Abstract
Objective: The purpose of this study was to develop a new method for minimally invasive mitral valve repair under direct endoscopic visualization in the beating heart. Methods: Fiberoptic cardioscopy of the left heart was conducted in 12 calves. Systemic perfusion was maintained by cardiopulmonary bypass through a median sternotomy. A clear solution (Ringer's lactate) was temporarily administered via the pulmonary artery to flush out the pulmonary vasculature, and additional perfusion of the left heart chambers enhanced visualization of the intracardiac anatomy. The endoscope, with an open-ended transparent flexible outer sheath, was inserted through the left ventricular apex, and an endoscopic clip was used for edge-to-edge mitral valve repair. Hemodilution was avoided by the drainage of irrigation fluid via a left ventricular cannula. Results: Direct endoscopic visualization of the mitral valve in an in vivo beating heart was obtained clearly, avoiding systemic hemodilution. In the last experiment, edge-to-edge repair using an endoscopic clip was successfully performed. Use of an effective intracardiac irrigation method was important for successful image acquisition and achievement of repair procedures. Conclusions: This acute animal study showed the technical feasibility of beating-heart mitral valve surgery under direct endoscopic imaging. Although this study was performed under open-chest conditions, our successful experiment is a first step toward closed-chest intracardiac surgery with direct endoscopic visualization.
| Original language | English |
|---|---|
| Pages (from-to) | 122-125 |
| Number of pages | 4 |
| Journal | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery |
| Volume | 6 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Mar 1 2011 |
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All Science Journal Classification (ASJC) codes
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine
Cite this
Direct endoscopy-guided mitral valve repair in the beating heart : An acute animal study. / Horai, Tetsuya; Fukamachi, Kiyotaka; Fumoto, Hideyuki; Takaseya, Tohru; Shiose, Akira; Arakawa, Yoko; Rao, Santosh; Dessoffy, Raymond; Mihaljevic, Tomislav.
In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 6, No. 2, 01.03.2011, p. 122-125.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Direct endoscopy-guided mitral valve repair in the beating heart
T2 - An acute animal study
AU - Horai, Tetsuya
AU - Fukamachi, Kiyotaka
AU - Fumoto, Hideyuki
AU - Takaseya, Tohru
AU - Shiose, Akira
AU - Arakawa, Yoko
AU - Rao, Santosh
AU - Dessoffy, Raymond
AU - Mihaljevic, Tomislav
PY - 2011/3/1
Y1 - 2011/3/1
N2 - Objective: The purpose of this study was to develop a new method for minimally invasive mitral valve repair under direct endoscopic visualization in the beating heart. Methods: Fiberoptic cardioscopy of the left heart was conducted in 12 calves. Systemic perfusion was maintained by cardiopulmonary bypass through a median sternotomy. A clear solution (Ringer's lactate) was temporarily administered via the pulmonary artery to flush out the pulmonary vasculature, and additional perfusion of the left heart chambers enhanced visualization of the intracardiac anatomy. The endoscope, with an open-ended transparent flexible outer sheath, was inserted through the left ventricular apex, and an endoscopic clip was used for edge-to-edge mitral valve repair. Hemodilution was avoided by the drainage of irrigation fluid via a left ventricular cannula. Results: Direct endoscopic visualization of the mitral valve in an in vivo beating heart was obtained clearly, avoiding systemic hemodilution. In the last experiment, edge-to-edge repair using an endoscopic clip was successfully performed. Use of an effective intracardiac irrigation method was important for successful image acquisition and achievement of repair procedures. Conclusions: This acute animal study showed the technical feasibility of beating-heart mitral valve surgery under direct endoscopic imaging. Although this study was performed under open-chest conditions, our successful experiment is a first step toward closed-chest intracardiac surgery with direct endoscopic visualization.
AB - Objective: The purpose of this study was to develop a new method for minimally invasive mitral valve repair under direct endoscopic visualization in the beating heart. Methods: Fiberoptic cardioscopy of the left heart was conducted in 12 calves. Systemic perfusion was maintained by cardiopulmonary bypass through a median sternotomy. A clear solution (Ringer's lactate) was temporarily administered via the pulmonary artery to flush out the pulmonary vasculature, and additional perfusion of the left heart chambers enhanced visualization of the intracardiac anatomy. The endoscope, with an open-ended transparent flexible outer sheath, was inserted through the left ventricular apex, and an endoscopic clip was used for edge-to-edge mitral valve repair. Hemodilution was avoided by the drainage of irrigation fluid via a left ventricular cannula. Results: Direct endoscopic visualization of the mitral valve in an in vivo beating heart was obtained clearly, avoiding systemic hemodilution. In the last experiment, edge-to-edge repair using an endoscopic clip was successfully performed. Use of an effective intracardiac irrigation method was important for successful image acquisition and achievement of repair procedures. Conclusions: This acute animal study showed the technical feasibility of beating-heart mitral valve surgery under direct endoscopic imaging. Although this study was performed under open-chest conditions, our successful experiment is a first step toward closed-chest intracardiac surgery with direct endoscopic visualization.
UR - http://www.scopus.com/inward/record.url?scp=79955643170&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79955643170&partnerID=8YFLogxK
U2 - 10.1097/IMI.0b013e3182168f6f
DO - 10.1097/IMI.0b013e3182168f6f
M3 - Article
C2 - 22437896
AN - SCOPUS:79955643170
VL - 6
SP - 122
EP - 125
JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
SN - 1556-9845
IS - 2
ER -