Name: fully endoscopic mitral valve repair with percutaneous cannulation of groin vessels
Uploaded: 2023-05-26T12:00:00
Description: Watch this Scientific Journal Video about Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels at JoVE.com

本文描述的所有程序步骤均根据汉堡大学心脏和血管中心机构审查委员会的指南并在获得书面知情同意后执行。
1. 全内镜MIS MV修复
<ol><li>确保患者处于全身麻醉状态，仰卧位，用碘消毒剂擦洗，并披上无菌窗帘。</li>
	<li>通过第四肋间隙沿乳周缘获得胸廓通路。</li>
	<li>使用软组织牵开器实现肋间隙的扩张。</li>
</ol>2.腹股沟血管经皮插管</...

<ol>
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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=ACC/AHA+guideline+for+the+management+of+patients+with+valvular+heart+disease:+a+report+of+the+American+College+of+Cardiology/American+Heart+Association+Joint+Committee+on+Clinical+Practice+Guidelines.">ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.</a> Journal of the American College of Cardiology. 77 (4), 450-500 (2020).</li><li>Vergnat, M., Finet, G., Rioufol, G., Obadia, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+femoral+artery+access+with+Prostar+device+for+innovative+mitral+and+aortic+interventions.">Percutaneous femoral artery access with Prostar device for innovative mitral and aortic interventions.</a> European Journal of Cardiothoracic Surgery. 39 (4), 600-602 (2011).</li><li>Ramponi, F., Yan, T. D., Vallely, M. P., Wilson, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+percutaneous+cardiopulmonary+bypass+with+Perclose+ProGlide.">Total percutaneous cardiopulmonary bypass with Perclose ProGlide.</a> Interactive Cardiovascular and Thoracic Surgery. 13 (1), 86-88 (2011).</li><li>Sahin, A. A., 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=Comparison+between+PeRcutanEous+and+surgical+femoral+aCcess+for+endovascuLar+aOrtic+repair+in+patientS+with+typE+III+aortic+Dissection+(PRECLOSE+Trial).">Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial).</a> Vascular. 29 (4), 616-623 (2020).</li><li>Malkawi, A. H., Hinchliffe, R. J., Holt, P. J., Loftus, I. M., Thompson, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+access+for+endovascular+aneurysm+repair:+a+systematic+review.">Percutaneous access for endovascular aneurysm repair: a systematic review.</a> European Journal of Vascular and Endovascular Surgery. 39 (6), 676-682 (2010).</li><li>Kastengren, 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=Percutaneous+vascular+closure+device+in+minimally+invasive+mitral+valve+surgery.">Percutaneous vascular closure device in minimally invasive mitral valve surgery.</a> The Annals of Thoracic Surgery. 110 (1), 85-91 (2020).</li><li>Ahmad, A. 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=First+experiences+with+MANTA+vascular+closure+device+in+minimally+invasive+valve+surgery.">First experiences with MANTA vascular closure device in minimally invasive valve surgery.</a> The Thoracic and Cardiovascular Surgeon. 69 (5), 455-460 (2021).</li><li>Wood, D. A., 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=Pivotal+clinical+study+to+evaluate+the+safety+and+effectiveness+of+the+MANTA+percutaneous+vascular+closure+device.">Pivotal clinical study to evaluate the safety and effectiveness of the MANTA percutaneous vascular closure device.</a> Circulation. Cardiovascular Interventions. 12 (7), e007258 (2019).</li><li>De Palma, R., Settergren, M., R&#252;ck, A., Linder, R., Saleh, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+percutaneous+femoral+arteriotomy+closure+using+the+MANTATM+device+on+vascular+and+bleeding+complications+after+transcatheter+aortic+valve+replacement.">Impact of percutaneous femoral arteriotomy closure using the MANTATM device on vascular and bleeding complications after transcatheter aortic valve replacement.</a> Catheterization and Cardiovascular Interventions. 92 (5), 954-961 (2018).</li></ol>

血管闭合装置在动脉CPB插管中的应用是一种经导管技术，有可能改善心脏手术的结果。近年来，该技术在心脏外科手术，特别是EMS瓣膜手术中的应用已被专业中心采用，以避免手术切除和腹股沟血管暴露。ProStar和ProGlide系统是最常用的设备7，12。在一系列300例接受MV MIS手术并应用ProStar设备进行动脉CPB插管的患者中，未观察到术后出血并发症。然而，在1...

治疗原发性退行性二尖瓣反流 （MR） 的金标准是手术二尖瓣 （MV） 修复。这种方法的有效性已在大型临床研究中得到证实，并具有确凿的长期数据1。由于MV修复的大量手术技术，例如环成形术或插入Gore-Tex新脊索科，几乎所有MV的病理都是可以治疗的。这包括复杂的情况，如Morbus Barlow与两个MV传单脱垂，具有经过验证的安全性和有效性以及长达20年的出色效果2。此外，在德国，大多数孤立的MV手术都是 通过 微创方法进行的，例如右前外侧小胸切开术3。此外，伴随的三尖瓣 （TV） 手术适用于微创通路，即使是以跳动的心脏方式4，5。
手术切除进入腹股沟血管的传统上是实施体外循环 （CPB） 的常规程序。然而，这种方法继承了术后伤口愈合障碍或血清肿形成的一定风险6。经导管技术用于完全经皮插入套管以建立CPB的适应性已被描述7，8，这可能会减少可能的腹股沟并发症。在内窥镜下二尖瓣手术（EMS）中已经使用的经皮血管闭合设备包括基于缝合的系统7，8。最近，一种基于胶原栓的血管闭合装置被引入经导管心脏瓣膜手术。这种大孔闭合装置可用于闭合多达 25 法国 （Fr.） 的动脉通路部位。该系统的安全性和有效性先前已在真实世界的经导管主动脉瓣植入 （TAVI） 患者队列9 中得到证实。MV或TV的微创手术（MIS）利用该系统闭合股动脉的第一个数据显示了关于术后腹股沟并发症的有希望的结果10。
我们在此描述了全内窥镜二尖瓣手术的基本步骤，包括经皮腹股沟插管和使用新型血管闭合装置的脱节。全内镜方法与 MIS 非内镜技术的不同之处在于胸廓切口非常小 （3-5 cm）、避免肋骨扩张以及使用内窥镜观察心脏结构，而不能直接看到心脏。
该手术可用于患有明显心脏瓣膜反流或房室心脏瓣膜狭窄的患者，适合进行心脏手术。术前诊断包括经胸/经食管超声心动图和老年患者或有外周动脉疾病病史患者的胸部和髂血管计算机体层成像。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>30&#176; camera head</td>
			<td>Aesculap Einstein Vision</td>
			<td>PV 632</td>
			<td></td>
		</tr>
		<tr>
			<td>3D-HD camera&#160;</td>
			<td>Aesculap Einstein Vision</td>
			<td>PV 630</td>
			<td></td>
		</tr>
		<tr>
			<td>Annuloplasty ring&#160;</td>
			<td>Edwards</td>
			<td>93381</td>
			<td></td>
		</tr>
		<tr>
			<td>Aortic clamp</td>
			<td>Cardio Vision</td>
			<td>CV 195.10</td>
			<td></td>
		</tr>
		<tr>
			<td>Aterial Cannula</td>
			<td>Medtronic</td>
			<td>96570-121</td>
			<td></td>
		</tr>
		<tr>
			<td>Femoral Cannula</td>
			<td>Metronic</td>
			<td>96670-125</td>
			<td></td>
		</tr>
		<tr>
			<td>Full HD 3D Monitor</td>
			<td>Aesculap Einstein Vision</td>
			<td>PV 646</td>
			<td></td>
		</tr>
		<tr>
			<td>Giude wire</td>
			<td>Merit Medica</td>
			<td>6678-71</td>
			<td></td>
		</tr>
		<tr>
			<td>Heart valve retractor set</td>
			<td>Cardio Vision</td>
			<td>CV 100.00</td>
			<td></td>
		</tr>
		<tr>
			<td>LED light source</td>
			<td>Aesculap Einstein Vision</td>
			<td>OP 950</td>
			<td></td>
		</tr>
		<tr>
			<td>Manta</td>
			<td>Teleflex Medical Inc.</td>
			<td>2115</td>
			<td></td>
		</tr>
		<tr>
			<td>Neo chordae</td>
			<td>Serag Wiesner</td>
			<td>MCL14A</td>
			<td></td>
		</tr>
		<tr>
			<td>Soft Tissue Retractor</td>
			<td>Cardio Vision</td>
			<td>Cv100/80</td>
			<td></td>
		</tr>
		<tr>
			<td>Stative table arm for endoscopes</td>
			<td>Cardio Vision</td>
			<td>CV 281.73</td>
			<td></td>
		</tr>
		<tr>
			<td>Stative table arm for instruments</td>
			<td>Cardio Vision</td>
			<td>CV 281.72</td>
			<td></td>
		</tr>
		<tr>
			<td>Suture for fixing Loops</td>
			<td>Gore-Tex Suture</td>
			<td>4N02</td>
			<td></td>
		</tr>
	</tbody>
</table>

fully endoscopic mitral valve repair with percutaneous cannulation of groin vessels

内窥镜下二尖瓣手术（EMS）已成为专业心脏中心的标准护理，与传统的微创开胸方法相比，进一步减少了手术创伤。在微创手术 （MIS） 中，通过手术切除 来 建立体外循环 （CPB） 的腹股沟血管暴露可能导致伤口愈合障碍或血清肿形成。通过使用全经皮技术插入CPB插管并实施血管预闭合装置来避免腹股沟血管的手术暴露，有可能减少这些并发症并改善临床结果。在本文中，我们介绍了一种基于栓塞的新型真空闭合装置的利用，该装置具有可吸收的胶原栓，并且没有缝合材料用于闭合MIS中CPB的动脉通路。虽然该装置最初主要用于经导管主动脉瓣植入（TAVI）手术，但凭借其安全性和可行性，我们在此表明它可以用于CPB插管，因为它能够关闭最大25法国（Fr.）的动脉通路部位。该装置可能适用于显著减少MIS的腹股沟并发症并简化CPB的建立。在这里，我们描述了EMS的基本步骤，包括经皮腹股沟插管和使用血管闭合装置的脱节。

在接受EMS并在我们中心使用这种新型血管闭合装置的初步患者队列中，记录了有希望的结果11。该队列包括35名患者，最常见的伴随疾病是动脉高血压（10/35，28.6%）和心房颤动（9/35，25.7%）。瓣膜衰竭机制包括原发性退行性MR（30/35，85.7%）、继发性功能性MR（3/35，8.6%）和心内膜炎（2/35，5.7%）。MV MIS MV的伴随手术包括三尖瓣修复术（6/35，17.1%），心房颤动消融术（AF）（6/35，17.1%...

Watch this Scientific Journal Video about Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels at JoVE.com

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels

该协议详细演示了如何使用基于经皮塞的血管闭合装置进行经皮腹股沟血管插管的全内窥镜二尖瓣手术 （EMS）。每个步骤都详细介绍了基本步骤和有用说明。

经皮插管腹股沟血管全内镜二尖瓣修复术

Endoscopic mitral valve surgery (EMS) has become a standard of care at specialized heart centers, further reducing surgical trauma compared to a ...

该协议详细演示了如何使用基于经皮塞的血管闭合装置进行经皮插管腹股沟血管的全内窥镜二尖瓣手术，经皮插管腹股沟血管。详细描述了成功程序的每个步骤的基本步骤和有用说明。然后沿着心包边缘进入第四肋间隙。使用软组织牵开器实现肋间隙的扩张。使用标准穿刺针刺穿股动脉，并在TE引导下插入导丝。使用插入导线上的穿刺定位扩张器确定初始穿刺的深度。这通过流出、回流、回流停止来检测穿刺深度。定义集肤水平的深度，由测量工具的可见回流停止定义。对于延迟释放血管闭合装置以延长，这被定义为皮肤水平的穿刺深度加一厘米。将动脉套管放在电线上。并将其连接到体外循环。以同样的方式将股静脉内侧穿刺至动脉。插入静脉套管后，连接到体外循环。将 3D 高清摄像头插入胸廓切口上。然后，打开右侧膈神经上方的心包。这是通过使用透热疗法实现的。通过小切口放置胸夹或夹子，以交叉夹住主动脉。这发生在诱导心室颤动下。用顺行心肌麻痹和32度的中度低温来阻止心脏，这是由心肺机建立和维持的。心电图记录了心脏停搏的有效性。左心房用剪刀打开。打开左心房后，用动态牵开器抬起左心房顶。然后，暴露二尖瓣。并检查病理。在这种情况下，我们可以看到二尖瓣后叶脱垂。检测病理后，尺寸为正确的环成形术环，这是通过环成形术测量工具实现的。通过卡尺为本地脊索的长度调整正确的新脊索科。重新悬挂后二尖瓣，并通过在相应的肌上植入新脊索来植入血管成形环。之后，放置环形环形缝合线。为此，首先将新脊索科固定在肌上。然后穿过后小叶的自由边缘两次，打结下来。然后进行环成形术以恢复正常的环形并防止进一步扩张，以及增加小叶的覆盖。环形缝合线放置在环周围。然后缝合线穿过环成形环，环形成形环通过缝合线将其取下到环上。在打结环成形术环后，进行水测试以确认二尖瓣修复的充分性。用聚丙烯封闭左心房，所有缝合线均不可吸收，采用跑步缝合技术。实现左心房闭合后，取下主动脉交叉钳。然后，关闭胸廓通路，并进行体外循环撤机。通过缝合技术移除静脉插管。穿刺动脉插管，并在TE引导下插入导线。缩回套管后，将闭合系统护套完全插入电线上，然后取下扩张器。在集成的插入工具上插入并关闭设备。然后慢慢地取出整个系统，以稳定的45度角，并恒定地回缩测量深度。观察护套上的标记。调整部署测试，并保护切换释放的杠杆。将系统从股动脉进一步缩回。张力出现，指标字段显示黄绿色。前进锁定工具，直到听到咔嗒声。获得止血后，取下导丝。剪断引线缝合线。并用单缝合线闭合皮肤。在我们35名患者的研究组中，没有发现死亡或中风。没有发生重大或危及生命的出血。并且没有发生访问部位并发症。在这个研究组中，它不会有任何与访问部位相关的输血吗？全内镜下二尖瓣修复术可以以高度的安全性、有效性和长达 20 年的出色效果进行。经皮实施体外循环术可促进手术。基于经皮塞子的闭合装置简化了手术，并实现了即时止血。

Research

JoVE Journal

Medicine

Development of an Algorithm to Perform a Comprehensive Study of Autonomic Dysreflexia in Animals with High Spinal Cord Injury Using a Telemetry Device

一个算法的开发与高位脊髓损伤使用遥测装置进行自主神经异常反射的动物的综合研究

Spinal cord injury (SCI) is a debilitating neurological condition characterized by somatic and autonomic dysfunctions. In particular, SCI above the ...

科研

医学

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

经皮肝脏灌注（PHP）与美法仑作为囿于肝脏不能手术切除转移的治疗

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

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

全根主动脉瓣置换主动脉瓣狭窄主动脉异种移植患者小主动脉根

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

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

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

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

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Assessment and Characterization of Hyaloid Vessels in Mice

小鼠透明血管的评估与表征

In the eye, the embryonic hyaloid vessels nourish the developing lens and retina and regress when the retinal vessels develop. Persistent or failed ...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

三维打印指南模板辅助皮椎间盘（PVP）

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat

大鼠中三极重化控制体积过载的图像引导透射斜线阀传单穿刺模型

Mitral regurgitation (MR) is a widely prevalent heart valve lesion, which causes cardiac remodeling and leads to congestive heart failure. Though the ...