Author + information
- Zurab Machaidze1,
- Benoit Rosa1,
- Margherita Mencattelli1,
- Sunil Manjila1,
- Karl Price1,
- Michael Borger2,
- Vinod Thourani3,
- David Brown4,
- Christopher Baird1,
- John Mayer1 and
- Pierre Dupont1
- 1Department of Cardiovascular Surgery Boston Children’s Hospital, Boston, Massachusetts, United States
- 2New York-Presbyterian/Columbia University Medical Center, New York, New York, United States
- 3Emory University Hospital Midtown, Atlanta, Georgia, United States
- 4Department of Cardiology Boston Children’s Hospital, Boston, Massachusetts, United States
Catheter-based procedures to repair heart valves allow interventions with lower risk than open surgery. We developed a novel cardioscopic device that improves visualization of intracardiac structures in blood-filled, beating heart by pressing its clear silicone tip against the tissue and displacing blood in front of the camera.
Porcine model of aortic paravalvular leak (PVL) was developed by replacing native aortic valve with lab-fabricated one, while leaving space for regurgitant flow between valve and aortic wall. In-vivo experiments were performed in pigs with aortic PVL, to evaluate visualization of intracardiac structures and deployment of the vascular occluder to repair the leak. The cardioscope was inserted transapically into blood-filled and beating heart. Neither fluoroscopy nor echocardiography were used to assist with guidance.
In 5 porcine experiments cardioscope was able to visualize intracardiac structures, implanted aortic valve and locate the regurgitant flow of PVL. In 3 cases PVLs were identified and vascular occluders were successfully deployed into the areas of regurgitation under cardioscopic guidance. In two other cases we could not successfully create PVL, however cardioscope was able to visualize and evaluate replacement aortic valve and areas of expected PVL.
Porcine experiments demonstrate the ability of the cardioscope to visualize intracardiac structures, identify paravalvular blood flow and deliver the occluding device to repair the PVL in beating heart. Further optimization of device is underway to adapt it for transvenous or transaortic access.
CORONARY: Cardiac Surgery