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Wiederherstellung der Trikuspidalklappenfunktionalität

Entwicklung eines neuen katheterbasierten interventionellen Verfahrens

Restoration of tricuspid valve function

Development of a new catheter-based interventional procedure

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Trikuspidalklappeninsuffizienz tritt am häufigsten aufgrund einer Dilatation des rechten Ventrikels, sekundär nach linksseitigen Herzerkrankungen, auf. Bis vor Kurzem wurde der Entwicklung von perkutanen Trikuspidalklappenprothesen wenig Aufmerksamkeit geschenkt. Im vorliegenden Beitrag wird ein neuartiger Ansatz zur interventionellen Therapie der Trikuspidalklappeninsuffizienz, im Speziellen das Design von 2 neuen klappentragenden, selbstexpandierbaren Stents vorgestellt. Material der Stents ist einmal geflochtener Nitinoldraht und einmal lasergeschnittenes Nitinol. Die primäre Verankerung der Prothesen wird beim Konzept A in die Vv. cavae superior und inferior verlagert, beim Konzept B alleinig in die V. cava superior. Die Herzklappe sitzt in orthotoper Position im Trikuspidalklappenanulus, in dem die sekundäre Verankerung stattfindet. Ein realistisches anatomisches 3D-Modell wurde erstellt, beide Konzepte mithilfe iterativer Design- und Simulationsschritte ausgearbeitet und schließlich beide Modelle gefertigt. In-vitro-Untersuchungen belegen eine gute anatomische Verankerung, keine Migration und ausreichende Flexibilität.

Abstract

Tricuspid valve regurgitation mostly occurs following dilatation of the right ventricle and secondary to left-sided cardiac diseases. Until recently, little attention was directed towards the development of percutaneous tricuspid heart valve prostheses. A novel approach to the interventional therapy of tricuspid regurgitation, specifically the design of two new valve-bearing, self-expandable stents, one made of braided nitinol wire and one of laser-cut nitinol, is presented. The primary anchoring of the prostheses is transferred into the superior and inferior vena cava for the first approach and into the superior vena cava only for the second approach. The heart valve is placed inside the tricuspid annulus in an orthotopic position for the secondary anchoring forces applied here. A realistic anatomical 3D model was developed, both concepts were finalized by means of an iterative design and finite element analysis process and finally both stents were manufactured. In vitro tests showed good anatomical anchoring and fit with no migration of the devices and adequate flexibility.

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Danksagung

Die Finanzierung des Projekts mit dem START-Programm und die Unterstützung der Rheinisch-Westfälischen Technischen Hochschule RWTH Aachen werden dankbar anerkannt.

Einhaltung der ethischen Richtlinien

Interessenkonflikt. D. Pott, M. Malasa, M. Kütting, J. Roggenkamp, U. Steinseifer, R. Autschbach, N. Hatam,·J. Spillner und A.L. Amerini geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Lehr- und Forschungsgebiet Kardiovaskuläre Technik (CVE), Institut für Angewandte Medizintechnik (AME), Helmholtz Institut, RWTH Aachen, Pauwelsstr. 20, 52074, Aachen, Deutschland

    D. Pott Dipl.-Ing., M. Kütting, J. Roggenkamp & U. Steinseifer

  2. Klinik für Thorax-, Herz- und Gefäßchirurgie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland

    M. Malasa, R. Autschbach, N. Hatam, J. Spillner & A.L. Amerini

Authors
  1. D. Pott Dipl.-Ing.
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  2. M. Malasa
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  3. M. Kütting
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  4. J. Roggenkamp
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  5. U. Steinseifer
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  6. R. Autschbach
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  7. N. Hatam
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  8. J. Spillner
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  9. A.L. Amerini
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Correspondence to D. Pott Dipl.-Ing..

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Pott, D., Malasa, M., Kütting, M. et al. Wiederherstellung der Trikuspidalklappenfunktionalität. Z Herz- Thorax- Gefäßchir 27, 361–365 (2013). https://doi.org/10.1007/s00398-013-1029-8

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  • DOI: https://doi.org/10.1007/s00398-013-1029-8

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