20 mm 미만인 성인 환자를 최초로 식별 한 후 환자는 신체 표면적이 1.6 m 2 보다 더 크게 선택됩니다. 이 환자 군에서 19 mm stented 심낭 대동맥 판막 삽입술 (EOA : 1.28 cm2 </0.85 cm2 / m2 미만의 투영 된 EOAI를 초래한다. 이 프로토콜에서이 환자들은 스텐트없는 대동맥 이식편의 완전 루트 이식을위한 후보자입니다. 최종 결정은 대동맥 판막 제거 후 수술 중 시행됩니다. stented 심낭 대동맥 판막을위한 19-mm valve sizer가 대동맥판을 지나치게 단단히 통과하고 환자가 혈역학 적으로 안정적이고 더 긴 수술을 견딜 수 있다면, 스텐트없는 대동맥 이식편의 전완부 이식이 수행됩니다. 스텐트리스 대동맥 이식편의 경우, 우리는 상업적으로 이용 가능한 2 개의 밸브 대용 물을 서로 교환하여 사용합니다 (자세한 내용은 표 참조). 두 밸브 모두 대동맥 판막을 지닌 돼지 대동맥 뿌리에서 조달됩니다. 그들은 하나의 밸브와 알파 아미노 올레산 (AOA)에 대한 항 석회화 ( 예 : XenoLogiX) 치료와 함께 저압 (0-2 mmHg) 고정 과정을 사용하여 준비됩니다.다른쪽에 대한 진료 처치. 스텐트 심낭 밸브의 19mm 크기 조절기가 대동맥 통과를 지나치게 통과하는 환자에서 23mm 크기의 스텐트없는 대동맥 이종 이식편 크기는 대동맥 순환에서 스텐트가없는 대동맥 이종 이식편을 잘 맞추는 23mm 크기로 나타납니다. 선택 되라. 이 프로토콜은 근위 봉합선과 관상 동맥 문합의 관리에 중점을두고 스텐트없는 대동맥 이식편의 완전 루트 임플란트 기술을 자세히 설명합니다. 이 기술과 대안 옵션의 한계가 논의됩니다.

<table border="0" cellpadding="0" cellspacing="0" width="761">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:368px;">Heart surgery infrastructure:</td>
			<td style="width:163px;"></td>
			<td style="width:151px;"></td>
			<td style="width:80px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Heart Lung Machine</td>
			<td>Stockert</td>
			<td>SIII</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">EOPA 24Fr. arterial cannula</td>
			<td>Medtronic</td>
			<td>77624</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Atrial caval venous cannula 34/48Fr.</td>
			<td>Medtronic</td>
			<td>93448</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">LV vent catheter 17Fr.</td>
			<td>Edwards</td>
			<td>E061</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Antegrade 9Fr. cardioplegia cannula</td>
			<td>Edwards</td>
			<td>AR012V</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Retrograde 14Fr. cardioplegia cannula&#160;</td>
			<td>Edwards</td>
			<td>NPC014&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Coronary artery ostial cannula 90&#176;</td>
			<td>Medtronic</td>
			<td>30155</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Coronary artery ostial cannula 45&#176;</td>
			<td>Medtronic</td>
			<td>30255</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Valve subsitutes:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Stentless aortic xenograft Prima Plus 23mm</td>
			<td>Edwards</td>
			<td>2500P-23</td>
			<td>anti-calcification XenoLogiX treatment</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Stentless aortic xenograft Sizer 23mm</td>
			<td>Edwards</td>
			<td>1170</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Stentless aortic xenograft Freestyle 23 mm</td>
			<td>Medtronic</td>
			<td>FR995-23</td>
			<td>alpha amino oleic acid (AOA) anti-calcification treatment</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Stentless aortic xenograft Sizer 23mm</td>
			<td>Medtronic</td>
			<td>7900</td>
			<td></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;">Electrocautery</td>
			<td>Covidien</td>
			<td>Force FXTM</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Sutures:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene 4/0</td>
			<td>Ethicon</td>
			<td>8871H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene 5/0</td>
			<td>Ethicon</td>
			<td>8870H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene 6/0</td>
			<td>Ethicon</td>
			<td>EH7400H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Braided polyesther 2/0 ligature with polybutylate coating&#160;</td>
			<td>Ethicon</td>
			<td>X305H</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Micro knife Sharpoint&#160;</td>
			<td>TYCO Healthcare PTY&#160;</td>
			<td>78-6900</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Drugs:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Midazolam</td>
			<td>Roche Pharma</td>
			<td>N05CD08</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Rocuronium</td>
			<td>MSD Merck Sharp &#38; Dohme&#160;</td>
			<td>M03AC09</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Propofol</td>
			<td>Fresenius Kabi</td>
			<td>N01AX10</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Fentanil</td>
			<td>Actavis</td>
			<td>N01AH01</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Heparin</td>
			<td>Braun</td>
			<td>B01AB01</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Protamin</td>
			<td>MEDA Pharmaceutical</td>
			<td>V03AB14</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Instruments:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Cooley vascular aortic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC40810-16</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Dissection forceps Carpentier</td>
			<td>Delacroix-Chevalier</td>
			<td>DC13110-28&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Scissors Metzenbaum</td>
			<td>Delacroix-Chevalier</td>
			<td>B351751</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Needle holder Ryder</td>
			<td>Delacroix-Chevalier</td>
			<td>DC51130-20&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Dissection forceps DeBakey</td>
			<td>Delacroix-Chevalier</td>
			<td>DC12000-21&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Micro needle holder Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC50002-21&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Micro scisors Jacobson</td>
			<td>Delacroix-Chevalier</td>
			<td>DC20057-21&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Lung retractor</td>
			<td>Delacroix-Chevalier</td>
			<td>B803990</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Allis clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>DC45907-25&#160;</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">O&#8217;Shaugnessy Dissector</td>
			<td>Delacroix-Chevalier</td>
			<td>B60650</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">18 blade knife</td>
			<td>Delacroix-Chevalier</td>
			<td>B130180</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Leriche haemostatic clamp</td>
			<td>Delacroix-Chevalier</td>
			<td>B86555</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Data analysis:</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Mann-Whitney and Chi-square tests</td>
			<td>GraphPad</td>
			<td>Prism 7</td>
			<td></td>
		</tr>
	</tbody>
</table>

full-root aortic valve replacement by stentless aortic xenografts in patients with small aortic roots

대동맥 근위 대동맥 판막 대체술이 필요한 대동맥 근부 혈류 환자에서 스텐트 심낭 밸브의 이식은 기능적 요구를 충족시키지 못할 수 있습니다. 0.85cm 2 / m 2 미만의 신체 표면 영역으로 인덱싱 된 유효 오리피스 영역을 유도하는 너무 작은 스텐트 심낭 밸브의 이식은 보철물 - 환자 불일치 (PPM)로 간주됩니다. PPM은 좌심실 비대의 퇴행에 부정적인 영향을 미치므로 좌심실 기능의 정상화와 증상의 완화에 부정적인 영향을 미친다. 지속적인 좌심실 비대는 부정맥과 급성 심장사의 위험 증가와 관련이 있습니다. 예측 가능한 PPM의 경우 다음과 같은 세 가지 옵션이 있습니다. 1) 환자의 합병증으로 인해 더 큰 보철물을 삽입하는 기술적으로 까다로운 수술 기법을 금지하는 경우 스텐트 심낭 밸브 삽입으로 인한 PPM을 허용합니다.큰 스텐트 밸브 대체물을 수용하기위한 대동맥 근위부, 또는 3) 스텐트없는 생물학적 밸브 또는 동종 이식편을 이식하십시오. stentless 대동맥 이종 이식편의 stootless 심낭 밸브로 고전적인 대동맥 판막 치환술에 비해 전체 루트 임플란트는 특정 환자에게 3-4 mm 큰 밸브를 이식 할 가능성을 제공하므로 변위 변화를 유의하게 감소시킬 수 있습니다. 그러나 많은 심장 외과의 사는 스텐트 심낭 밸브를 사용한 고전적 대동맥 판막 치환술을 스텐트없는 대동맥 이식편의 기술적으로 어려운 풀 루트 이식으로 바꾸는 것을 꺼립니다. 스텐트없는 대동맥 이식편의 잠재적 인 혈역학 적 이점을 고려할 때 대동맥 판막 대체가 필요한 대동맥 근부의 환자에서 PPM을 피하기 위해 풀 루트 이식을 채택했습니다. 여기에서는 근위부 봉합선의 관리에 중점을두고 스텐트없는 대동맥 이식편의 전완부 이식술에 대한 기술을 자세히 설명합니다.d 관상 동맥 문합술. 이 기술과 대안 옵션의 한계가 논의됩니다.

통계 분석 23 mm 크기의 이식 된 스텐트리스 대동맥 이종 이식편에 대한 신체 표면 영역 (EOAI, cm 2 / m 2 )으로 인덱싱 된 투영 된 유효 오리피스 영역의 값은 평균 ± 표준 편차로 표현되고 스텐트 심낭 밸브의 계산 된 EOAI와 비교하여 4 mm 더 작습니다 즉, 19 mm)를 매개 변수가 아닌 Mann Whitney 검정법을 사용하여 ...

Watch this Scientific Journal Video about Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots at JoVE.com

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

스텐트없는 대동맥 이식편을 이용한 대동맥 판막 치환술은 대동맥 근부의 작은 환자에게 유용한 옵션입니다. 우리는 근위부 봉합선과 관상 동맥 문합의 관리에 중점을두고 스텐트없는 대동맥 이식편의 전완부 이식술에 대한 기술을 설명하고 그 한계와 대안을 논의합니다.

작은 대동맥 근위 대동맥을 가진 환자에서 스텐트리스 대동맥 이식편을 이용한 대동맥 판막 치환술

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial ...

full-root-aortic-valve-replacement-stentless-aortic-xenografts

Research

JoVE Journal

Medicine

11.2K 조회수.  University of Zurich.  스텐트없는 대동맥 이식편을 이용한 대동맥 판막 치환술은 대동맥 근부의 작은 환자에게 유용한 옵션입니다. 우리는 근위부 봉합선과 관상 동맥 문합의 관리에 중점을두고 스텐트없는 대동맥 이식편의 전완부 이식술에 대한 기술을 설명하고 그 한계와 대안을 논의합니다. 

비디오: Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

Orthotopic Aortic Transplantation in Mice for the Study of Vascular Disease

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. This is largely true, but there are a number of important principles that can reduce the difficulty of these procedures and enhance reproducibility. Orthotopic aortic transplantation is an excellent procedure in which to learn these principles because it involves only two end-to-end anastomoses, but requires good suturing technique and handling of the vessels for consistent success. This procedure begins with the procurement of a length of abdominal aorta from a donor animal, followed by division of the native aorta in the recipient. The procured aorta is then placed between the divided ends of the recipient aorta and sutured into place using end-to-end anastomoses. To accomplish this objective successfully requires a high degree of concentration, good tools, a steady hand, and an appreciation of how easily the vasculature of a mouse can be damaged, resulting in thrombosis. Learning these important principles is what occupies most of the beginner's time when learning microsurgery in small rodents. Throughout this protocol, we refer to these important points. This model can be used to study vascular disease in a variety of different experimental systems1-8. In the context shown here, it is most often used for the study of post-transplant vascular disease, a common long-term complication of solid organ transplantation in which intimal hyperplasia occurs within the allograft. The primary advantage of the model is that it facilitates quantitative morphometric analyses and the transplanted vessel lies contiguous to the endogenous vessel, which can serve as an additional control9. The technique shown here is most often used for mice weighing 18-25 grams. We have accumulated most of our experience using the C57BL/6J, BALB/cJ, and C3H/HeJ strains.

We describe a technique in which a section of the abdominal aorta from a mouse is transplanted orthotopically to just below the renal arteries in an allogeneic or syngeneic recipient. This technique can be useful in studies in which transplantation of large arteries of uniform size is deemed advantageous.

혈관 질병의 연구에 대한 마우스의 Orthotopic 대동맥 이식

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. ...

연구

의학

A New Murine Model of Endovascular Aortic Aneurysm Repair

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 19901 in a rat, then described in mice2. Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

Histological and biochemical modifications after aneurysm endograft exclusion are still unclear. We describe a new model of endograft implantation on a murine aneurysm. Through thrombus analysis with and without persistant circulating blood stream interface, and new endovascular biomaterials evaluation, this model will help to better understand endovascular aneurysm exclusion pathobiology.

혈관 동맥류 수리의 새로운 쥐과 모델

Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of ...

Reproducible Arterial Denudation Injury by Infrarenal Abdominal Aortic Clamping in a Murine Model

Percutaneous vascular interventions uniformly result in arterial denudation injuries that subsequently lead to thrombosis and restenosis. These complications can be attributed to impairments in re-endothelialization within the wound margins. Yet, the cellular and molecular mechanisms of re-endothelialization remain to be defined. While several animal models to study re-endothelialization after arterial denudation are available, few are performed in the mouse because of surgical limitations. This undermines the opportunity to exploit transgenic mouse lines and investigate the contribution of specific genes to the process of re-endothelialization. Here, we present a step-by-step protocol for creating a highly reproducible murine model of arterial denudation injury in the infrarenal abdominal aorta using external vascular clamping. Immunocytochemical staining of injured aortas for fibrinogen and &#946;-catenin demonstrate the exposure of a pro-thrombotic surface and the border of intact endothelium, respectively. The method presented here has the advantages of speed, excellent overall survival rate, and relative technical ease, creating a uniquely practical tool for imposing arterial denudation injury in transgenic mouse models. Using this method, investigators may elucidate the mechanisms of re-endothelialization under normal or pathological conditions.

Understanding the cellular and molecular mechanisms of re-endothelialization following arterial denudation injury is of paramount importance in preventing thrombosis and restenosis of arteries. Here we describe a protocol for reproducible arterial denudation injury of the infrarenal abdominal aorta. The procedure was developed to investigate the underlying mechanisms that regulate endothelial regeneration using mouse models.

쥐 모델에서 Infrarenal 복부 대동맥 클램핑에 의해 재현 동맥 발가 벗김 부상

Percutaneous vascular interventions uniformly result in arterial denudation injuries that subsequently lead to thrombosis and restenosis. These ...

Minimally Invasive Transverse Aortic Constriction in Mice

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard open-chest transverse aortic constriction (TAC). Although transverse aortic constriction is a highly functional method for the induction of high pressure in the left ventricle, it is a more difficult and lengthy procedure due to its use of artificial ventilation with tracheal intubation. TAC is oftentimes also less survivable, as the newer method, MTAC, neither requires the cutting of the ribs and intercostal muscles nor tracheal intubation with a ventilation setup. In MTAC, as opposed to a thoracotomy to access to the chest cavity, the aortic arch is reached through a midline incision in the anterior neck. The thyroid is pulled back to reveal the sternal notch. The sternum is subsequently cut down to the second rib level, and the aortic arch is reached simply by separating the connective tissues and thymus. From there, a suture can be wrapped around the arch and tied with a spacer, and then the sternal cut and skin can be closed. MTAC is a much faster and less invasive way to induce left ventricular hypertension and enables the possibility for high-throughput studies. The success of the constriction can be verified using high-frequency trans-thoracic echocardiography, particularly color Doppler and pulsed-wave Doppler, to determine the flow velocities of the aortic arch and left and right carotid arteries, the dimension of the blood vessels, and the left ventricular function and morphology. A successful constriction will also trigger significant histopathological changes, such as cardiac muscle cell hypertrophy with interstitial and perivascular fibrosis. Here, the procedure of MTAC is described, demonstrating how the resulting flow changes in the carotid arteries can be examined with echocardiography, gross morphology, and histopathological changes in the heart.

Minimally invasive transverse aortic constriction (MTAC) conserves the essentials of regular transverse aortic constriction (TAC) while eliminating the use of a ventilator with tracheal intubation. It proves to be a highly desirable method for high-throughput studies on left ventricular overload, particularly in translational studies.

마우스의 최소 침습 가로 대동맥 수축

Minimally invasive transverse aortic constriction (MTAC) is a more desirable method for the constriction of the transverse aorta in mice than standard ...

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures prevents a number of cardiac surgeons from incorporating them into their practice. The aim of this protocol is to describe a simplified and user-friendly technique of an aortic valve-sparing root replacement (VSRR) procedure by re-implantation of the aortic valve. Proper selection of patients and limitations of the technique are discussed.
In 54 consecutive patients, normal appearing aortic valves were re-implanted in a commercially available polyester prosthesis with pre-shaped sinuses by a simplified and standardized technique. Placement of the first row of the proximal suture line, choice of the prosthesis size, and adjustment of the height of the commissures of the patient to the fixed height of the sinus portion of the prosthesis were slightly modified from the reference techniques with the aim of increasing its feasibility for use by other cardiac surgeons. Early mortality and morbidity as well as 5-year survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were collected in all patients.
Thirty-day mortality, re-sternotomy for bleeding, re-sternotomy for mediastinitis, and the incidence of stroke were very low, 1.8% for each (1 of 54). No patient required permanent pace-maker implantation. At 5 years, survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were 97.5%, 95.2%, and 91.6%, respectively.
Mid-term results of our standardized technique of re-implantation of the aortic valve for valve-sparing aortic root replacement are very good and compare with more complex techniques reported by experienced surgeons. By following the present protocol of the standardized re-implantation technique, a greater number of cardiac surgeons can perform this procedure with comparable good results.

Valve-sparing aortic root replacement has the advantage of preserving the patient&#39;s own aortic valve. The complexity of the reported techniques to date restricts their use to a limited number of cardiac surgeons. This protocol describes step-by-step a standardized technique reproducible by a greater number of cardiac surgeons.

대동맥 밸브 밸브 스페어링 대동맥에 다시 주입의 표준화 된 기술 루트 교체

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer tomography measurements. The indications and limitations of this technique, as well as its alternatives, are discussed.

The goal of this protocol is to describe in detail the technique of minimally invasive aortic valve replacement through a right anterior mini-thoracotomy and central aortic cannulation. This technique can potentially enhance patients&#39; comfort and, by reducing post-operative morbidity, promote lowering the length of stay and global costs.

기술 및 최소한의 액세스 대동맥 밸브 교체에 대 한 바로 앞쪽 미니 Thoracotomy의 환자 선택 기준

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The ...

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to facilitate anatomical guidance is of huge interest for complex cardiac interventions like TAVI procedures with cerebral protection. Co-registration of CTA and XR has been introduced either based on additional intraoperative non-/contrast-enhanced cone-beam computed tomography (CBCT) or two separate aortograms. With the related increase of radiation exposure and/or contrast agent (CA) dose, a potential additional risk for the patient is introduced. Here, we propose a modified co-registration approach making use of arteriograms of the iliofemoral arteries, routinely performed during the femoral puncture and sheath introduction. On-the-fly refinement of the co-registration during the on-going procedure enables accurate co-registration without any additional angiograms, thus reducing CA, XR dose and procedure time, while simultaneously improving operator confidence and procedure safety.

The aim of this study was to improve the co-registration for image fusion (IF) of pre-interventional CT data with real-time x-ray (XR) fluoroscopy during transfemoral transcatheter aortic valve implantation (TAVI).

간 대동맥 밸브 주입 하는 동안 이미지 퓨전에 대 한 x 선 Fluoroscopy와 3D CT 혈관의 등록 향상

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, mice undergo RR upon removal of the aortic constriction. In this paper, we describe a step-by-step procedure to perform a minimally invasive surgical aortic debanding in mice. Echocardiography was subsequently used to assess the degree of cardiac hypertrophy and dysfunction during LV remodeling and RR and to determine the best timing for aortic debanding. At the end of the protocol, terminal hemodynamic evaluation of the cardiac function was conducted, and samples were collected for histological studies. We showed that debanding is associated with surgical survival rates of 70-80%. Moreover, two weeks after debanding, the significant reduction of ventricular afterload triggers the regression of ventricular hypertrophy (~20%) and fibrosis (~26%), recovery of diastolic dysfunction as assessed by the normalization of left ventricular filling and end-diastolic pressures (E/e&#39;&#160;and LVEDP). Aortic debanding is a useful experimental model to study LV RR in rodents. The extent of myocardial recovery is variable between subjects, therefore, mimicking the diversity of RR that occurs in the clinical context, such as aortic valve replacement. We conclude that the aortic banding/debanding model represents a valuable tool to unravel novel insights into the mechanisms of RR, namely the regression of cardiac hypertrophy and the recovery of diastolic dysfunction.

Here we describe a step-by-step protocol of surgical aorta debanding in the well-established mice model of aortic-constriction. This procedure not only allows studying the mechanisms underlying the left ventricular reverse remodeling and regression of hypertrophy but also to test novel therapeutic options that might accelerate myocardial recovery.

설치류에서 대동맥 탈밴드에 의해 왼쪽 심실 역 리모델링 공부

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

Porcine Model of Infrarenal Abdominal Aortic Aneurysm

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal abdominal aortic aneurysms (AAA) in swine. To achieve this, we use a combination of balloon angioplasty, elastase and collagenase, and a lysyl oxidase inhibitor, called &#946;-aminopropionitrile (BAPN), to create clinically significant infrarenal aortic aneurysms, analogous to human disease.
Noncastrated male swine are fed BAPN for 7 days prior to surgery to achieve a steady state in the blood. A midline laparotomy is performed and the infrarenal aorta is circumferentially dissected. An initial measurement is recorded prior to aneurysm induction with a combination of balloon angioplasty, elastase (500 units)/collagenase (8000 units) perfusion, and topical elastase application. Swine are fed BAPN daily until terminal procedure on either postoperative day 7, 14, or 28, at which time the aneurysm is measured, and tissue procured. BAPN + surgery pigs are compared to pigs that underwent surgery alone.
Swine treated with BAPN and surgery had a mean aortic dilation of 89.9% &#177; 47.4% at day 7, 105.4% &#177; 58.1% at day 14, and 113.5% &#177; 30.2% at day 28. Pigs treated with surgery alone had significantly smaller aneurysms compared to BAPN + surgery animals at day 28 (p &#60; 0.0003). The BAPN + surgery group had macroscopic and immunohistochemical evidence of end stage aneurysmal disease.
Clinically significant infrarenal AAA can be induced using balloon angioplasty, elastase/collagenase perfusion and topical application, supplemented with oral BAPN. This model creates large, clinically significant AAA with hallmarks of human disease. This has important implications for the elucidation of AAA pathogenesis and testing of novel therapies and devices for the treatment of AAA. Limitations of the model include variation in BAPN ingested by swine, quality of elastase perfusion, and cost of BAPN.&#160;

This novel model creates robust infrarenal abdominal aortic aneurysms in swine using a combination of balloon angioplasty, elastase/collagenase perfusion, topical elastase application, and oral compound &#946;-aminopropionitrile administration, which interferes with collagen cross-linking.

돼지 모델 의 관막 복 대동맥류

Large animal models to study abdominal aortic aneurysms are sparse. The purpose of this model is to create reproducible, clinically significant infrarenal ...

Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy

Based on twice transverse aortic constrictions (TACs) in mice, it is proved that myocardial hypertrophic preconditioning (MHP) could attenuate cardiomyocyte hypertrophy and slow down progression to heart failure. For novices, however, the MHP model is usually quite difficult to establish because of the technical obstacles in ventilator operation, opening the chest repeatedly, and bleeding caused by debanding. To facilitate this model, to increase the surgical success rate and to reduce the incidence of bleeding, we switched to absorbable sutures for the first TAC combing with a ventilator-free technique. Using a 2-week absorbable suture, we demonstrated that this procedure could cause significant myocardial hypertrophy in 2 weeks; and 4 weeks after surgery, myocardial hypertrophy was almost completely regressed to the baseline. Using this protocol, the operators could master the MHP model easily with a lower operation mortality.

This protocol presents an improved method to obtain transient myocardial hypertrophy with absorbable suture, simulating left ventricular hypertrophy decrease after removing pressure overload. It could be valuable for the studies on myocardial hypertrophic preconditioning.