CN106943207B - A kind of atrioventricular valve valve bracket and its transport system for puncturing merging - Google Patents
A kind of atrioventricular valve valve bracket and its transport system for puncturing merging Download PDFInfo
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- CN106943207B CN106943207B CN201610009313.2A CN201610009313A CN106943207B CN 106943207 B CN106943207 B CN 106943207B CN 201610009313 A CN201610009313 A CN 201610009313A CN 106943207 B CN106943207 B CN 106943207B
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- valve
- valve bracket
- bracket
- merging
- support arm
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2409—Support rings therefor, e.g. for connecting valves to tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
- A61F2/2418—Scaffolds therefor, e.g. support stents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
- A61F2/2466—Delivery devices therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0008—Fixation appliances for connecting prostheses to the body
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- Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Transplantation (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
A kind of atrioventricular valve valve bracket and its transport system for puncturing merging, it is related to that internal prosthese can be placed in, more particularly to a kind of heart valve bracket and its implantation surgery instrument, including expansible support arm, valve and several fixed arms, overhead kick portion and the fixed arm of fixed arm constitute seesaw sample lever；Drag wire pulls overhead kick portion that fixed arm abduction is driven to catch on mitral leaflet, and valve bracket is fixed on atrioventricular valve；Valve Zhou Fanliu is prevented corresponding to the gap of antireflux side sealing cover interface between the valve of leaflet interface.Transport system includes outer sheath, inner core and push rod, and the head end of inner core connects head end sheath；The front end of valve bracket is compressed in head end sheath, and back-end compression is in outer sheath；Valve bracket out of outer sheath is released and is discharged with multistage subsection pattern by push rod；The drag wire of valve bracket connection matches sympetalous antireflux side, and merging, adjustment or recycling are easy and safe to operate, success rate is high, can effectively prevent perivalvular leakage.
Description
Technical field
The present invention relates to can be placed in internal prosthese more particularly to a kind of heart valve bracket and its implantation surgery instrument.
Background technology
Surgical operation changes the main means that valve is mitral valve disease patient treatment, heart valve replacement surgery technology maturation, reliable, effect
Certainly.Bicuspid valve is extremely complex in anatomical structure, as shown in Figure 1, its annulus 24 is oval, 24 diameter of annulus is big and opposite
It is relatively soft, mobility is big, valve is bilobal, has chordae tendineae and papillary muscle 27 under valve, and the positioning for intervening artificial valve needs to exist
It can be carried out under the guidance of esophagus ultrasound or X-ray examination, and fixed difficult.During merging it is possible to that chordae tendineae or breast can be injured
Head flesh, it is postoperative easily to form perivalvular leakage.These situations often cause serious pulmonary edema or death once occurring.Therefore, two point
Valved prosthesis routinely needs open chest surgery.But the intrinsic defect of cardiac operation is to need extracorporal circulatory system, operation wound is big, there is one
Surely operation associated death incidence, rehabilitation of patients after surgical treatment time are longer.Jeopardize especially for advanced age, height and changes valve there are surgery and control
The patient for treating contraindication, is still the problem treated at present.If to be placed in through conduit valve, first in the design of artificial valve
There is breakthrough, secondly needs to innovate in operating technology.
With percutaneous aortic valve film replacement operation (AVI) it is clinical gradually promote the use of, percutaneous mitral valve
The research of displacement has also caused the great interest of people.2014, four doctors of St Thomas hospitals of Britain completed generation
Earlier through conduit bicuspid valve implantation (TMVI) in boundary, used is the research and development of Edwards Lifesciences companies
FORTIS valves.The valve is made of holder and bovine pericardium valve.Special support Design can utmostly reduce valve
Week leakage, there is unique dissection anchor system valve to be made to be not easy to shift.The valve is sacculus self-expanding valve, passes through apex of the heart way
Diameter is placed in.The transport system and implantation mode of above-mentioned FORTIS valves first discharge an outer sheath using the design of double epithecas
Fixed arm is set to discharge abduction, after clamping leaflet, then discharging another outer sheath makes atrium portion discharge, last ventricle portion release, should
Technical solution solves the problems, such as that atrial side first discharges when valve bracket merging, but the two-sheath structure of the program is but also conveying
System is whole coarseer, reaches 42Fr, easily causes the complication of site of puncture.
After some months, another kind intervention valve Tiara valves (Neovasc Inc.) are also successfully placed in human body.The valve
It is constituted for the bovine pericardium of Nitinol self-expanding stent and cloverleaf.Valve bracket is pressure of the D-shaped to reduce to left ventricular outflow tract view
Compel, the shirt rim of atrial surface sheet abduction prevents perivalvular leakage, and two special anchoring structures of ventricular side prevent valve from shifting, through the apex of the heart
It is placed in by 32Fr sheaths.Operation is carried out in the case where general anesthesia, the heart surpass and DSA is guided, and is first punctured the apex of the heart, is placed in sheath, seal wire is put
To atrium sinistrum, be sent into valve system along seal wire, first discharge atrial surface, after valve is pulled at annulus, then discharge ventricular side
Anchoring system finally withdraws transport system.
In addition in several atrioventricular valve valve brackets for conducting a research of clinic other than, also have some atrioventricular valve valves in recent years
The patent application of holder provides various related art schemes.For example, entering the application for a patent for invention of China through PCT application approach
" be unfolded successively through conduit mitral " (Chinese invention patent application number：201280067082.0 application publication number：
CN104302247A a kind of prosthetic heart valve being unfolded successively) is disclosed comprising self expandable frame, self expandable frame tool
There are atrium skirt section, the annulus of ventricle skirt section and placement therebetween, and there are two the front and back auricles of self expandable (to be equivalent to for tool
Fixed arm), play the role of secure valve.
Entering Chinese patent of invention " through conduit valve delivery system and method " through PCT application approach, (Chinese invention is special
Profit number：ZL201180020522.2, Authorization Notice No.：CN102985032B a kind of device including mitral) is disclosed.
The prosthese includes the inner supporting structure for having downstream part and upstream portion, and upstream portion has the cross section bigger than downstream part
Area.Inner supporting structure is configured in the atrial side for being located in primary commissure of mitral valve body, and prevents prosthese from being left from left ventricle.
Prosthetic valve with prosthetic valve leaflet is connected to inner supporting structure.There is outer supporting structure engagement arm (to be equivalent to fixation
Arm), the downstream of engagement arm is connected to inner supporting structure.The function of auricle in the similar above-mentioned technical proposal of its engagement arm, can be with
Using the structure of multiple engagement arms.
Enter the application for a patent for invention " artificial heart valve film device and related system and method " of China through PCT application approach
(Chinese invention patent application number：201280040748.3 application publication number：CN103997990A it) discloses a kind of for nature
The valvular artificial heart valve film device percutaneously replaced and related system and method.The heart valve prosthesis device includes tool
It may include multiple asymmetric arrangements to have the expansible support element that can be placed between the leaflet of natural valve, expansible support element
Arm (fixed arm).The heart valve prosthesis device utilizes the air bag or spoon shape slipper push fixed arm being arranged in transport system
Expansion, transport system is complicated and is difficult to control.
Chinese utility model patent " mitral valve device and its conveying device " (utility model patent number：
ZL201220575567.8 Authorization Notice No.：CN202908881U a kind of recyclable bicuspid valve conveyed through conduit) is disclosed
Valve device and its conveying device.The mitral valve device is used to be placed in the bicuspid valve in situ of heart, including is provided with
The braced frame of connection ring；Conveying device includes push rod, and one end of push rod is cased with protective case and is connect with connection ring, is used for
Push or recycling mitral valve device, mitral valve device are compressed in protective case before releasing, realize two points
Recuperability of the valve valve device before complete release.
Although some technical problems that above-mentioned prior art solves the manufacture of atrioventricular valve valve bracket and uses respectively,
But due to the particularity of mitral valve apparatus so that be not fixed easily, be also easy to produce after bicuspid valve intervention support merging difficulty and merging
Perivalvular leakage, the probability that Left ventricular outflow tract obstruction occurs is high, and may be produced to coronary sinus vein and left circumflex artery
It is raw to influence, lead to the research of bicuspid valve intervention support and using there are prodigious difficulties.There are following skills for above-mentioned each technical solution
Art problem：
1. needed during holder merging by control to adjust make the auricle, engagement arm or expansible support element (with
Under be referred to as fixed arm) abduction as possible, former and later two former mitral leaflets are sandwiched.It, can shadow if fixed arm abduction is inadequate
Holder positioning is rung, causes implantation surgery difficult.And after valve bracket discharges completely, and fixed arm clamping lobe as possible must be made
Leaf.If fixed arm can not clamp former mitral two leaflets, the fixed arm of front leaflet side influences left ventricular outflow tract view, posterior valve leaflet
The fixed arm of side, which is withstood on left locular wall, easily causes left room to damage or rupture, or influences the coronary artery blood vessel through Atrioventricular septum traveling, valve
Membrane support also easily shifts.
2. according to the mitral anatomical features of human body, front and back leaflet boundary position is slightly lower and there are certain gaps, and
The position of valve periphery blood reflux is most easily produced after valve bracket merging.Valve bracket is placed in using prior art
Afterwards, although being less prone to the leakage of valve periphery by the position of two front and back leaflets of the leaflet clamped barrier, due to front and back valve
Easily there is gap in leaf boundary position, especially for the patient of mitral regurgitation, easily make valve commissure portion after valve bracket merging
The holder of position takes off the reflux that valve periphery is generated into atrial side.
3. existing endovascular stent and foregoing invention patent or patent application transport system, is all made of valve bracket
After merging in such a way that release lever of extrapolating gradually discharges valve bracket.With the careful of above-mentioned 201280067082.0 patent application
For the approach row operation of tip, it is first to discharge head end that valve bracket, which discharges process, so that the skirt section of atrial side is expanded, then discharges again
Auricle.But this mode has the following problems in atrioventricular valve valve bracket implantation：Holder can cause after atrium portion expands
The transport system of carrying Holder can not be freely up and down, or may hook some position due to holder atrial side and cause entirely
Holder is sliding out transport system, and holder or transport system up and down cannot necessarily affect the contraposition of auricle and to two valves
The fixation of leaf.Since the blood stream pressure of ventricular side is significantly larger than the pressure of atrial side, atrial side discharges the impact of rear left room side blood flow
It is also easy to that valve bracket is made to be detached from or shift.Meanwhile once above-mentioned existing holder delivery mode starts to discharge there is also holder
The problem of just can not recycling and adjust.
If in addition, the atrium skirt section of valve bracket and the structure in ventricle skirt section do not meet human heart dissection requirement,
Can cause head end damage ventricle wall, influence left ventricular outflow tract view, influence coronary artery blood vessel etc..Therefore, the knot in the two faces of valve bracket
Structure design is also the technical issues of above-mentioned prior art not yet solves.
Invention content
The object of the present invention is to provide a kind of atrioventricular valve valve brackets for puncturing merging, solve above-mentioned existing valve branch
Technical problem of the frame present in structure and its merging process.
Technical solution is used by the present invention solves above-mentioned technical problem：
A kind of atrioventricular valve valve bracket for puncturing merging, including expansible support arm, are fixed on expansible support arm
Inside can unidirectionally open valve, and be fixed on several fixed arms on the outside of expansible support arm, and the fixed arm will
Valve bracket is fixed on atrioventricular valve, and the atrioventricular valve is the bicuspid valve or tricuspid valve of heart, it is characterised in that：
The fixed arm is connected to the fixed arm tie point positioned at expansible support arm back edge, and extends downwardly shape
At the barb for being convex to valve bracket rear end and abduction；The barb is linked together with fixed arm, and composition is connected with fixed arm
Contact is the seesaw sample lever of fulcrum；
During valve is placed in, barb can be pulled around fixed arm by being connected to the drag wire of transport system end
Tie point rotates, and drives fixed arm abduction and hooks the leaflet of atrioventricular valve, valve bracket is fixed on atrioventricular valve；
The rear end of the expansible support arm extends back in the interconnecting piece of each leaflet of atrioventricular valve and abduction, formation correspond to
The antireflux side between the valve of leaflet interface.
A kind of preferable technical solution for puncturing the atrioventricular valve valve bracket being placed in of the present invention, counnter attack between the valve
The length for flowing side is more than the length of the barb of fixed arm rear end, during the merging of valve bracket, fixed arm and its barb
After portion's release, antireflux side is still compressed in outer sheath between the valve, defeated to make the rear end of valve bracket be continually maintained in
It send in system；The barb on antireflux side and fixed arm between the valve is connected in the drag wire of barb, collectively forms
The merging auxiliary device of valve bracket；It is placed in failure in valve bracket or positioning is not punctual, it can be by the drawing of transport system
Line adjusts the position of valve bracket, or valve bracket is recovered in transport system.
The preferable technical solution of another kind of the atrioventricular valve valve bracket for puncturing merging of the present invention, is used for heart two
Cusp valve replacement, it is characterised in that the expansible support arm is consolidated by left room side fixed part, support arm main part, left room side
Determine antireflux side between portion and valve to form；The position at place is different after rack surface is placed according to holder, and coating or part apply overgrowth
Object film；Wherein, the shape of support arm main part is adapted with lesion bicuspid valve actual form, can be the shape of a saddle, circle or half
Circle, the equal overlay film of support arm main part；After valve bracket merging, opposed flattened preceding valve side is in towards mitral front leaflet
Arc-shaped back lobe side is towards mitral posterior valve leaflet；The left room side fixed part is in loudspeaker sample openning shape, is located at expansible
The end of support arm left room side is used for fixation and antireflux of the valve bracket in atrium sinistrum side, left room side fixed part different parts
Length and loudspeaker sample opening abduction angle, correspond to atrium sinistrum anatomical shape, it is ensured that valve bracket implantation after paste
Annulus is taken, to reduce perivalvular leakage；The loudspeaker sample opening of atrium side position at left ventricular outflow tract view position, left room side fixed part is outer
Angle is opened up to reduce, at the same orifice of coronary sinus position shirt rim is shorter and not overlay film, it is left to coronary sinus vein and coronary artery to reduce
The influence of Circumflex branch；The left room side fixed position is in the end of the left room side of expansible support arm, for valve bracket on a left side
The fixation of ventricular side and antireflux, shape is corresponding with the anatomical shape of left ventricle, close to anterior mitral cusp and left room
The left room side fixed part at the position of efferent tract, expansible support arm has small barbed edge, and the barb of small barbed edge is relatively
Short and not overlay film；The equal overlay film in remaining position of expansible support arm.
A kind of superior technique scheme of the atrioventricular valve valve bracket for puncturing merging of the present invention, it is characterised in that institute
The expansible support arm stated be self-inflated material made of it is netted or " Z " shape braided supports.
Another superior technique scheme of the atrioventricular valve valve bracket for puncturing merging of the present invention, it is characterised in that
The expansible support arm be using expand netted of balloon expandable mode or " Z " shape braided supports.
A kind of improved technical solution of the atrioventricular valve valve bracket for puncturing merging of the present invention, it is characterised in that institute
The valve stated leaflet made of 2 or more biovalve materials forms, and is placed in the support arm main part of expansible support arm
Inside, from left room, laterally left room side unidirectionally opens.
The improved technical solution of another kind of the atrioventricular valve valve bracket for puncturing merging of the present invention, it is characterised in that
At least two fixed arm is configured on the outside of the expansible support arm, one of fixed arm corresponds to the position in front leaflet center,
Remaining fixed arm is distributed in posterior valve leaflet side；The head end of the fixed arm relatively round blunt, stretches to left room side, and surface can be through
Coating processing；The length for being shorter in length than support arm main part of the fixed arm；The barb and fixed arm at 125~
145 ° of obtuse angles；It is fixed when fixed arm discharges and barb is still compressed in transport system or barb outside drag wire by drawing
55~35 ° of arm abduction；When valve bracket discharges expansion completely, fixed arm is adjacent to support arm main body under own resilient effect
Portion clamps former mitral two leaflets.
A kind of further improved technical solution of the atrioventricular valve valve bracket for puncturing merging of the present invention, for passing through
The valve bracket of left ventricular apex approach is placed in, it is characterised in that the rear end of valve bracket includes that the left room side of expansible support arm is solid
Determine portion, fixed arm barb and valve between antireflux side, the back-end compression of the valve bracket is in the outer sheath of transport system；
The edge on antireflux side is used to inside edge or thick-layer structure of film between the valve, and edge thickness is more than the push of transport system
Fit clearance between bar and outer sheath.
The further improved technical solution of another kind of the atrioventricular valve valve bracket for puncturing merging of the present invention, is used for
Valve bracket merging through left room approach or through femoral vein approach, it is characterised in that the rear end of valve bracket is expansible support arm
Left room side fixed part, the back-end compression of the valve bracket is in the outer sheath of transport system；Left room side fixed part
Edge is used to inside edge or thick-layer structure of film, and edge thickness is more than matching between the push rod and outer sheath of transport system
Close gap.
It is a further object to provide a kind of punctures for above-mentioned atrioventricular valve valve bracket to be placed in transport system,
Used technical solution is：
A kind of atrioventricular valve valve bracket puncture merging transport system, the puncture merging behaviour for above-mentioned atrioventricular valve valve bracket
Make, the described puncture merging transport system includes that can puncture the outer sheath for arriving at surgical site, can by the inner core of guide wire,
And it is sleeved on the push rod except inner core, it is characterised in that：
The head end of the inner core connects one section of head end sheath identical with outer sheath structure；Valve bracket to be placed in is sleeved on
The front end of the front of inner core, the valve bracket is compressed in the head end sheath, and the back-end compression of the valve bracket exists
In outer sheath；The push rod is with valve bracket without connection；During holder is placed in, the front end of the push rod against
In the rear end of valve bracket, valve bracket out of outer sheath is released and discharged with multistage subsection pattern；
The rear end of the valve bracket is at least connected with the drag wire that 1 root knot is annular, and the drag wire passes through outer sheath
Gap between push rod is drawn out to the end of transport system, cuts toroidal tail end and can be pulled out from transport system and is led
Bracing wire；By the end of outer dragline bracing wire, the position of valve bracket can be adjusted, adjust the abduction of fixed arm or puts into mistake
The valve bracket lost is recovered in outer sheath.
The atrioventricular valve valve bracket of the present invention punctures a kind of preferable technical solution of merging transport system, it is characterised in that
The outer diameter of the push rod and the internal diameter of outer sheath are slidably matched, and the drag wire can be by between outer sheath and push rod
Gap flexibly pull sliding；The edge thickness of the valve bracket rear end is more than the slit width between outer sheath and push rod
Degree, can prevent the rear end of valve bracket to be caught in the gap between outer sheath and push rod.
The atrioventricular valve valve bracket of the present invention punctures a kind of superior technique scheme of merging transport system, for through left room
The valve bracket of apical approach is placed in, it is characterised in that the left room side fixed part of expansible support arm is placed in conduct in head end sheath
Valve bracket front end；Each fixed arm of the valve bracket configures a drag wire, and the front end sleeve of drag wire is in fixed arm
Barb.
The atrioventricular valve valve bracket of the present invention punctures a kind of improved technical solution of merging transport system, for through left room
The valve bracket of apical approach is placed in, it is characterised in that the left room side fixed part of expansible support arm is placed in conduct in head end sheath
Valve bracket front end；The edge on the front end sleeve of drag wire antireflux side between the valve.
The atrioventricular valve valve bracket of the present invention punctures a kind of further improved technical solution of merging transport system, is used for
Valve bracket merging through left room approach or through femoral vein approach, it is characterised in that the left room side fixed part of expansible support arm,
Antireflux side is placed in head end sheath between the barb and valve of fixed arm, the front end as valve bracket；Before the drag wire
End cap is at the edge of left room side fixed part.
The beneficial effects of the invention are as follows：
1, the atrioventricular valve valve bracket for puncturing merging of the invention, using the fixed arm with lever construction barb
The antireflux side between valve can be realized the hierarchical segmented release of valve bracket by transport system, can adjust movement, have merging
Feature easy and safe to operate, success rate is high；
2, of the invention for puncturing the atrioventricular valve valve bracket being placed in, using antireflux side between valve, left room fixed part and
Left room fixing part structure realizes that various ways are fixed, and can effectively prevent perivalvular leakage；
3, atrioventricular valve valve bracket of the invention punctures merging transport system, can be used for through left ventricular apex approach, through a left side
Room approach or atrioventricular valve valve bracket through femoral vein approach puncture implantation surgery, can be by the head end sheath of inner core and connection
To the drag wire of valve bracket fixed arm, coordinate antireflux side between the valve of valve bracket, assist the merging of valve bracket, realizes branch
Mount into unsuccessfully when adjustment or recycling.
Description of the drawings
Fig. 1 is the vertical section schematic diagram of heart mitral valve apparatus.
Fig. 2 is the structural schematic diagram of the atrioventricular valve valve bracket for puncturing merging of the present invention；
Fig. 3 is diagrammatic cross-section of the atrioventricular valve valve bracket along three leaflet valves for puncturing merging of the present invention；
Fig. 4 is the fixed arm structural schematic diagram of the atrioventricular valve valve bracket for puncturing merging of the present invention；
Fig. 5 is that the atrioventricular valve valve bracket of the present invention punctures the structural schematic diagram of merging transport system；
Fig. 6 is the schematic diagram being placed in through left ventricular apex approach row valve bracket：10 part of valve bracket discharges in figure, fixed
The opening of arm 5 hooks mitral valve leaflet；
Fig. 7 is the schematic diagram after the atrioventricular valve valve bracket for puncturing merging of the present invention is placed in and fully discharges；
Fig. 8 is the schematic diagram of the valve bracket release process first step：Fixed arm 5 discharges in figure, and barb 6 is still compressed in defeated
It send in the outer sheath 14 of system, 5 abduction of fixed arm；
Fig. 9 is the schematic diagram of valve bracket release process second step：Discharge fixed arm 5 and barb 6, antireflux side between valve
4 are still compressed in transport system, 5 abduction of fixed arm；
Figure 10 is the schematic diagram of valve bracket release process third step：The left room side of release valve bracket 10 completely；
Figure 11 is placed in through left ventricular apex approach row valve bracket, and atrium sinistrum side fixed part first discharges the schematic diagram of expansion：Valve
Membrane support part discharges, and fixed arm opening hooks mitral valve leaflet, and left room side fixed part opens；
Figure 12 is the schematic diagram being placed in through left room or femoral vein approach row valve bracket；
In figure, 1- left rooms side fixed part, 2- support arm main parts, the left room side fixed parts of 3-, antireflux side between 4- valves, 5- is solid
Fixed arm, 51- fixed arm tie points, 6- barb, the small barbed edges of 7-, 8- valves, the expansible support arms of 9-, 10- valve brackets,
11- guide wires, 12- inner core head ends, 13- head end sheaths, 14- outer sheaths, 15- drag wires, 16- push rod, 17- inner cores, 18-
Preceding valve side, 19- back lobes side, 20- left ventricular outflow tract views, the atrium sinistrums 21-, 22- left ventricles, the 23- apexes of the heart, 24- annulus, 25- front leaflets,
26- posterior valve leaflets, 27- chordae tendineaes and papillary muscle, 28- leaflet interfaces, 29- leaflet lower edges.
Specific implementation mode
For better understanding of the above-mentioned technical proposal of the present invention, carry out with reference to the accompanying drawings and examples further
Detailed description.
One embodiment of the atrioventricular valve valve bracket for puncturing merging of the present invention is as shown in Figures 2 and 3, including can
Support arm 9 is expanded, be fixed on 9 inside of expansible support arm can unidirectionally open valve 8, and be fixed on expansible support arm 9
Valve bracket 10 is fixed on atrioventricular valve by several fixed arms 5 in outside, the fixed arm 5, to block valve week and prevent
Perivalvular leakage, the atrioventricular valve are the bicuspid valve or tricuspid valve of heart, and the following description is by taking bicuspid valve as an example；
As shown in Fig. 2, the fixed arm 5 is connected to the fixed arm connection positioned at 9 left room lateral edges of expansible support arm
Point 51, and it is downwardly extending the barb 6 for being convex to 10 left room side of valve bracket and abduction；The barb 6 and fixed arm 5
It is linked together, it is the seesaw sample lever of fulcrum to constitute with fixed arm tie point 51, as shown in Figure 4；
During valve is placed in, by being connected to the drag wire 15 of transport system end, pull barb 6 around fixed arm
Tie point 51 rotates, and drives 5 abduction of fixed arm and under leaflet along 29, hooks mitral front leaflet 25 and posterior valve leaflet 26,
Valve bracket 10 is fixed on bicuspid valve；
Room face extends interconnecting piece of the expansible support arm 9 at anterior mitral cusp 25 Yu 26 both ends of posterior valve leaflet to the left
And abduction, form antireflux side 4 between the valve that two correspond to leaflet interface 28；After the merging of valve bracket 10, the valve
Between antireflux side 4 be fitted in the leaflet interface 28 of left ventricle side, the gap that capping leaflet interface 28 is formed is to prevent valve all
Reflux.
The embodiment of the atrioventricular valve valve bracket for puncturing merging of the present invention according to figure 1, it is anti-between the valve
The length on reflux side 4 is more than the length of the barb 6 of 5 rear end of fixed arm, during the merging of valve bracket 10, fixed arm 5
And its after barb 6 discharges, antireflux side 4 is still compressed in outer sheath 14 between the valve, to make a left side for valve bracket 10
Room side is continually maintained in transport system；The barb 6 on antireflux side 4 and fixed arm 5 between the valve is connected in barb
The drag wire 15 in portion 6 collectively forms the merging auxiliary device of valve bracket 10；It is placed in failure in valve bracket or positioning is inaccurate
When, the position of valve bracket 10 can be adjusted by the drag wire 15 of transport system, or valve bracket 10 is recovered to conveying
In system.
Embodiment according to the present invention for puncturing the atrioventricular valve valve bracket of merging, the expansible support arm 9
For network made of self-inflated material；The expansible support arm 9 by left room side fixed part 1, support arm main part 2,
Antireflux side 4 forms between left room side fixed part 3 and valve；The self-inflated material is Nitinol etc..Rack surface is according to branch
The position mounted where rear is different, coating or part coating biomembrane；The biomembrane includes pericardium piece, ultra-thin polytetrafluoro
Vinyl film etc.；Wherein, the shape of support arm main part 2 is adapted with lesion bicuspid valve actual form, can be the shape of a saddle, round
Or semicircle, 2 equal overlay film of support arm main part；After valve bracket 10 is placed in, opposed flattened preceding valve side 18 is towards mitral
Front leaflet 25, the back lobe side 19 being arc-shaped is towards mitral posterior valve leaflet 26；The left room side fixed part 1 is opened in loudspeaker sample
Mouth shape, is located at the end of 9 left room side of expansible support arm, is used for fixation and antireflux of the valve bracket 10 in atrium sinistrum side, left
The abduction angle of length and loudspeaker the sample opening of 1 different parts of room side fixed part, corresponds to the anatomical shape of atrium sinistrum, Ke Yibao
Docile annulus 24 after valve bracket 10 is implanted into is demonstrate,proved, to reduce perivalvular leakage；Atrium side position at left ventricular outflow tract view position, left room
The loudspeaker sample opening abduction angle of side fixed part 1 reduces, at the same orifice of coronary sinus position shirt rim is shorter and not overlay film, to reduce pair
The influence of coronary sinus vein and left circumflex artery；The left room side fixed part 3 is located at 9 left room side of expansible support arm
End, be used for fixation and antireflux of the valve bracket 10 in left ventricle side, shape is corresponding with the anatomical shape of left ventricle,
Close to the position of anterior mitral cusp 25 and left ventricular outflow tract view 20, the left room side fixed part 3 of expansible support arm 9 have it is small fall
The barb of hook edge 7, small barbed edge 7 is relatively short and not overlay film；The equal overlay film in remaining position of expansible support arm 9.
Other embodiment according to the present invention for puncturing the atrioventricular valve valve bracket of merging, described is expansible outer
Holder 9 is the network expanded using balloon expandable mode.
The embodiment of the atrioventricular valve valve bracket for puncturing merging of the present invention according to Fig.2, described expands
9 outside configuration at least two fixed arm 5 of support arm is opened, one of fixed arm corresponds to the position in 25 center of front leaflet, remaining
Fixed arm is distributed in 26 side of posterior valve leaflet；As shown in figure 4, the head end of the fixed arm 5 relatively round blunt, stretches to left room side,
It surface can be through coating processing；The length for being shorter in length than support arm main part 2 of the fixed arm 5；The barb 6 and fixation
Arm 5 is at 125~145 ° of obtuse angles；When the release of fixed arm 5, barb 6 is still compressed in transport system or barb 6 is pulled
When being drawn outside line 15,55~35 ° of 5 abduction of fixed arm；When the release expansion completely of valve bracket 10, fixed arm 5 is made in own resilient
It is adjacent to support arm main part 2 under, clamps former mitral front leaflet 25 and posterior valve leaflet 26.
The embodiment of the atrioventricular valve valve bracket for puncturing merging of the present invention according to Fig.3, the valve 8
Leaflet forms made of 2 or more biovalve materials, is placed in the inside of support arm main part 2, from the lateral left room side of left room
It is unidirectional open.In the embodiment shown in fig. 3, valve 8 is made of 3 leaflets, and the specially treated heart can be used in leaflet material
The biovalve of packet valve or other materials.
One embodiment according to the present invention for puncturing the atrioventricular valve valve bracket of merging, for through left ventricular apex way
The valve bracket implantation of diameter, 10 rear end of valve bracket include the left room side fixed part 3 of expansible support arm 9, fixed arm 5 fall
Antireflux side 4 between hook portion 6 and valve, the back-end compression of the valve bracket 10 is in the outer sheath 14 of transport system；Between the valve
The edge on antireflux side 4 is used to inside edge or thick-layer structure of film, edge thickness be more than the push rod 16 of transport system with
Fit clearance between outer sheath 14.
One embodiment according to the present invention for puncturing the atrioventricular valve valve bracket of merging, be used for through left room approach or
Valve bracket implantation through femoral vein approach, 10 rear end of valve bracket being compressed in outer sheath 14 are expansible support arm 9
Left room side fixed part 1, the back-end compression of the valve bracket 10 is in the outer sheath 14 of transport system；The left room side is fixed
The edge in portion 1 is used to inside edge or thick-layer structure of film, and edge thickness is more than the push rod 16 and outer sheath of transport system
Fit clearance between 14.
Fig. 5 is that the atrioventricular valve valve bracket of the present invention punctures one embodiment of merging transport system, is used for above-mentioned chamber
The puncture merging operation of valve valve bracket, the transport system include that can puncture the outer sheath 14 for arriving at surgical site, can be led to
The inner core 17 of guide wire 11 is crossed, and is sleeved on the push rod 16 except inner core 17；
As shown in figure 5, the head end 12 of the inner core 17 connects one section of head end sheath identical with 14 structure of outer sheath 13；It waits for
The valve bracket 10 of merging is sleeved on the front of inner core 17, and the front end of the valve bracket 10 is compressed in the head end sheath 13
Interior, the back-end compression of the valve bracket 10 is in outer sheath 14；The push rod 16 is with valve bracket 10 without connection；?
During holder merging, the front end of push rod 16 is resisted against the rear end of valve bracket 10, with multistage subsection pattern by valve bracket
10 release and are discharged out of outer sheath 14；
The rear end of the valve bracket 10 is at least connected with the drag wire 15 that 1 root knot is annular, and the drag wire 15 passes through
Gap between outer sheath 14 and push rod 16 is drawn out to the end of transport system, and cutting toroidal tail end can be from delivery system
Drag wire 15 is pulled out in system；By the end of outer dragline bracing wire 15, the position of valve bracket 10 can be adjusted, or puts into mistake
The valve bracket 10 lost is recovered in outer sheath 14.
Atrioventricular valve valve bracket according to the present invention punctures one embodiment of merging transport system, the push rod 16
Outer diameter and the internal diameter of outer sheath 14 are slidably matched, and the drag wire 15 can pass through the seam between outer sheath 14 and push rod 16
Gap flexibly pulls sliding；The edge thickness of 10 rear end of valve bracket is more than the gap width between outer sheath 14 and push rod 16,
The rear end of valve bracket 10 can be prevented to be caught in the gap between outer sheath 14 and push rod 16.
The atrioventricular valve valve bracket of the present invention punctures merging transport system and can be used for through left ventricular apex approach, through left room way
Diameter or valve bracket through femoral vein approach puncture implantation surgery.Fig. 6 is that the atrioventricular valve valve bracket puncture merging of the present invention is defeated
One embodiment of system is sent, for the valve bracket merging through left ventricular apex approach, wherein the left room of expansible support arm 9
Side fixed part 1 is placed in head end sheath 13 as 10 front end of valve bracket；Each fixed arm 5 of the valve bracket 10 configures
A piece drag wire 15, the barb 6 of the front end sleeve of drag wire 15 in fixed arm 5；It, can band by the end of outer dragline bracing wire 15
The head end abduction of dynamic fixed arm 5, makes it easy to the gap along 29 under chordae tendineae and papillary muscle 27 and mitral valve leaflet, clamps
Mitral front leaflet 25 or posterior valve leaflet 26.
Atrioventricular valve valve bracket according to the present invention punctures one embodiment of merging transport system, for through left ventricular apex
The valve bracket of approach is placed in, wherein the left room side fixed part 1 of expansible support arm 9, which is placed in head end sheath 13, is used as valve
10 front end of holder；The edge on front end sleeve antireflux side 4 between the valve of the drag wire 15.
Figure 12 is that the atrioventricular valve valve bracket of the present invention punctures another embodiment of merging transport system, for through left room
Approach or through femoral vein approach valve bracket merging, wherein counnter attack between the left room side fixed part 3 and valve of expansible support arm 9
Stream side 4 is placed in head end sheath 13, the front end as valve bracket 10；The front end sleeve of the drag wire 15 is in left room side fixed part
1 edge.In the above two embodiments, structure of the fixed arm 5 without barb 6 can be used in the valve bracket 10.
The atrioventricular valve valve bracket and its transport system for puncturing merging of the present invention, can be used for through left ventricular apex portion
Approach, atrium sinistrum approach or the merging of femoral vein approach row atrioventricular valve valve bracket, during implantation surgery, as long as valve bracket
10 not releases completely, so that it may by pulling the drag wire 15 drawn from transport system end, will be recovered in transport system, in fact
Now remove the recycling of valve bracket 10；Meanwhile as long as the rear end of valve bracket 10 is still compressed in transport system, so that it may be adjusted with passing through
Section transport system and the mode for pulling drag wire realize the adjustment of 10 position of valve bracket.
The embodiment of the atrioventricular valve valve bracket and its transport system application method for puncturing merging of the present invention：
Embodiment 1：It punctures and is placed in through left ventricular apex approach
Operation pathway through the merging of left ventricular apex approach row valve bracket as shown in fig. 6, in figure, release by 10 part of valve bracket
It puts, fixed arm opening hooks mitral front leaflet 25 and posterior valve leaflet 26；
It is preoperative, valve bracket 10 is compressed in transport system first, wherein 10 front end of valve bracket is expansible outer branch
The left room side fixed part 1 of frame 9, is compressed in the head end sheath 13 of 17 head end of inner core, and the rear end of valve bracket 10 includes expansible
Antireflux side 4 between the left room side fixed part 3 of support arm 9, the barb 6 and valve of fixed arm 5, is compressed in the outer sheath of transport system
In 14, drag wire 15 is sleeved on the rear end of valve bracket 10, can be sleeved on antireflux side 4 between the barb 6 or valve of 5 rear end of fixed arm
Edge, two head ends of drag wire 15 are knotted into ring-type, are drawn from transport system end by the inside of outer sheath 14.
Surgical procedure is as follows：Two purse string sutures are done in left ventricular apex portion, puncturing implantation in pocket punctures sheath, in x lines
Under perspective or the super guiding of the heart, merging guide wire 11 reaches pulmonary vein by mitral orifice up to left room or further, exits puncture sheath
Pipe temporarily tightens purse wire hemostasis.
The first step of valve bracket multistage subsection release mode：It is placed in the delivery system with valve bracket 10 along guide wire 11
System, head end 12 is by mitral orifice to left room, and behind the orientation for specifying valve bracket 10, push rod 16 of slowly extrapolating discharges valve
The fixed arm 5 of holder 10；At this point, the barb 6 of 5 rear end of fixed arm is still compressed within the outer sheath 14 of transport system, barb
Portion 6 is made 5 abduction of fixed arm by the constraint of outer sheath 14, referring to Fig. 8.
The second step of valve bracket multistage subsection release mode：The orientation for reaffirming valve bracket 10 is shunk in left room
When to left room side push, so that fixed arm 5 is entangled mitral front leaflet 25 and posterior valve leaflet 26；If unsuccessful can continue to push
Barb 6 is discharged, but antireflux side 4 is still compressed in the outer sheath 14 of transport system between valve, at this moment can pass through outer dragline bracing wire
15, make 5 abduction of fixed arm, referring to Fig. 9.
The third of valve bracket multistage subsection release mode walks：If mitral leaflet 25 and 26 still cannot successfully be clamped,
It can make it into the inside of valve bracket 10 by continuing to send push rod 16 outside, push down valve bracket 10 and make its left room side
Expansion discharges the left room side of valve bracket 10 completely；Meanwhile outer dragline bracing wire 15 makes 5 abduction of fixed arm, so as to bicuspid valve valve
Leaf 25 and 26 sandwiches fixed arm 5, the important step of valve bracket implantation is completed, referring to Figure 10.
4th step of valve bracket multistage subsection release mode：After fixing push rod 16 and tensing drag wire 15, in push
Core 17 makes the left room side fixed part 1 of valve bracket 10 be released from the head end sheath 13 of inner core head end 12, valve bracket 10
Left room side fixed part 1 completely release and it is swelling in left room；Outer drawing transport system keeps swelling valve bracket left room side solid
Determine portion to block in mitral left room side and fixation；Drag wire 15 is decontroled, sending push rod 16 outside makes valve bracket 10 discharge completely
And it is swelling be fixed on mitral position, side 4 of preventing backflowing between two longer valves is blocked in front leaflet 25 and 26 both ends of posterior valve leaflet
The leaflet interface 28 of interconnection；Finally, after by checking clear effect, cut cyclic annular drag wire 15 one, extraction is led
Bracing wire 15 simultaneously exits transport system, and two purse string suture line tightenings of apex are knotted, atrioventricular valve valve bracket is completed and is placed in hand
Art.Valve bracket after being placed in mitral valve position and fully discharging is as shown in Figure 7.
Embodiment 2：Expansion is first discharged through left ventricular apex approach, left room side fixed part 1
Implementation such as Figure 11 institutes of expansion are first discharged through the merging of left ventricular apex approach row valve bracket, left room side fixed part 1
Show, in figure, 10 part of valve bracket release, fixed arm opening hooks mitral front leaflet 25 and posterior valve leaflet 26, and left room side is solid
Determine the opening of portion 1.In the present embodiment, the first and second steps of valve bracket release process are identical with embodiment 1, still,
It is opened in the fixed arm 5 that valve bracket 10 discharges, after hooking mitral front leaflet 25 and posterior valve leaflet 26, first passes through push inner core
17 release the front of valve bracket 10 from head end sheath 13, and the left room side fixed part 1 of valve bracket 10 is made to release completely
It puts and swelling in left room, is then further continued for pushing push rod 16, discharges antireflux side 4 between left room side fixed part 3 and valve, complete
Holder is placed in release process.
Embodiment 3：It punctures and is placed in through left room approach
Figure 12 is the one embodiment for the operation pathway being placed in through left room approach row valve bracket, and valve bracket 10 is conveying
Placing direction in system is as shown in figure 12, and in figure, 10 part of valve bracket release, fixed arm opening hooks mitral preceding valve
Leaf 25 and posterior valve leaflet 26；The left room of valve bracket 10 is placed on the proximal end of transport system, and the left room side of expansible support arm 9 is fixed
Portion 1 as valve bracket 10 back-end compression in outer sheath 14；The left room of valve bracket 10 is placed on the distal end of transport system,
Antireflux side 4 between the barb 6 and valve of 5 rear end of left room side fixed arm, the front end as valve bracket 10 is compressed to inner core head end
In 12 head end sheath 13；Drag wire 15 is sleeved on the bracket lip edge of left room side fixed part 1, and the end of drag wire 15 passes through epitheca
It is drawn from transport system end the inside of pipe 14.
Surgical procedure is as follows：Two purse string sutures are done in the left auricle of heart portion of left room, puncturing implantation in pocket punctures sheath,
X lines are had an X-rayed or the heart surpasses under guiding, and merging guide wire 11 reaches left room by mitral orifice, exits puncture sheath, temporarily tightens lotus
Envelope curve stops blooding.
The first step of valve bracket multistage subsection release mode：It is placed in the delivery system with valve bracket 10 along guide wire 11
System, head end 12 is by mitral orifice to left room, and behind the orientation for specifying valve bracket 10, push rod 16 of slowly extrapolating discharges valve
The fixed arm 5 of holder 10；At this point, antireflux side 4 between 10 front end of valve bracket, including the barb 6 and valve of 5 rear end of fixed arm,
Still it being compressed in the head end sheath 13 of inner core 17, barb 6 is made 5 abduction of fixed arm open by the constraint of head end sheath 13,
Referring to Figure 12.
The second step of valve bracket multistage subsection release mode：The orientation for reaffirming valve bracket 10 is shunk in left room
When drawn to outside left room side, so that fixed arm 5 is entangled mitral leaflet, front leaflet 25 and posterior valve leaflet 26.
The third of valve bracket multistage subsection release mode walks：After fixing push rod 16 and tensing drag wire 15, in push
Core 17 makes the left room side fixed part 3 of valve bracket 10 be released from the head end sheath 13 of inner core 17, the left room side of valve bracket
It discharges completely and swelling in left interior；Outer drawing transport system makes swelling valve bracket 10 and fixed arm 5 block in bicuspid valve
Left room side, side 4 of preventing between two longer valves backflowing blocks the leaflet being connected with each other in front leaflet 25 and 26 both ends of posterior valve leaflet and hands over
Portion of boundary 28.
4th step of valve bracket multistage subsection release mode：Drag wire 15 is decontroled, sending push rod 16 outside makes valve bracket
10 releases completely, the left room side of valve bracket 10 is completely swelling, and valve bracket 10 is made to be completely fixed in mitral position；Most
Afterwards, after by checking clear effect, cut cyclic annular drag wire 15 one extracts drag wire 15 out and exits transport system, will be left
The purse string suture line tightening of two, auricle position knots, and completes atrioventricular valve valve bracket implantation surgery.
Embodiment 4：It punctures and is placed in through femoral vein approach
It is placed in through femoral vein approach row valve bracket, placing direction of the valve bracket 10 in transport system is the same as through left room way
Diameter, operation pathway is as shown in figure 11, i.e.,：The left room of valve bracket 10 is placed on the proximal end of transport system, expansible support arm 9
Left room side fixed part 1 as valve bracket 10 back-end compression in outer sheath 14；The left room of valve bracket 10 is placed on conveying
The distal end of system, antireflux side 4 between the barb 6 and valve of 5 rear end of left room side fixed arm, the front end as valve bracket 10 are compressed
Into the head end sheath 13 of inner core head end 12；Drag wire 15 is sleeved on the bracket lip edge of left room side fixed part 1, the end of drag wire 15
It is drawn from transport system end by the inside of outer sheath 14 at end.But transport system need to be implanted by femoral vein, total length
It is longer.
Surgical procedure is as follows：Through femoral venous puncture, merging punctures sheath and guide wire 11, surpasses in x lines perspective or the heart and draws
It leads down, is placed in atrial septal puncture device, reach right room row atrial septal puncture, guide wire 11 is sent into left room and left room；Exit puncture
Device is placed in sacculus through guide wire 11 and reaches atrial septum position, having sexual intercourse interval position expansion, after exiting sacculus, through guide wire 11
It is placed in the transport system with valve bracket 10, follow-up valve bracket release process is identical with embodiment 3, no longer superfluous herein
It states.
Embodiment 5：Expand the method for holder using ball
Although above-mentioned implant surgery embodiment is illustrated according to self-expandable stent mode, of the invention sets for puncturing
It is the case where ball expands holder that the atrioventricular valve valve bracket and its transport system entered, which is equally applicable to expansible support arm 9,.For ball
Expand the merging of holder, it is preoperative to also need to ball while valve bracket 10 is compressed in head end sheath 13 and outer sheath 14
Capsule is placed in the head end 12 of transport system inner core；In art, behind 10 in-position of valve bracket, first according to the various embodiments described above
Release steps, discharge the fixed arm 5 of holder, and the barb 6 of 5 rear end of fixed arm is still compressed in transport system, makes fixation
Arm 5 opens, and clamps mitral front leaflet 25 and posterior valve leaflet 26；Then, valve bracket 10 is discharged completely, executes balloon expandable
So that expansible support arm 9 is expanded completely, valve bracket 10 is blocked in mitral orifice position, other concrete operation steps with it is above-mentioned from
The embodiment 1 to 4 of swollen formula holder is identical.
Although be described by taking bicuspid valve as an example in above embodiment, as long as according to heart tricuspid valve
The structure of valve bracket is simply transformed in structure, the atrioventricular valve valve bracket for being used to puncture merging of the invention and its conveying
System be equally applicable to tricuspid valve through conduit valve replacement surgery.
Those of ordinary skill in the art it should be appreciated that more than embodiment be intended merely to illustrate the present invention's
Technical solution, and be not used as limitation of the invention, any connotation based on the present invention is to embodiment described above
Made by variation, modification, all will fall the present invention scope of the claims in.
Claims (14)
1. a kind of atrioventricular valve valve bracket for puncturing merging, including expansible support arm, are fixed in expansible support arm
Side can unidirectionally open valve, and be fixed on several fixed arms on the outside of expansible support arm, and the fixed arm is by valve
Membrane support is fixed on atrioventricular valve, and the atrioventricular valve is the bicuspid valve or tricuspid valve of heart, it is characterised in that：
The fixed arm is connected to the fixed arm tie point positioned at expansible support arm back edge, and is downwardly extending convex
To valve bracket rear end and the barb of abduction；The barb is linked together with fixed arm, is constituted with fixed arm tie point
For the seesaw sample lever of fulcrum；
During valve is placed in, barb can be pulled to be connected around fixed arm by being connected to the drag wire of transport system end
Point rotation drives fixed arm abduction and hooks the leaflet of atrioventricular valve, valve bracket is fixed on atrioventricular valve；
The rear end of the expansible support arm extends back in the interconnecting piece of each leaflet of atrioventricular valve and abduction, formation correspond to valve
Antireflux side between the valve of leaf interface.
2. the atrioventricular valve valve bracket according to claim 1 for puncturing merging, which is characterized in that counnter attack between the valve
The length for flowing side is more than the length of the barb of fixed arm rear end, during the merging of valve bracket, fixed arm and its barb
After portion's release, antireflux side is still compressed in outer sheath between the valve, defeated to make the rear end of valve bracket be continually maintained in
It send in system；The barb on antireflux side and fixed arm between the valve is connected in the drag wire of barb, collectively forms
The merging auxiliary device of valve bracket；It is placed in failure in valve bracket or positioning is not punctual, by the drag wire tune of transport system
The position of whole valve bracket, or valve bracket is recovered in transport system.
3. the atrioventricular valve valve bracket according to claim 1 for puncturing merging, which is characterized in that for two point of heart
Valve valve replacement, the expansible support arm between left room side fixed part, support arm main part, left room side fixed part and valve by preventing
Reflux side forms；Rack surface be placed according to holder after where position it is different and coat biomembrane；Wherein, support arm main part
Shape and lesion bicuspid valve actual form be adapted, be the shape of a saddle, round or semicircle, the equal overlay film of support arm main part；Valve
After membrane support merging, opposed flattened preceding valve side is towards mitral front leaflet, and the back lobe side that is arc-shaped is towards mitral
Posterior valve leaflet；The left room side fixed part is in loudspeaker sample openning shape, is located at the end of expansible support arm left room side, is used for valve
Fixation and antireflux of the holder in atrium sinistrum side, the angle of splay of length and loudspeaker the sample opening of left room side fixed part different parts
Degree corresponds to the anatomical shape of atrium sinistrum, it is ensured that docile annulus after valve bracket implantation, to reduce perivalvular leakage；On a left side
The loudspeaker sample opening abduction angle of the atrium side position at ventricular outflow tract view position, left room side fixed part reduces, while orifice of coronary sinus position
The shirt rim set is shorter and not overlay film, to reduce the influence to coronary sinus vein and left circumflex artery；The left room side
Fixed position is used for fixation and antireflux of the valve bracket in left ventricle side, shape in the end of the left room side of expansible support arm
Shape is corresponding with the anatomical shape of left ventricle, close to the position of anterior mitral cusp and left ventricular outflow tract view, expansible support arm
Left room side fixed part there is small barbed edge, the barb of small barbed edge is relatively short and not overlay film；Expansible support arm
The equal overlay film in remaining position.
4. the atrioventricular valve valve bracket according to claim 1,2 or 3 for puncturing merging, which is characterized in that described
Expansible support arm is netted or Z-shaped braided support made of self-inflated material.
5. the atrioventricular valve valve bracket according to claim 1,2 or 3 for puncturing merging, which is characterized in that described
Expansible support arm is the netted or Z-shaped braided support expanded using balloon expandable mode.
6. the atrioventricular valve valve bracket according to claim 1,2 or 3 for puncturing merging, which is characterized in that described
Valve leaflet made of 2 or more biovalve materials forms, and is placed on the inside of the support arm main part of expansible support arm,
From left room, laterally left room side unidirectionally opens.
7. the atrioventricular valve valve bracket according to claim 3 for puncturing merging, which is characterized in that described is expansible
At least two fixed arm is configured on the outside of support arm, one of fixed arm corresponds to the position in front leaflet center, remaining fixed arm
It is distributed in posterior valve leaflet side；The head end of the fixed arm relatively round blunt, stretches to left room side, surface is through coating processing；It is described
The length for being shorter in length than support arm main part of fixed arm；The barb is with fixed arm at 125~145 ° of obtuse angles；Work as fixation
Arm discharges and when barb is still compressed in transport system or barb outside drag wire by drawing, 55~35 ° of fixed arm abduction；When
When valve bracket discharges expansion completely, fixed arm is adjacent to support arm main part under own resilient effect, clamps former bicuspid valve
Two leaflets.
8. the atrioventricular valve valve bracket according to claim 3 for puncturing merging, which is characterized in that for through the left room heart
The valve bracket of sharp approach is placed in, and the rear end of valve bracket includes that the left room side fixed part of expansible support arm, fixed arm fall
Antireflux side between hook portion and valve, the back-end compression of the valve bracket is in the outer sheath of transport system；Antireflux between the valve
The edge on side is used to inside edge or thick-layer structure of film, and edge thickness is more than between the push rod and outer sheath of transport system
Fit clearance.
9. the atrioventricular valve valve bracket according to claim 3 for puncturing merging, which is characterized in that for through left room way
Diameter or valve bracket merging through femoral vein approach, the rear end of valve bracket is the left room side fixed part of expansible support arm, institute
The back-end compression of valve bracket is stated in the outer sheath of transport system；The edge of left room side fixed part use to inside edge or
Thick-layer structure of film, edge thickness are more than the fit clearance between the push rod and outer sheath of transport system.
10. a kind of atrioventricular valve valve bracket, which punctures, is placed in transport system, described in any claim for claim 1 to 9
Atrioventricular valve valve bracket puncture merging operation, punctures merging transport system include can puncture arrival surgical site
Outer sheath, can be by the inner core of guide wire, and is sleeved on the push rod except inner core, it is characterised in that：The head of the inner core
One section of head end sheath identical with outer sheath structure of end connection；Valve bracket to be placed in is sleeved on the front of inner core, the valve
The front end of holder is compressed in the head end sheath, and the back-end compression of the valve bracket is in outer sheath；
The push rod is with valve bracket without connection, and during holder is placed in, the front end of the push rod is resisted against valve
Valve bracket out of outer sheath is released and is discharged with multistage subsection pattern by the rear end of membrane support；
The rear end of the valve bracket is at least connected with the drag wire that 1 root knot is annular, and the drag wire is by outer sheath and pushes away
The end for sending the gap between bar to be drawn out to transport system, drawing can be pulled out from transport system by cutting toroidal tail end
Line；By the end of outer dragline bracing wire, the abduction of fixed arm can be adjusted, adjusts the position of valve bracket, or puts into mistake
The valve bracket lost is recovered in outer sheath.
11. atrioventricular valve valve bracket according to claim 10 punctures merging transport system, which is characterized in that the push
The outer diameter of bar and the internal diameter of outer sheath are slidably matched, and the drag wire can pass through the gap spirit between outer sheath and push rod
Drawing sliding living；The edge thickness of the valve bracket rear end is more than the gap width between outer sheath and push rod, Neng Goufang
Only the rear end of valve bracket is caught in the gap between outer sheath and push rod.
12. atrioventricular valve valve bracket according to claim 10 punctures merging transport system, which is characterized in that for through a left side
The valve bracket of room apical approach is placed in, and the left room side fixed part of expansible support arm, which is placed in head end sheath, is used as valve bracket
Front end；Each fixed arm of the valve bracket configures a drag wire, the barb of the front end sleeve of drag wire in fixed arm.
13. atrioventricular valve valve bracket according to claim 10 punctures merging transport system, which is characterized in that for through a left side
The valve bracket of room apical approach is placed in, and the left room side fixed part of expansible support arm, which is placed in head end sheath, is used as valve bracket
Front end.
14. atrioventricular valve valve bracket according to claim 10 punctures merging transport system, which is characterized in that for through a left side
Room approach or through femoral vein approach valve bracket merging, counnter attack between the left room side fixed part of expansible support arm and left room side lobe
Stream side is placed in head end sheath, the front end as valve bracket.
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| EP3061422B1 (en) * | 2010-06-21 | 2021-11-03 | Edwards Lifesciences CardiAQ LLC | Replacement heart valve |
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| CN104274259B (en) * | 2014-10-30 | 2016-06-01 | 宁波健世生物科技有限公司 | The artificial valve prosthese of a kind of band lobe leaf clamping device |
| CN205307151U (en) * | 2016-01-07 | 2016-06-15 | 上海市同济医院 | A atrioventricular valve valve support for $puncturing put into and conveying system thereof |
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