人工弁

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人工臓器最近の進歩 Shigehiko TOKUNAGA, Ryuji TOMINAGA 1. はじめに 1960 Ball-Cage CE 2. 生体弁 1) これまでのスタンダード :CEP, Hancock Ⅱ Carpentier-Edwards Perimaunt CEP Medtronic Hancock 著者連絡先 812-8582 3-1-1 E-mail.

1 人工臓器最近の進歩 Shigehiko TOKUNAGA, Ryuji TOMINAGA 1. はじめに 1960 Ball-Cage CE 2. 生体弁 1) これまでのスタンダード :CEP, Hancock Ⅱ Carpentier-Edwards Perimaunt CEP Medtronic Hancock 著者連絡先 CEP Banbur y 1) CEP Marchand 14 SVD actuarial freedom from explant ) CEP MAGNA Carpentier-Edwards Perimaunt Plus Hancock 1970 Hancock Standard 2 T6 X Bor tolotti Valfrè Hancock Standard Hancock 3),4) Borger 20 SVD actuarial freedom from explant ) 2) ステント生体弁 Carpentier-Edwards Perimount MAGNA Carpentier-Edwards Perimount MAGNA 20 Edwards Perimount

図 1 Carpentier-Edwards Perimount MAGNA EOAI Effective Orifice Area Index: EOA/BSA cm 2 / m 2 19 27 mm 27 mm 7.5 mm 2007 2008 8 20 Perimount PET 19 mm Perimount EOAI effective orifice area index 0.

2 図 1 Carpentier-Edwards Perimount MAGNA EOAI Effective Orifice Area Index: EOA/BSA cm 2 / m mm 27 mm 7.5 mm Perimount PET 19 mm Perimount EOAI effective orifice area index 0.85 BSA 1.4 m 2 MAGNA 1.8 m 2 EOAI mm Perimount BSA 1.6 m 2 MAGNA 2.0 m 2 図 1 MAGNA Totaro Perimount Prima Plus Perimount PPM patient-prosthesis-mismatch 6) Medtronic Mosaic Mosaic AOA Hancock Mosaic Hancock Freestyle 2 mm mm 27, mm 33 Mosaic AOA Riess 10 Mosaic 7) 図

(A) (M) 図 2 Medtronic Mosaic A M Mosaic Ultra 2 3) ステントレス生体弁 8) Full root Root-inclusion Subcoronary technique Medtronic Freestyle 1997 11 Medtronic Freestyle Mosaic AOA Bach 8 10 9) 2 mm 19 mm 29 mm

3 (A) (M) 図 2 Medtronic Mosaic A M Mosaic Ultra 2 3) ステントレス生体弁 8) Full root Root-inclusion Subcoronary technique Medtronic Freestyle Medtronic Freestyle Mosaic AOA Bach ) 2 mm 19 mm 29 mm 29 mm Edwards Prima Plus Edwards Prima Plus XenologiX Jin mmHg EOA ef fective orifice area 1.91 cm 2 10) 2 mm 19 mm 29 mm 19 mm 29 mm 4) ホモグラフト Subcoronar y, Mini-root, Full root

4 40 11) 3. 機械弁 1) これまでのスタンダード :SJM, CM Starr- Edwards ball Ball-Cage Björk- Shiley Medtronic-Hall Single-tilting disc Ball-Cage 12),13) St. Jude Medical SJM CarboMedicus SJM PTFE HP Hemodynamic Plus Regent Emery 25 4,480 SJM 1 12) CarboMedicus CarboMedicus mm 18 mm R Reduced Supraannular Top Hat OptiForm Aagaard 15 14) 2) 二葉弁 SJM Regent St. Jude Medical 2004 Regent / 19 mm 56 HP 72 Regent 84 図 3 in vivo 17 mm Takaseya 19 mm 17 mm Regent 15) Bach Regent 16) 2 mm 17 mm 29 mm 23 mm 29 mm On-X valve On-X

On-X anticoagulation trial 1,200 2008 PROACT On-X 19 21 23 25 27/29 mm 23 25 27/29 31/33 mm ATS

5 (A) a b c 図 3 SJM Regent A SJM B a SJM Standard Valve, b SJM HP Series, c SJM Regent (A) 図 4 On-X A B 50 Closing volume 図 4 図 4 Williams 5 On-X 17) On-X FDA PROACT: prospective randomized On-X anticoagulation trial 1, PROACT On-X /29 mm /29 31/33 mm ATS open pivot ATS open pivot 図 5 LDH 18) PT-INR 19),20) ATS AP Advanced Performance

(A) 図 5 ATS A B GOA ATS Standard 2 mm 19 31 mm 19 33 mm AP 2 mm 16 24 mm 16 20 mm ATS Advancing The

study SJM Regent Sorin Bicarbon Slimlineno 2 best performance 21) Edwards-MIRA 2007 12 Advantage 2007

6 (A) 図 5 ATS A B GOA ATS Standard 2 mm mm mm AP 2 mm mm mm ATS Advancing The Standard Sorin Bicarbon Sorin Bicarbon Carbofilm 図 6 3 PTFE PET carbofilm / Bottio in vitro study SJM Regent Sorin Bicarbon Slimlineno 2 best performance 21) Edwards-MIRA Advantage 図 6 Sorin Bicarbon Omnicarbon ) 弁付きグラフト Carbo-Seal ) 21 mm 2 mm 27 mm 3 mm

7 SJM SJM Meadox Hemashield Graft 19 mm 2 mm 33 mm 1 mm Carpentier-Edwards Medtronic-Venpro Contegra Pulmonary Valved Conduit ) sinus eptfe 24) カテーテル人工弁 ( 嵐に備えよ!) Varadarajan 80 25) ) CoreValve Revalving System Edwards SAPIEN THV 2 CE Euro PCR2008 Serruys keynote lecture NYHA CoreValve 7 79 SAPIEN THV ) Millennium Research Group CE 2 EuroPCR 2008 keynote lecture Ready for the Storm! 23 mm 26 mm 29 mm 1)CoreValve Revalving System Self-expandable Nitinol 図

(A) 図 7 CoreValve Revalving System A B (A) 図 8 Edwards SAPIEN THV A B 26 mm 20 23 mm 29 mm 23 27 mm 18 Fr. Device Rapid pacing ECMO 27),28) 18 Fr.

CoreValve left anterolateral minithoracotomy 5 2 0 purse-string suture Rapid pacing ECMO 30),31) 5.

Ann Thorac Surg 72: 753-7, 2001 2) Marchand MA, Aupart MR, Norton R, et al: Fifteen-year e x p e r i e n c e w i t h t h e m i t r a l C a r p e n t i e r - E d w a r d s

8 (A) 図 7 CoreValve Revalving System A B (A) 図 8 Edwards SAPIEN THV A B 26 mm mm 29 mm mm 18 Fr. Device Rapid pacing ECMO 27),28) 18 Fr. Rapid pacing ECMO 29) 2)Edwards SAPIEN THV Baloon 2 図 8 23 mm 14.5 mm 26 mm 16.0 mm 2 22 Fr. 24 Fr. 33 Fr. CoreValve left anterolateral minithoracotomy purse-string suture Rapid pacing ECMO 30),31) 5. おわりに文献 1) Banbury MK, Cosgrove DM, White JA, et al: Age and valve size effect on the long-term durability of the Carpentier- Edwards aortic pericardial bioprosthesis. Ann Thorac Surg 72: 753-7, ) Marchand MA, Aupart MR, Norton R, et al: Fifteen-year e x p e r i e n c e w i t h t h e m i t r a l C a r p e n t i e r - E d w a r d s PERIMOUNT pericardial bioprosthesis. Ann Thorac Surg 71: S236-9, ) Bortolotti U, Milano A, Mossuto E, et al: Porcine valve durability: a comparison between Hancock standard and Hancock II bioprostheses. Ann Thorac Surg 60: S216-20, ) Valfrè C, Rizzoli G, Zussa C, et al: Clinical results of Hancock II versus Hancock Standard at long-term follow-up

9 J Thorac Cardiovasc Surg 132: , ) Borger MA, Ivanov J, Armstrong S, et al: Twenty-year results of the Hancock II bioprosthesis. J Heart Valve Dis 15: 49-56, ) Totaro P, Degno N, Zaidi A, et al: Carpentier-Edwards PERIMOUNT Magna bioprosthesis: A stented valve with stentless performance? J Thorac Cardiovasc Surg 130: , ) Riess FC, Bader R, Cramer E, et al: Hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis up to ten years. Ann Thorac Surg 83: , ) Cohen G, Christakis GT, Joyner CD, et al: Are stentless valves hemodynamically superior to stented valves? A prospective randomized trial. Ann Thorac Surg 73: , ) Bach DS, Kon ND, Dumesnil JG, et al: Ten-year outcome after aortic valve replacement with the Freestyle stentless bioprosthesis. Ann Thorac Surg 80: 480-7, ) Jin XY, Ratnatunga C, Pillai R: Performance of Edwards prima stentless aortic valve over eight years. Semin Thorac Cardiovasc Surg 13:163-7, ) Willems TP, Takkenberg JJ, Steyerberg EW, et al: Human tissue valves in aortic position: determinants of reoperation and valve regurgitation. Circulation 103: , ) Emery RW, Krogh CC, Arom KV, et al: The St. Jude Medical cardiac valve prosthesis: A 25-year experience with single valve replacement. Ann Thorac Surg 68: , ) Tominaga R, Kurisu K, Ochiai Y, et al: A 10-year experience with the Carbomedics cardiac prosthesis. Ann Thorac Surg 79: 784-9, ) Aagaard J, Tingleff J: Fifteen years clinical experience with the CarboMedics prosthetic heart valve. J Heart Valve Dis 14: 82-8, ) Takaseya T, Kawara T, Tokunaga S, et al: Aortic valve replacement with 17-mm St. Jude Medical prostheses for a small aortic root in elderly patients. Ann Thorac Surg 83: , ) Bach DS, Sakwa MP, Goldbach M, et al: Hemodynamics and early clinical performance of the St. Jude Medical Regent mechanical aortic valve. Ann Thorac Surg 74: , ) Williams MA, van Riet S: The On-X heart valve: mid-term results in a poorly anticoagulated population. J Heart Valve Dis 15: 80-6, ) Sezai A, Shiono M, Orime Y, et al: Evaluation of valve sound and its effects on ATS prosthetic valves in patients' quality of life. Ann Thorac Surg 69: , ) Van Nooten GJ, Van Belleghem Y, Caes F, et al: Lowerintensity anticoagulation for mechanical heart valves: a new concept with the ATS bileaflet aortic valve. J Heart Valve Dis 12: , ) Stefanidis C, Nana AM, Cannière DD, et al: 10-year experience with the ATS mechanical valve in the mitral position. Ann Thorac Surg 79: , ) Bottio T, Caprili L, Casarotto D, et al: Small aortic annulus: The hydrodynamic per formances of 5 commercially available bileaflet mechanical valves. J Thorac Cardiovasc Surg 128: , ) Ukpabi P, Marois Y, King M, et al: The Gelweave polyester arterial prosthesis. Can J Surg 38; , ) Rastan AJ, Walther T, Daehnert I, et al: Bovine jugular vein conduit for right ventricular outflow tract reconstruction: Evaluation of risk factors for mid-term outcome. Ann Thorac Surg 82: , ) Miyazaki T, Yamagishi M, Nakashima A, et al: Expanded polytetrafluoroethylene valved conduit and patch with bulging sinuses in right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg 134: , ) Varadarajan P, Kapoor N, Bansal RC, et al: Sur vival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a cohort of 277 patients aged 80 years. Eur J Cardiovasc Surg 30: 722-7, ) Serruys PW: Keynote Lecture; Transcatheter aortic valve implantation. EuroPCR2008. Barcelona, Spain ) Grube E, Schuler G, Buellesfeld L, et al: Percutaneous aor tic valve replacement for severe aor tic stenosis in high-risk patients using the second- and current thirdgeneration self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 50: 69-76, ) Marcheix B, Lamarche Y, Berry C, et al: Surgical aspects of endovascular retrograde implantation of the aor tic CoreValve bioprosthesis in high-risk older patients with severe symptomatic aortic stenosis. J Thorac Cardiovasc Surg 134: , ) Piazza N, Grube E, Gerckens U, et al: Procedural and 30-day outcomes following transcatheter aor tic valve implantation using the third generation 18Fr. CoreValve Revalving System: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. Eurointerv 4: 242-9, ) Walther T, Falk V, Kempfert J, et al: Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J Cardiothorac Surg 33: 983-8, ) Walther T, Simon P, Dewey T, et al: Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation 116: I240-5,

Proven Design, Enhanced Durability Heat treatment of glutaraldehyde-treated bioprostheses significantly mitigated calcification Sophie Carpentier, Ph.

PROVEN DESIGN, ENHANCED DURABILITY CARPENTIER-EDWARDS PERIMOUNT PERICARDIAL AORTIC BIOPROSTHESIS with ThermaFix process カーペンターエドワーズ PERIMOUNT 牛心のう膜生体弁 ThermaFix Process Proven Design, Enhanced Durability